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diliMARION COUNTY BUILDING INSPECTIONSALEM INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 5 3-588 OR 97305 PERMIT NO. 555-2 I-SO'32E12. <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 35 36-y F .E1US S+. S El <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: i...ions,O12 <br /> Scale: 1"= T <br /> North <br /> -F-0. .S �>L L�. -1 — <br /> y e • <br /> 1 I ja4j:1—fh. .... <br /> Li\ N <br /> S <br /> t 4 621 <br /> 3 , to 0 .(4_: --- <br /> g4 <br /> a <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 /> J Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow <br /> �^ STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 15 OPp total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: �4'I+ '5 V' Imo' 1530[K double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: p(o.S4t-e.... [ I flow-through KT have tested the septic tank and certify it to be watertight. . <br /> Effluent Sewer:& Header Pipe: The system was installed by: <br /> Size/Mat'l 2. SC, /© Size/Mat'I I I Property Owner(permittee) <br /> ft'ricensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) q /' <br /> Rock and under pipe G I I Drop I I Concrete DEQ License Number: 3 1 3 2 P <br /> Pipe l` <br /> total depth (2 I I Distribution I I Plastic <br /> DEQ Certification Number: RT 90 <br /> Drainfield Material(Alternative or perf.pipe) -tt Pvc 9c.- ` 49 <br /> Total Drainfield Footage I O '9 Trench Depth Minimum I$t Maximum_3O4 I C/���/ <br /> Curtain Drain Depth 'r Signed: N_Slit_r%%__s_ <br /> e6,... <br /> Effluent Pump: Pump Model �2 "l P WE V �-(I rk D <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: bo...r t Qc god arT+'i-0- S, _ <br /> ATE Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 2- (2(Z 3 <br /> (For Marion County Use The ab septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: J[tA roved I I A proved with corrections:� see inspection report I I Denied <br /> Signed: ` Title: V� O,_ Date:r ± 2 <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; YELLOW: ner;PINK:Installer <br />