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iiiiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. 2 I ---U 06\(�tif V MARION C 0 8 <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: 7967 „�ZcJ��inr� ,Q3) <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1" = s T <br /> North <br /> APPROVED AS-BUILT - -SGr, <br /> DRAWING ' 4- , <br /> QG I ACC-{ticJ GIX� t!C/' I w N . <br /> `-r,k- - D,-� e�d ,3 e s o 11 - 5,7' l o" •, -- - — — . _ <br /> / _ , <br /> 1 1 _ <br /> r. <br /> , t....... <br /> i l J <br /> r t <br /> n <br /> • <br /> \ r 1 <br /> i ` 1 - - - - <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow /45-o Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /SUU total gallons /single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: L le,..e.--Lejli <br /> [ ] flow-through ] I I have-tested the septic tank and certify it to be watertight. <br /> Material: Cr",,s-e � <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mall LI it ��1/ Size/Mat'I q" 2...7V9 I I Property Owner(permittee) <br /> (�L icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) �,! 7 -�) <br /> Rock and under pipe 6it N Drop /Concrete DEQ License Number: 3�/ / <br /> Pipe total depth /Zji I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) Z7Z, <br /> Total Drainfield Footage 37 5 Trench Depth Minimum L U Maximum_Curtain Drain Depth /J/A Signed: <br /> Effluent Pump: Pump Model /(JJ . <br /> Pump cycle I <br /> times in minutes: on off Gallons per Cycle Company name:_. p 4-rs4,—,5 PA <br /> (please print) <br /> ATI'Make and Model 41/_ � <br /> Attach an additional sheet for components and materials not listed above. Date: 4,JAZ )ZZ <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: Approved I ) Approved withit� corrections: see inspection report I 1 Denied <br /> Si ned: Title: / `�/" (oi Z Date: 1 7/1r 1 `' <br /> MC:S-4 rev:3/03:4/12:5/14: 11/17 G:\Forms\Septic\S-41 As-Built20 I 5Version20 I 7.doc WHITE:MarionCounty: YELLOW:Owner;PINK:Installer <br />