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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTE1&RECORD <br /> 5155:Silverton-RdNE (to be completed by system installer) <br /> SALEM OR 97305 �Q <br /> 503-588-5147 PERMIT NO. a `0314SS <br /> RAARION <br /> COUNTY hitp:i/www.co.marion.or.us/PW/BuildingInspection. <br /> SITE ADDRESS: 1Cfk <br /> '`� T_A <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scaler 1"= '` <br /> A- 0 ' <br /> 7 <br /> 15 - L 1‘.0` }t <br /> I ,D� � � / <br /> ,:-., _ <br /> . . <br /> ..._..../ <br /> ,-. , ,. , <br /> „s, <br /> (show all details and dimensions necessary to locate all components of the system in the.firture) <br /> SYSTEM MATERIALSAND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> 1 HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN-. <br /> System Design-Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED INACCOR- <br /> TANK Size: L total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE.PERMIT AND THE RULES. <br /> Manufacturer. ' lA ��; f� [ 1.double compartment <br /> nFTHEEhIVIRONMENTALQUALITYCOMMISSION_ <br /> Material: , [ 1 flow-through I 1 I have tested the.septic tank and certify it to be watertight. <br /> EfiluentSewer:1,1,�� T�r E Header Pipe:. The system was installed by: - <br /> Size/Mat l L. Size/Marl.. I I Property Owner(permittee) <br /> DRAINFIELD rock depth(inches) Box(es) bQ:Licensed Sewage Disposal Service <br /> Rock and under pipe [ I Drop [ I Concrete DEQ License Number. ? 3.?3. <br /> Pipe total depth l I:Distribution [ I Plastic DEQ Certification N ber: R 1: -5'7 <br /> Drainfield Material(Alternative orperf pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum <br /> Curtain:Drain.Depth_. Signed: ,...„.„.......„...7 <br /> Effluent Pump: Pump"Modei , <br /> Pump cycle <br /> name: A (\ <br /> times in minutes: on off Gallons per Cycle 'ompany3N <br /> (please print) <br /> KIT Make and Model <br /> Attach an additional sheet for components and materials not listed above. Date: __ <br /> (For Marion Conn .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 <br /> ved I 1 - roved with corrections:see inspection report I'I Denied <br /> Signed .. tle: ' . inQiifa___________ 'Date: <br /> a _ <br /> MC:S-41 re :3/03;4/12:5/14;11/17 G:CEoims\Septic\S-41.AI-HuiIt2015Version2017.doc WHITE:Marion County:YEL OW: -ner;PINK:liislaller <br />