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„� Marion County Public Works <br /> dii cK,a•. Building Inspection Division <br /> In,,: <br /> --- „zz5155 SHverton Rd N <br /> R -, , Salem OR 97305 <br /> MIN (503)588-5147 Fax(603)588-7948 <br /> http://www/ca.madon.or.us <br /> ON-SITE SYSTEM MATERIAL LIST <br /> (DIRECTIONS s DEFINITIONS ON BACK) <br /> ADDRESS 1-' (I ) F f id elvirs ad. TAX LOT# Q S ) t,./ }OA C. O i ;° _ <br /> SECTION TOWNSHIP RANGE LOT <br /> 1. SEPTIC TANKS <br /> 0/SEPTIC TANK: MFG. Li o f”"t CAPACITY, I6 00 MATERIAL (cI"L er"J i. <br /> 0 POSING TANK:MFG. CAPACITY MATERIAL <br /> ❑ SEPTIC/DOSING TANK: 0 SINGLE COMPARTMENT 0 TWO COMPARTMENT 0 FLOW THROUGH <br /> MFG. CAPACITY MATERIAL <br /> MFG.'S SPECS.INCLUDED <br /> 2. PUMPING ASSEMBLIES Go S <br /> PUMP t: MFG. 0 r�r c c MODEL (INCLUDE PERFORMANCE CURVE) <br /> PUMP Z MFG. MODE. (INCLUDE PERFORMANCE CURVE) 0 <br /> CONTROL PANEL.: MFG. MODEL 0 <br /> HYDROSPLITTER: MFG. MODEL (INCLUDE ORIFICE CALCULATIONS) ❑ <br /> i., <br /> MFG. MODEL 0 <br /> DISTRIBUTION VALVE MFG. MODEL 0 <br /> 3. EFFLUENT TRANSPORT PIPING t j <br /> Ca' CRAVnY EFFLUENT SEWS LENGTH ?..p' DIAMETER 1 MATERIAL h J FALL(IN INCHES) i. c'I i <br /> /PRESSURE PIPING: LENGTH 1 QOe DIAMETER i'?S MATERIAL PVC PSI <br /> 4. DISPOSAL FIELD(DRAINFIELD)DISTRIBUTION TECHNIQUE: E// 0 LOP 0 SERIAL 0 PRESSURIZED <br /> TOTAL LINEAR FOOTAGE: ''' hly f�7/O (et' <br /> DRAIN MEDIA: 0 GRAVEL-LESS AB^S9RPT10N METHOD BOOCK A�PIPE 0 OTHER . <br /> TOTAL DEPTH l U DEPTH BELOW PIPE • 11 <br /> TRENCH DEPTH(FROM ORIGINAL GROUND SU FACEI: MIN I �f' MAX /c f rt. <br /> CAPPING FILL DEPTIIDEF TH OF CAP): I 2 <br /> SETBACKS FROM WELLS: SEPTIC TANK S'0' SAND FILTER OR ATT UNIT JO DRAINFIFI n / }6 <br /> ...................... <br /> 5. DEWATERINO SYSTEMS(IF REQUIRED) <br /> 0 CURTAIN DRAIN 0 TILE DEWATERING <br /> WENCH DEPT1{: <br /> pRAIN MEDIA: 0 ROCK&PIPE ❑OTHER . <br /> TOTAL DEPTH DEPTH BELOW PIPE 0 FILTER FABRIC <br /> PERFORATED PIPING: DIAMETER MATERIAL <br /> 6. ADVANCED TREATMENT UNITS STATE CERTIFIED <br /> 0 SAND FILTER ❑ 'RGF (! OTT: TYPE Dam CO 60,0 Environmental Health Specialist <br /> "!> - EH-S-10 654. <br /> -� /Y/9-3 <br /> G:IFORMSLSEPTICIFORMSI.S-40 MATERIALS LIST.DOCX Rey 3/18 .,�� <br /> Robert Goodwin <br />