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iiiii . 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 /> 503-588-5147 PERMIT NO. 2I - OOG Z$7 <br /> MARION <br /> COUNTY htt ://www.co.marion.or.us/PW/Buildin Ins ection <br /> P g P SITE ADDRESS: Ii 07 8 D OS 1-Ooi tN I IYvnJ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1" _ Ho ' 't <br /> North <br /> i <br /> / <br /> i <br /> I <br /> ) .....,21 / <br /> q/. <br /> ��' • <br /> c <br /> �d S\ �� / <br /> t) Q i:/ <br /> h <br /> / <br /> l9bi <br /> 4 -c. - ye <br /> C - 0 = 34 ' <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 375 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: ` owe total gallons k] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> r OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: L."; 1 [ ] double compartment <br /> Material: czml r tr...-ft- [ ] flow-through I,,J I have tested the septic tank and certify it to be watertight. <br /> The system was installed by: <br /> Effluent Sewer: Header Pipe: <br /> " <br /> Size/Mat'I 11` 3/2)/ Size/Mat'I h �i�y I IPro a►� Owner(permittee) <br /> kl Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) / <br /> Rock and under pipe 6 I I Drop H Concrete DEQ License Number: 36 ICJ 6 <br /> Pipe total depth 121 ICI Distribution I I Plastic <br /> DEQ Certification Number: r3 3$ <br /> Drainfield Material(Altemative or,perf.pipe) Qtr.t. }o 3/ <br /> Total Drainfield Footage I Q o Trench Depth Minimum Zk Maximum 34 � If /(- <br /> Curtain Drain Depth- Signed: C--'UCnt'/1 1' <br /> Effluent Pump: Pump Model <br /> Pump cycle ((��� <br /> times in minutes: on off Gallons per Cycle Company name: tS(ska <br /> ATT Make and Model l (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 3/3 /2_l___ <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: NA Approved w I I Approved with corrections:(� r see' inspection report I 1 Denied /( ( <br /> Signed: --_ - —Title: Af 15 W 7/Z ( Date: ( ( 1 rIL( <br /> MC:S-41 rev:3/03.4/12.5/14. 1 1/17 G:\Forms\Septic\S-41 As-BuiIt2015Version2017.doc WHITE:Marion County; YELLOW:Owner:PINK:Installer <br />