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r. <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE,SEWAGE SYSTEM RECORD <br /> 5155 Siifverton Rd NE; (to be completed by system installer) <br /> :SALEM OR 9705 <br /> '543-588 5147 i PERMIT NO: 24-004898 <br /> MARION <br /> _ ,h€tp:/wwwco:maroon:or.us/PWBuildiogl`nspec SITE ADDRESS: <br /> tion 560 NORTH SANTIAM HWY W <br /> - <br /> I GATES, OR <br /> AS-BUILT PLAN OF CO,NSTRUGTED SYSTEM::: <br /> s; <br /> Scale: t' <br /> North <br /> I <br /> s E E ATTAC H E D <br /> 1 • . <br /> . ... ._... ...,... ,,., . _ <br /> _ (sliow all details and,dimensions necessary to,locate;all.pomponent of the"system io the future)` <br /> SY 1 E14t=M GERIAI S ANf3.SRECIF.fCI1TIONSk <br /> INSTALLERS CERTIFICATION:' <br /> System:t�esiga ewage'Plox-' EXISTING t allonslDay I HEREBY CERTIFY"THAT THE ON=SITE'SEWAG SYSTEM IN- <br /> . STALLED AT THE lE ABOVE ADDRESS WAS CONSTRUC t uD'IN ACCOR- <br /> TA'VIC Size: . . to of gallons g ' ` p meat DANCE WITH THE REQUIREMENTS OF THE:PERMIT.AND THE RULES <br /> 1000 single art " <br /> doublecom OP THE FNVIRONMENTAL QUALITY COMMISSION. <br /> IVEanufactu er Waite t E 1 partrncat <br /> 'Material: Concrete II .1 .flow-through XI have tested the septic tank and certify it to be watertight. <br /> Effluent Seive`ri Meader:Pipe: T'he system was installed.by: <br /> -Size/Mat I4" /3p34 - ';Size/Mat'i 4" / 3034 I I:Property Owner_(permittee): <br /> . `I�I'Licensed Sewage Disposal Service <br /> DIiAINFIELD rock depth(inches) Bos(es)' //�� <br /> Rock and underpipe. I'I Drop I J`,Concrete .DEQ License Number: 39002 <br /> Pipe' <br /> total depth_,,,, i— I' I Distribution , I (;Plastic <br /> 13iain i. c Ems. .;'v r. :DEQ CertifieationNumber: RI 823 <br /> Total.' it aSiNG <br /> /� <br /> Curti .Dram De P . <br /> : Slatted: O J „iv-, <br /> E ag:I::tromp::'Pump`Ivlodei <br /> Pump cycle # <br /> times n.ininutes: on . .. . ;off :Gallons`per.Cycle. Conipany;name; 3-A Construction, LLC. <br /> ATE MakeAo:Mlodei (please:print) <br /> Attach aq additional sheetfor..components and_materials not listed>above. Date:. 08/27/2024 <br /> _(:For Marion Count se Utrl/ZThe above septic system has been inspt.eted by�Marton•County. Tile information <br /> has,been determined to,be accurate <br /> and the system is: Approved, 1 , I 1 Approved.with corrections,;see inspection report. 1 J Denied <br /> .Sin;ed: Title:.. - lOZ33-4'n' Dafe.� <br /> IC:S-4hrev..3/03v4/12:5/F ;Ei/I7 Cx:\F.onnst;Sentias-44 A.:R»iuon sv innlnrl:a,., ,. .,. ...__:_ <br /> 1, <br />