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�,���� Marion County Public Works • <br /> ,�l '!lout,, Building Inspection Division (44 <br /> ��,"`_ 5155 Silverton Rd NE Z/a� <br /> o <br /> �li��. Salem OR 97305 <br /> .iiii <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www/co.marion.or.us <br /> ON-SITE SYSTEM MATERIAL LIST <br /> (DIRECTIONS&DEFINITIONS ON BACK) <br /> • <br /> ADDRESS t3 /6s- Abor viiz c 12. ` TAX LOT# D 7 01 I J 0s ow -2/40 r4-( <br /> I - SECTION TOWNSHIP RANGE LOT <br /> 1. SEPTIC TANKS • <br /> ' ❑ SEPTIC TANK: MFG. CAPACITY, MATERIAL <br /> El DOSING TANK:MFG. CAPACITY _ MATERIAL <br /> VLSEPTIC/DOSING TANK <br /> �� 0 SINGLE COMPARTMENT 0 TWO COMPARTMENT FLOW- OUGH <br /> qq <br /> MFG. 9N IQ/fit— CAPACITY !S60 MATERIAL 0 4 Cs <br /> MFG.'S SPECS. INCLUDED <br /> 2. PUMPING ASSEMBLIES • <br /> PUMP 1: MFG. i(1 BTcL MODEL A 5 (INCLUDE PERFORMANCE CURVE) ❑ <br /> PUMP 2: MFG. MODEL (INCLUDE PERFORMANCE CURVE) 0 <br /> CONTROL PANEL: MFG. MODEL - 0 <br /> HYDROSPLITTER: MFG. MODE (INCLUDE ORIFICE CALCULATIONS) 0 <br /> EFFLUENT FILTER: MFG. ODEL ❑ <br /> DISTRIBUTION VALVE:MFG. MODEL 0 <br /> 3. EFFLUENT TRANSPORT PIPING - <br /> • <br /> ❑ GRAVITY EFFLUENT SEWER: LENGTH DIAMETER - - MATERIAL FALL(IN INCHES) <br /> kPRESSURE PIPING: LENGTH 17.,— DIAMETER c=•tk MATERIAL f J(-- -PSI S e.'\ 41 3 <br /> 4. DISPOSAL FIELD(DRAINFIELD) ra._16-. ST t nD P. <br /> DIST II� ION TECHNIQUE0 EQUAL 0 LOOP <br /> BUT 0 SERIAL PRESSURIZED . <br /> TOTAL LINN TAGS: <br /> • DRAIN MEDIA: El GRAVEL- SORPTION MET ❑ROCK&PIPE 0 OTHER . <br /> TOTAL DEPTH - BELOW PIPE ' <br /> TRENCH DEPTH RIGINAL GROUND SURFACE): M MAX <br /> CAPPI FILL DEPTH(DEPTH OF CAP): <br /> SETBACKS FROM WELLS: SEPTIC TANK SAND FILTER OR ATT UNIT DRAINFIELD <br /> 5. DEWATERING SYSTEMS(IF REQUIRED) <br /> URTAIN DRAIN ❑ TILE DEWATERING <br /> TRENCH <br /> DRAIN MEDIA: ❑RO ❑OTHER • - <br /> OTAL DEPTH DEPTH BELOW PIPE ❑ FILTER FABRIC <br /> RATED PIPING: DIAMETER ERIAL ` <br /> 6. NCED TREATMENT U STATE CERTIFIED <br /> ❑ SAND FILT ATT: TYPE <br /> Environmental Health Specialist <br /> �- EH-S- 2 40 <br /> ram= <br /> G:IFORMS ISEPTICIFORMSIS-60 MATERIALS LIST.DOCX Rev 3/18 "ykt am . <br /> obey ‘G odwin <br />