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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ' —_ 5155 Silverton Rd NE (to be completed by system installer) <br /> = SALEM OR 97305 •MARION <br /> ` 503-588-5147 PERMIT NO. 7..i'/ " (70 3 S n� <br /> COUNTY http://www.co.marion.or.us/PWB nspec <br /> uildingltion <br /> SITE ADDRESS: 7,-53 3 _ /(,Lt,, 14.47,15 �r- <br /> i <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ►yol.�� <br /> Scale: 1"_ ' <br /> T <br /> ______________________„,„..,„"/"/ <br /> North <br /> c <br /> �I \DV <br /> r e <br /> /r-d <br /> K <br /> • <br /> V3719.5 S "? is' <br /> 29 <br /> i <br /> ' 2S <br /> -- - <br /> 9 re_ `rOp to' sf(,l� - .1. <br /> t <br /> As. "A-rti.-- rV-- <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 0 dC> Gallons/Day <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 'I$V v total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: ...1 e._�ta OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> [ ] double compartment <br /> Material: e-z?./--e-- [ ] flow-through [4,have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: i i Header Pipe: The system was installed by: <br /> Size/Mat'l i V 4-1 Se-'i a Size/Mat'l I ]Property Owner p rty (permittee) <br /> KLicensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe •, I I Drop 1 I Concrete DEQ License Number: .3?" 3 <br /> Pipe total depth t Z <br /> 1 I Distribution t I Plastic DEQ Certification Number: (2.,y ?/3 <br /> Drainfield Material(Alternative or pert,pipe) <br /> Total Drainfield Footage r Trench Depth Minimum Ir Maximum <br /> Curtain Drain Depth Signed:_ •L---"-- <br /> ' Effluent Pump: Pump Model L]•` ._ -, <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ e-ci'-'-‘--i,, I f ,'-.i l't°L.5 <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 7— 2`I - 2`-/ <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system 1`l/L^Ap roved [ ]Approved with corrections:see inspection-report [ j Denied <br /> Signed: Title: I a' Date: 7 <br /> MC:S-4I rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County:Y LLOW:•Owner;PINKInstaller <br />