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. 2\\*' MARION COUNTYNE BUILDING INSPECTIgibON <br /> 5155 Silverton Rd r. •;,,. <br /> SALEM OR 97305 ' ' aY <br /> s.; <br /> MraR+pN --- INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> COUNTY ''ii (to be completed by system installer) <br /> c7 <br /> SITE ADDRESS: 34Uq Fran CI6 7f•, Lpi')S PERMIT NO. I3-0O6C3- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=306 P RoPELTY Li hfE r <br /> 1 .•_,,,,- <br /> T. E North <br /> I 3 1�5 P/kGc 13W <br /> . <br /> r , 13. ' <br /> 1 •a v 1 cOt TO Rev t�. �� <br /> n E-,3t7� • <br /> n J <br /> 1 al 33 <br /> a <br /> i <br /> �s°3 5 .\ .s <br /> I , c-,1 �. <br /> oPEl2 L.Tt Li '' <br /> R ' . <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 /> System Design Sewage Flow: 30 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size: Mat'I Mfg: DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> (ajr*tbb I /� ii i ,OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> .Dosing Tank:Size: 9OC) Mat'I d0RG I fg:II)a 14- s "I have tested the septic tank and certify it to be watertight. <br /> Alternative Treatment Technology 'pc. P. YJ-e-4 The system was installed by: <br /> ti 4J Ji I J Property Owner(permitee) <br /> Effluent Sewer:Size: o Mat'l: PV S G —1(� Licensed Sewage Disposal Service <br /> Box(es): 11 Distribution; I I'Drop / I I Concrete; I J Plastic • DEQ License Number: 27CD78 b <br /> Drainfield Pipe:Size: 1 11 ;Material:Header: (J Z` /' ;Perf: DEQ Certification Number. R I 3 <br /> ,i sT• p Zia <br /> ,► <br /> Total Drainfield Footage: —I(�b :Rock Depth:Total:1 ;Under Pipe: <br /> Signed: / <br /> Alternative Drainfield Materials: <br /> 1 <br /> big <br /> r �� •V r'XCri•V • lU+ <br /> Trench Depth:Minimum: � :Maximum:�� ;Curtain Drain Depth: Company name: r�e 5e�1 G� <br /> (please print) <br /> Effluent Pump:Pump Model:PT3O,,Static Head in System b Ft. ��✓ �11 20 J� <br /> i Date: NnV1: <br /> Pump Cycle Time: I '� +'1 WI';Gallons per Cycle: 3() / <br /> Attach an additional sheet for components and materials not listed above. <br /> (For Marion County Use Only) • <br /> The above septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> It 4pproved <br /> J J Approved wi • correct[.ns:see inspection report <br /> J J Denied _ <br /> � � . <br /> Signed•��� Title::.. !t'? Date: g1$ (rN <br /> MC: S-41 rev:3/03;4/12 -:y:, .WH.1.TE:Marion Cnuntv_..YRLLOW:rhunar• PINK•lsictnllcr <br />