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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> - .- SALEM OR 97305 , <br /> MARION 503-588-5147 PERMIT NO. 21-002265-PRMT <br /> COUNTY http://www.co.marion.or.usiPWIBuildinglnspectinn <br /> ' , SITE ADDRESS; 22636 Jennie RD Lyons. OR 97358__ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= T <br /> North <br /> S E E ATTACH E D <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 Ciallon�RTay I HEREBY CERTIFY THATTHE ON-SITE SEWAGE SYSTEM IN- <br /> SystemSTALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN AC'CY1R- <br /> TANK Size: 1500 total gallons I 1 single compartment. DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE It I'1.E S <br /> Manufacturer. Waite doublet compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Concrete <br /> [ ) flow-through IX) I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Pleader Pipe: The system was installed by: <br /> sire/Mori 1"-1/4" SCH40 Size/Mat'i I I Property Owner(permittee) <br /> N Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Boxes) <br /> Rock and under pipe 1 1 Drop 1 I Concrete DEQ License Number: 39002 <br /> Pipe total depth 1 1 Distribution I 1 Plastic <br /> DEQ Certification Number: RI 823 <br /> Draintield Material(Alternative or pert.pipe) <br /> oc.v/(7_. <br /> Total Drainfleld Footage 100 Trench Depth Minimum, la Maximum 30 <br /> Curtain Drain Depth_ Signed:_ <br /> Effluent Pump: Pump Model Orenco PF5005 <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle_ Company name:_ 3-A Construction, LLC. <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Dote: 1/10/2022 <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accuritc <br /> and the system is: ,Approved I j Approved with corrections:see inspection report I I Denied [,� <br /> Signed: Title: REs (027 g� Date: 2 Q2 1 <br /> MC:S-4I rev:3103:4,I2.):€4: I 1 I- <i_Tenns\Septic`vS-41 As-Built2tlt5Version2017_doc 1171IFL Vnri+mCnuni,, YELLOW-Owner,PINK Invialic. <br />