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.a.., itt,‘ MARION COUNTY BUILDING:INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM.RECORD <br /> ..,„. .... <br /> 51 55-1 Silverton Rd NE On be completed by gystem installer) <br /> SALEM'OR:97305 <br /> • ;ARION 503,588-5147 PERMIT NO, j3 — 00 q 93. 1 - <br /> !M <br /> CO.UNTY ' itttptifwwW.Co.inariolt.Or.us/PW/Builifingfnspectitin. SITE ADDRESS: 4 571# .R:iv!mat.0 ion K <br /> A&BUILT PLAN OF CONSTRUCTED.SYSTEM:: .. <br /> . - <br /> ;., <br /> Scale::I"= t <br /> , • North <br /> ....--- --.. , <br /> - - <br /> , . <br /> / <br /> I 1 / <br /> . „ <br /> • , . <br /> / I <br /> 1 <br /> :/ i , <br /> . ..., . ....., 4..,...P. <br /> 1 <br /> 40 , <br /> 1. 1 <br /> . , <br /> I 1 <br /> 1 . . _ , 1 <br /> , : ,4•11,16..1.11...:iSti, I I R.40e <br /> i <br /> R - • , <br /> 7C / <br /> -, / I ,i,,e7 . ' - :. <br /> ..0 zr: 104‹..itib. <br /> __ __. _.„. ..... <br /> 0 .10 <br /> I0 <br /> I <br /> .;%''' <br /> . ,-. <br /> I . (show.all.details and dimensions necessary to locate all:components of the system in the future) <br /> SYSTEM NIATERIALSANDSPECIFICATIONS: INSTALIERS'CERTIFICATION: <br /> 111E0flY GEItTIFYTHAT TK-ONSITE:sEWAQg SYSTEM IN- <br /> System Design Sewage Flow -Gallons/Dayi STALLEDAT THE ABOVE ADDRESS WAS CONSTRUCTED' IN ACCOR, <br /> „ . . <br /> , [ji sinoctomparmitnt DANCE WITH THE REQUIREMENTS OF THE!EMT AND THE RULES <br /> 'TANK:Size: ./S0 tp total gallons <br /> OF THE ENVIA:CMMENTALQUALEY cOMMISSION. <br /> . - lvtantifacturer: 4,4,./aile5 , jrordouble comparttent <br /> Material: ,e. 0,e [1-flow-gimp: I 11.have-tested the septic tank-andicertify it to be Watertight. <br /> fffluentSewert 1 °fr " A I_ I 1 i A 'f ICIAgr A'1pg: ' ' Thesystem was inStalled by: <br /> Size/Mar I 1 7 (..7.r.i 1 -iv Size/Matl- I I Property Owner(permitted <br /> - ' I ir Licensed Se*age Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> • Rock and under pipe "----- 1,(15rpp Veppetete I)EQ LietalSoNutilben '330/3 <br /> Pipe total depth .• I f:Distribution I 1 Plastic <br /> DEQ Certification NUmbet <br /> ' - Drainfield Material(Alternative or perf.pipe) <br /> ToM1Drainfield Footage ?"-- Trench Depth Minimum"----:Maximum."'" <br /> Curtain Drain Depth ,-.-.7" .i Signedel):: <br /> Effluent Pump: Pump Model 4a.14.0iii'f?' ' 1.1.644:/e , <br /> Purim!.cycle' ,A A Ir. . <br /> tidies in minutes::On Off ' " Gallons.per Cycle , Ctiniptinytanit: r7C 1:::-r. <br /> An Make:mitiModel (plegijititit) <br /> Attach an additional sheet for components and niaterials..notiiated above. Datc::___ <br /> (For Marion County Use.Only) The above.septiesystemlas been itispeetPii by MarionCounty. The inforrnatibn has'been detenninediobe accurate,. <br /> , <br /> and the system is:: [ 1 Approved 1 :1.Approved with corrections:see inspection.report: [ :I Denied <br /> .., . <br /> Silned: . , • Title:. Date: <br /> MC5-41 relit 3103;.4/12;914;11117 G:Worms\SepticNS-41 As-Built2015VerSion2017.doe WIIITEWarionCounV;'YELLOW:Owner;RINK;Insteiller <br />