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iiihiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. �l ` 0®7 -2 6 "� <br /> MARION { <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection 3�, a <br /> SITE ADDRESS: GU-OV''�I^ 1:---cvk <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= 4 6 ' T <br /> North <br /> 0 <br /> I t <br /> �t <br /> •- E._\ ...g) <br /> _r- ---) \ <br /> el "�15 c% � <br /> , ( q 1 <br /> 3 0 <br /> v <br /> (show all details and dimensio s necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> so <br /> HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow as Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /000` total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> �����/� [At double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: Al/Zi [ ] flow-through [1 have tested the septic tank and certify it to be watertight. <br /> The system was installed by: <br /> Effluent Sewer: / Header Pipe: / Property Owner(permittee) <br /> / 1 Size/Mat'I / l7 I P Y (P ) <br /> *Licensed Sewage Disposal Service <br /> 7LD rock depthnches) Box(es) <br /> under pipe l� I I Drop I I Concrete DEQ License Number: 8ti "► 8 <br /> total depth 11` I I Distribution I I Plastic DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) /� <br /> Total Drainfield Footage ISO 4rTrench Depth Minimum i - Maximum Curtain Drain Depth_ '� Signed f <br /> eA 144144 <br /> Effluent Pump: Pump Model 131` 30 . <br /> Pump cycle r ' <br /> times in minutes: on 3 u off 90 Gallons per Cycle S Company name:_ C✓ $r l <br /> i <br /> ii tto C:1 Cd' <br /> ATT Make and Model '% (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: ® 2 2 <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: [ ] Approved 1 1 Approved with corrections: <br /> corrections: see inspection report [ I Denied <br /> Signed: rt e it <br /> :-!it'd \O1 Date: R'17 IZ' <br /> MC:S-41 r :3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-BuiIt20l5VVersion2017.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />