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D <br /> ' dill M-A:R ON COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SVS:TEM RECORD <br /> - 5.1:55 Silverton Rd NE (to be•completed by system installer) <br /> ( SALEM OR,97305 <br /> 503-588-5147 PERMIT NO. 2- -- 0/06737 <br /> MARION <br /> COUNTY /j <br /> - hitp:IIwww.co.Marion.or.us/PW/BuildingInspection SITE ADDRESS: -7i i -+� ft t.. -4 <br /> I" <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scaler 1"_ _ ., _,I, <br /> . North <br /> is <br /> p <br /> 74 <br /> :Gr> <br /> vtl4- h am— <br /> (show all details and dimensions recess to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERSCERTIFICATION: <br /> L 1 HEREBY CERTIF`CTHAT THE ON-SITE SEWAGE.SYSTEM IN- <br /> System Design Sewage Flow 4. , Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TAN:Tf Size: (,flI.> total gallons ( I single compartment DANCE WITH THE:REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: v-3 G--- s A double compartment <br /> OF TEIE ENVIRONMENTAL QUALITY COMMISSION:. <br /> Material: !rU--L'L [j flow-through . have tested the septic tank and certify it to be watertight <br /> Effluent Sewer: Header Pipe; ,;� The system was installed by: <br /> Size/Mat1 /\Y`) Size/Mat 1 q 2,7 2,4 [ I Property Owner(permittee) <br /> IAALicensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe J) Drop: I I Concrete DEQ License Number: 2 <br /> Pipe total depthp¢Plastic I I Distribution DEQ Certification Number: t .. 9/3 <br /> Drainfield Material.(Alternative <br /> rorr pelf pipe) ' t n�-$7 "- <br /> Total Drainfield Footage�V Trench Depth.Minimum 24I maximum age, <br /> Curtain Drain Depth Signed: � .. <br /> Effluent Pump: Pump Model 36473r Or <br /> Pump cycle - }� <br /> timesin;minutes: on off' Gallons.per.Cycle Company name:_ �n d`�`e-- • t Le-- ,S imp t�.LS <br /> (please print) <br /> NTT Make and;Model <br /> Attach an additional sheet for components and materials not listed above. Date: -7 /i0 2� <br /> (For Marion Couix y 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: [ [Approved [ ].Approved withcC corrections:see inspection report I I Denied <br /> Signed: Title Yi 51 33- Date: pIiS/Zj <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\SeptictS-41 As-BuiIt2015Version2017.doc WHITE:Marion County;YELLOW Owner;PINK:Installer <br /> I <br />