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iiiiiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-BYTE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> r S <br /> 503-588-5147 PERMIT NO.3 sir -Z 11- oo Z A(2 - P C:3'(- 1y� <br /> T- <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: t:'rJ 2.7 Veil ,r, <br /> AS-BUILT/PLAN OF CONSTRUCTED SYSTEM: T�tr1 cr <br /> Scale: 1"= 9a ' __----- — — — — _— — we <br /> d <br /> / <br /> orth <br /> or <br /> D to C.. _a$ toy• <br /> C <br /> 9.9' VI `. t Ie- <br /> £ it c-4/2' o 6or,c • <br /> 1t <br /> . 11t `ale J <br /> r, _.. <br /> .71 ----- to. <br /> S• s to IL:en • _p, •4 <br /> op le�- I1 Ct, <br /> •1�!r <br /> A S v• <br /> iQ <br /> ry4 ^ <br /> • <br /> 13 <br /> . ~=7 <br /> • /;//.. /...-"---r- ... ,.. <br /> • <br /> • <br /> show all details and dimensions Flew ssa to locate all cont.onents of the s stem in the future). <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: I <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 14SU Gallons/Day <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I 1 000 total gallons >TCI.single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer. lov-•I4-a r <br /> I ) double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Ca4 Of I ] flow-through bit have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer Header Pipe: t, The system was installed by: <br /> Size/Mat'l LI QV C. Size/MaVI LI QVC_ I J Property Owner(permittee) <br /> It(J_Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) �� <br /> Rock and • under pipe G 114-Drop i4Concrete DEQ License Number: <br /> Pipe 'total depth il." I I Distribution I I Plastic 8 3� <br /> DEQ Certification Number: <br /> Drainfield Material,(Altemative or pert".pipe) <br /> Total Drainfield Footage 4Sa Trench Depth Minimum'VI Maximum ��.,Curtain Drain Depth Signed:- SAC atiV Ki•! <br /> Effluent Pump: Pump Model • <br /> Pump cycle � t <br /> times in minutes: on off Gallons per Cycle Company name: a.eslrl e ft-�, eN.i,• tS <br /> ATT Make and Model (please{� print) <br /> Attach an additional sheet for components and materials not listed above. _ Date: _0 J L I <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 is: I I Approved J ]Approved with correcti9ns:see inspection report I I Denied . <br /> Si:tied: Title: . Date: <br /> MC:S-41 rev:3/03;4/12:5/14;11/17 G:IForms\Septic\S-41 As-Built2015Vcrsiun2017.dnc WHITE:Marion County: YELLOW:Owner;PINK:Installer <br />