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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton RdNE (to be completed by system installer) <br /> Salem,OR 97305 <br /> 503-588-5147 PERMIT NO. 555-21-009752 <br /> COUNTYr <br /> http:llwww.co.tnarion.or.us/PW/Buildinglnspectiou SITE ADDRESS: 16407 Emerald Green In SE <br /> Jefferson OR 97352 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: i" T <br /> See Attachment North <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 /> System Design Sewage Flow225 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> Willamette STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> SepticTank:Size1000 gallons Matz Concrete ivifgGraystone DANCE WITH THE REQUIREMENTS OF THE'PERMIT AND THE RULES <br /> Willamette OF THE ENVIRONMENTAL QUALITY COMMISSION. , <br /> . Dosing Tank:Size 500 pitons Marl CO11Crete MfgGraystone <br /> lCj I have tested the septic tank and certify it to be watertight. <br /> ATT Make and Model 13ox(es): <br /> Distribution The system was installed by: <br /> Effluent Sewer:Size 2" Marl Sch40 PVC IA Drop <br /> I I I I'mperiy Owner(pertrtittee) <br /> 'Concrete <br /> nrainfietd Pipe:Size 4" Dd Plastic VI Licensed Sewage Disposal Service <br /> Material:Header Pipe,SDR35 -Perforated Pipe EZ Flow DEQ License Number: 37913 <br /> Total Drainfleld Footage 380' Trench Depth Minimum 24" Maximum 3:i" DEQ Certification Number: RI797 <br /> Rock Depth:Total Under Pipe Curtain Drain Depth _v <br /> Signed: <br /> Alternative Drainfleld Materials F7 Flow <br /> Effluent Pump: Pump Model Franklin Little Giant WE30G05P4-21 Company name: Groundhog LLC <br /> Pump Cycle minutes minutes (please print) <br /> Time on ofFC)n DsmarmiCations per Cycle___T._ __ <br /> Attach an additional sheet for components and materials not listed above. Date: 06(1812022 <br /> (For Marion County Use Only) <br /> The above septic system has beers inspected by Marion County.The information has been determined to be accurate and the system is: <br /> \j Appro r j Approved with corrections:see inspection report j j Denied <br /> ,,Ci . <br /> Signed: . VI Title: _g b/1.5, Date: 7 d , <br /> MC:S-31 rev:3/0;4/12:a/14 WHITE:Marion County:YELLOW:Owner:PINK:Installer <br />