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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 /> MARION <br /> SALEM OR 97305' <br /> 503-588-5147 <br /> PERMIT NO. 23..._.' ka2 jj•-a___..___-__H• <br /> COUNTY <br /> httpillwww.coanarion.onas/PW/BuildinglospeetiOn SITE ADDRESS: 22 p <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> 11%>10 Scale:I"•= ' <br /> -,— <br /> North <br /> , . <br /> • <br /> .-....•. <br />' 4 <br /> . . <br /> . • - <br /> - - - - • • • <br /> . . <br /> .. .- - <br /> . . . <br /> • <br /> - -- -.- - - <br /> . , <br /> • -.." - ...,' , ... <br /> igt! • <br /> . •:,' ..,:'' i21 • • - - • • , <br /> 6sto) 14-24k <br /> ,..... <br /> ,,, t i z... ,a <br /> •• •• .. • • j S• „jets s ... tlx.L__„ <br /> (show all,details and dimensions necessary to locate all cornponents of the system in the future) <br /> ,SYSTEM MATERIALS AND SPECIFICATIONS. INSTALLERS CERTIFICATION: <br /> [HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow de5"0 gallons/Day <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED INACOOR- <br /> TANK.Size: Al:409 0°cuto total gallons [1 shoe aampatatient DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> ENTAL QUALITY COMMISSION. <br /> • •,./vianufaoutet: grjak.2--(-acz / 0„.se.ct4,4101.. [j double compartment OFT <br /> Material; Oirka.e- / Pteat-4;._ r j flow-through pfl have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: .-, Header Pipe: , ThsySten1 was installed by: <br /> • - <br /> .sizemati eV ibt.->id Ac it0 size/men y' 2.- , I I ProPelly Owner(permittee) <br /> pcfLicensed Sewage Disposal'Service <br /> 1 DRAINFIELD I rock depth(inches) Box(es) I <br /> • <br /> Rock and under pipe I. i DruP <br /> ?Concrete DEQ Licenae Niunber: a ay.,1 <br /> Pte totodeoth <br /> Agoistrmution f•mastic DEQ Certification Number: 0..1 tat t <br /> Drainfield'Material(Alternative or pert pipe), <br /> Total Draintield Pilotage 200 Trench Depth Minimum Maxiinum <br /> Curtain Drain Depth <br /> Signed:4- <br /> EMuent Plimp:Pump Model , <br /> Pump cycle <br /> times in minutes:on off Gallons per Cycle. Company name:_ if%. ' _ <br /> A <br /> AUMake and Model - (pilec print) <br /> - <br /> ' <br /> Attach an additional sheet for components.and materials not listed above. Date: da 7_. •..---_. - <br /> (For Marion County Use OHM.The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: [ 1 Approved i J Approved with corrections:see inspeetion report. I I Denied <br /> Si ned: <br /> Title: <br /> Date: i <br /> MC:S4 i rev!Wm-41i17-vizi-ii/1-i r:.tc—lo-..:.... ... •-.-...:.•-•---. • .--- • <br />