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- MARION COUNTY BUILDING INSPECTIONSALEM INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> iiiiii <br /> 5155 Silverton Rd NE OR97305 (to be completed by system 1 �" tlr)/installer) r <br /> 5 3-88 PERMIT NO. �" 2 II 0073 61 - `t <br /> MARION <br /> COUNTY htt ://www.co.marion.or.us/PW/Buildin Ins ection P r� <br /> P g P SITE ADDRESS: I/7 n`bfirt C 1,i� <br /> AS-BUILT PLAN OF CONSTRe'C FIi ,SYSTEM: 's�` <br /> /pro• ff.',it. - / North <br /> • <br /> �� / <br /> li / <br /> ... N p <br /> A .� <br /> / O <br /> ' U. tG. \ 0'IG i <br /> NI <br /> '"S• • Vdik, \ <br /> c, �7 10 <br /> k <br /> kesle. 4 \ <br /> s \Om <br /> G <br /> � '� <br /> .• \ i <br /> >S., 1. <br /> I Q \ • <br /> 1. <br /> (show all details an necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPNS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow Gallo \ital I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 1,500 total gallons [ I single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: we. <br /> double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Cob(4'e 1.- [ I flow-through VI. have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer; Header Pipe: „ The system was installed by: <br /> Size/Mat'I 1`'tp 5+t,f. Ito `)rake size/man !1 3014/ I I Property Owner(permittee) <br /> DRAINFIELD rock depth(inches) Box(es) IA Licensed Sewage Disposal Service <br /> Rock and under pipe lam[Drop 64 Concrete DEQ License Number: 7 61 le <br /> Pipe total depth 1 I Distribution I I Plastic <br /> S. <br /> DEQ Certification Number: - <br /> Drainfield Material(Alternative or perf pipe) E-? P.1 0 i...f <br /> • <br /> Total Drainfield Footage 3 IS Trench Depth Minimum Z4/ Maximum c <br /> Curtain Drain Ve s t Depth Signed: e. <br /> P g r/!/ <br /> Effluent Pump: <br /> P P Model (9'' 10 <br /> Pump cycle <br /> times in minutes: on ae�eq.— off v'-- Gallons per Cycle i-ct.) Company / <br /> name: +�,�7:f'!t e•I 61- �� <br /> � c°j1 <br /> i,").S' <br /> ATT Make and Model <br /> (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 7l 1212,.. <br /> (For Marion Count 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: ItfApproved I I Approved with corrections:see inspection report 1 I Denied <br /> Signed: Title: IH ST 02-3 Date: 41I8- L <br /> MC:S-4l rev:3/03;4/12;5/14; 11/17 G:\Fonns\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOW:Owner;PI K:In.ia/er <br />