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^^ , MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-S3TE SEWAGE SYSTEM.RECORD <br /> ... '5155 Siiveiton Rd NE (to be completed by system installer) <br /> .•,: •° SALEM OR 97305 503-588-5147 PERMIT NO: 2 "005\58 <br /> MARION <br /> COUNTY http://www,co.marion.or:ys/PW/Buildinginspection SITE ADDRESS'Di'� D. og•.(1� <br /> AS-BUILT PLAN:OF CONSTRUCTED SYSTEM: <br /> fScale:..1"_ ' I' <br /> i blotthA - - , <br /> C ,(2' <br /> ,, ty _ D z . 5 A <br /> GeV' .. <br /> 0 , A.,\Icr <br /> � s�'►� <br /> evs <br /> • <br /> A 0. �. <br /> Wes" <br /> ,. . <br /> 4 <br /> /Ag <br /> .. <br /> . . <br /> • E,,,,,- <br /> ckisPi- , ._.. <br /> ,,,,,.. <br /> . . <br /> , . <br /> . . , <br /> , „ <br /> ______..... . <br /> , . <br /> ------,J <br /> : .. . (show all details•and dimensi t necessary to loca a all components of:thesystein uìi the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION <br /> s. CraiionslDay I HEREBY CERTIFY THAT THE ON-SITE SEW.AGE SYSTEM iN- <br /> System Design Sewage,Flow .. oh STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTEDIN ACCOR-- <br /> TANK Size; I total gallons *ngle compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT ANDTHE RULES <br /> OF THE ENVIRONM +•TAL Q. <br /> UALITY COMMISSION. 4 <br /> ManufactureManufacturerWf ti\•C [.] double t ompgmricnt <br /> Material: . .LOn[.ram!-e [.I flow-through have tested the septic tank and certifyit to-be watertight <br /> i Effluent Sewer: .:. Header Pipe: Tbesystem was installed by:' <br /> ize/Mafi � �AQ ?V._. Size/Mat 1 Lk. 924i '\O ? I I.Property Owner(permittee); <br /> L .. .. 'bQ;Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) 1 <br /> Rock and under pipe ( i Drop: ( I'Concrete DEQ.License Number 3 632 3 - <br /> Ptpe total depth {]j �} -7. . .... [ <br /> a l i Distribution l i Plastic DEQ Certification Number: 15c i -.. t1. <br /> Drainfield Material(Alternative or.perf.pipe) <br /> 1 <br /> Total.Draiufield Footage TrenchDepth Minimum Maximum i= • r <br /> Curtain Drain Depth_ Signed: I <br /> Effluent Pump: Pump Model j <br /> Pump cycle Cycle per .. <br /> times in inutes:on off GallopsC <br /> y Company name:_ ! YJ ra{ <br /> AUTMake and Model (pl a pi <br /> t): I <br /> Attach an additional sheet for components and materials not listed.above. Date: j/30 2(For Marion CountyUse.Only) The above septic systemhas been inspected by Marion County. Tho lion has been determined to be accurate i <br /> and the.system IT :[" pproved [ ik•pproved with corrections:see inspection report [ I enied 3 <br /> Signed: N ,f 1 / 1 k, Title: 4j 4 . r3' . . Date.0 II' Ji I <br /> MC S-41 rev:3/03;4/12;511.4;11/17 0:\Forms\Septic\S-41 As-Built20ISVersion20l7:doe WHITE:Marion Comfy;I' ' 01.0xner;PINK'Install& i <br /> i <br />