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SITE <br /> SALEM COUNTY BUILDING INSPECTION <br /> IOIti INDIVIDUAL <br /> Oompte ed by system minstaller): <br /> E RECORD: <br /> iike _t s5 Silverton.Rd NE ,Q <br /> SALEM OR 97305 PERMIT NO. c - Z(1` e2e y.76 - t/ f i- <br /> 5d3 588-S147 <br /> hAARION / L �F <br /> COUNTY t `9 9 <br /> httprllww.w:co.marian.or.uslPW.J.Buildinginspection BITE.ADDRESS: 1 ! }/C� ht /7 <br /> 'AS-B.U;ILT PLAN OF CONSTRUCTED:SYSTEM: <br /> STEM: <br /> T <br /> Scale:1" Northetri <br /> i <br /> wtil 1 ZP \ 1\4' <br /> . 'Fe p___. <br /> "......__________ <br /> * <br /> (show all.details and dimensions necessary to locate all components:cifthe system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS`CERTI FICATION: <br /> 1:HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design.Sewage Flow 3 74 Gallons/Day STALLED AT THE ABOVE.ADDRESS:WAS CONSTRUCTED IN ACCOR= <br /> 6 6-Ci [I single compartment DANCE WITH THE.REQIREMENFS OF THE PERMIT AND THE RULES <br /> TAlriIC Size: total gallons OF'HIE ENVIRONMENTALQUALITY COMMISSION. <br /> Manufacturer: 'Lie Os, 1-Z.- ( J double compartment <br /> Material: C typo G/e <br /> [ 1 flow-through ( I I have:tested.the:septie:tank and.certify it to be watertight. <br /> Effluent Sewer: ti `"�'/ Header Pipe: The system was installed by: <br /> Size,':vtat'I L� .'etL / SizeNtat'I I 'roperty Owner(permittee) <br /> icenscd Sewage:Disposal Service <br /> DR:tINFIELD rock.depth(inches) I Box(es) [ 3_ I <br /> Rock and under pipe . I I Drop I [Concrete <br /> DEQ LicenseNumber: 3' ._ <br /> Pipe .r <br /> total.depth I I Distribution I I Plastic Q l 3 z r �/ 25 <br /> DI Certification Number: , <br /> Drainfeld Material(Alternativeor pelf.pipe) <br /> Total Drainfteld.Footage. Trench Depth Minimum_ Maximum;, r <br /> Curtain Drain Depth g Signed:_ d27417 a f,4 <br /> Effluent Pump: Pump Model. _ r <br /> Pump cycle j I f.� <br /> times in minutes: on: off Gallons per Cycle Company name:_ f 1 I jI l�/ <br /> .. .:...... <br /> (please print) <br /> Arr Make and:Model <br /> Attach an additional sheet f r components and materials not listed above. Date: 7— / T 2-9 <br /> (For Marton CountyAse On1Y) The above septic system has been inspected by Marion County. The information has been determined to be'accurate <br /> and the system is: [VI Approved [ I Approved with corrections:see inspection report [ I:.Denied <br /> Signed: -_ - Title Z 3e <br /> —St t Dat :L[6'1 VA <br /> Mc:S-4t. rev;3Id3;4/12,:5f 1:4;11/17 Cir\Forms\Septic\-S-41 As-Buiht2Q l5 Vt:rsion20I7.doe WFLITE:Uarion County YELLOIL:Owner Pl\:G installer <br />