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diNMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 <br /> 5G3=588-5147 PERMIT NO. j%- !1- 06 i jqc <br /> MARION <br /> COUNTY, http:/lwww.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: ---/s6g- 1?`" S <br /> AS-BUILT',PLAN OF CONSTRUCTED SYSTEM: , '4c.t/2r„.t, ea 4 g73414 , <br /> Scale: 1"= I <br /> North <br /> ldI S 141l 4ta PA-(Felue) <br /> 7dt I <br /> 7S t tic. <br /> r 13'„ <br /> Cs iYr <br /> • <br /> 74, <br /> Az-tt1 <br /> G. � <br /> 4 f gc.-t3 ' <br /> Zt _ a <br /> r <br /> ilr*----'.................'51.1V <br /> 41 <br /> C'4'.‘.4"%4 <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 4156 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONS7RUCIED IN ACCOR- <br /> TANK Size: I total gallons ( ] single compartment DANCE wrrn THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> " f�G]double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer. LAT4.t <br /> Material: f at•tdvr L I ] flow-through in I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer. 1 c, Header Pipe: The system was installed by: <br /> Size/Marl i c> SC.t,KCi Size/Mat'I 4," pec I I Property Owner(permittee) <br /> pQ Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe ,42 " Drop Flit Concrete DEQ License Number: 66i <br /> Pipe total depth (i I I Distribution 1 I Plastic <br /> DEQ Certification Number: 19J?Gr+ <br /> Drainfield Material(Alternative or pert pipe) fJl,,i-(�s <br /> f <br /> Total Drainfield Footage �3754 Trench Depth Minimum ZZtl rr Maximum_3'6'` _ <br /> Curtain Drain Depth Signed:_ <br /> ' --- <br /> Effluent Pump: Pump yodel PP-SO <br /> Pump cycle <br /> times in minutes: on i esKa+0C off Gallons per Cycle — Company name: ( Qt+1 ►'- 9- e 1.1-e_ <br /> `� GG11 (please print) <br /> AT[Make and Model <br /> Attach an additional sheet for components and materials not listed above. Date:________, J7 -12- <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: j4 Approved I I Approved with corrections:see inspection report [ I Denied ����� <br /> Signed: ��Title:. � Date: <br /> 4_ <br /> _11 <br /> MC:S-41 rev'3/03;4/I21;5/14;11/17 G:CForms4Septic\S-4I As-Built2Q15Version2017.doc WHITE:Varian County;YELLOW:Owner;PINK:Installer <br />