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iikiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE SALEM OR 97305 (to be completed by system installer)503-588-5147 PERMIT NO. (r7 3 0 Q 6-2-�� <br /> � <br /> MARION 'Z 5 <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: 357 rAdl� I...,es., <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: / <br /> Scale: 1"_ rj b _ CM le, ?' <br /> North <br /> k\vw <br /> f� <br /> fVCI.- h�fc 'V� �'rkS`' , li 0 APPROVED AS-QUILT <br /> L DRAWING <br /> ,'c5 <br /> 1 <br /> G <br /> i • <br /> . i <br /> • 0-.4 <br /> ...,, <br /> J.., fir.._ <br /> L,17 <br /> 7C <br /> eclhi,ens <br /> . Or... rh.A._/ / <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> Design Sewage Flow Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: Al/r4—iby total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> double <br /> Manufacturer: [ ] compartment <br /> Material: [ ] flow-through I ] I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'I Size/Mat'l I I Property Owner(permittee) <br /> }Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) / <br /> ' Rock and under pipe I I Drop I I Concrete DEQ License Number: 36(1 g <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: jj 7_5- <br /> Drainfield Material(Alternative or pert'.pipe) <br /> Total Drainfield Footage_ Trench Depth Minimum Maximum <br /> Curtain Drain Depth_ Signed:_ <br /> Effluent Pump: Pump Model V 30 . <br /> Pump c eal ^ bi - <br /> times in minutes: on off 001144 Gallons per Cycle Company name:_ ��1 Lam_ (A <br /> ATT Make and Model 6itoe...te-44-i, <br /> ( lease print) <br /> Attach an additional sheet for components and materials not listed above. Date: Cf JjL/ tz 5 <br /> (For Marion Cou V Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system ' : I Approved I I Approved with corre tions: see inspection report I I Denied <br /> Signed: Title: Date:_ V /2./.3 <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WNITE:Marron County; YELLDW:Owner;PINK:Installer <br />