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7 <br /> iti-s....,1/4.. .... . MARION COUNTY 1311ILDINg INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> - - 5155.&Welton Rd NE (to be completed by system installer). ' <br /> . .._. <br /> SALEM OR 97305 <br /> ... <br /> • <br /> •MAI:110N- 503-588-5147 PERMIT NO.-5S5L- <br /> - --'-- - 1- 00C3.-S—1 . .. ' <br /> .: <br /> COUNTY '. <br /> http://www.mmarion.or.us1PW/BuildingInspectiou syrE ADDRESS: 6,14, Did \\)t_ (..,0 IN LA <br /> ' S <br /> AS-BUILT PLAN OF CONSTRUCTED.SYS'TER: _ <br /> Scale:I"= ' //: lt <br /> North <br /> --• <br /> D czkt,g..q d(1 <br /> 11 7—...7.). <br /> (../ / <br /> , <br /> I <br /> , <br /> • . <br /> I <br /> l <br /> 0 T 2Li% <br /> ..- <br /> i vt.-rai <br /> /7—E:144:‘,N. <br /> i-totAt.... <br /> -------/, <br /> • <br /> (show all details and dimensions necessary to locate all cordporients&the system in thefutine) <br /> SYSTEM MATERIALSANDSPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON=SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow ..-3-c Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONS MIR.tat IN ACCOR- <br /> TANKSize: I .. total gallons <br /> tksiligle compartment DANCE <br /> ' ODANFTHECE EWNDVNIRT01-1ENMENT.REQUAlLitEMQI/ENTSAfiri.DCFOTNEWIIISERMITSION.AND THE <br /> RULES <br /> •Manufacturer 1-k't-d:'/Mr- <br /> OT <br /> [1 double compartment <br /> Material: \ti;S-V1 C_ [ j•flow-through biThavetested the septic tank and certify it to be watertight <br /> • - <br /> •EffluentSewert, ,s,- 1: , , ,., , The system:was installed by: <br /> NeadevPipe: <br /> Size/Marl (-4 4-,/,-V\Lk0 WI Siie/Marl I 1 Property Owner(permittee) <br /> 'KLicensed Sewage Disposal.Service <br /> DRAINFFELD'1 rock depth(inches): •'Box(es) <br /> Rock and Oiltotild7dtiPthe `It liDDithution i IPlastic <br /> rostrp I I Concrete , DEQ"Liuense Number: 56 XS S <br /> p <br /> DEQ Certification Number; , 2- <br /> DrMilfield'Material(Alternative or perf.pipe) <br /> Total Drainfieldyliotago_ TrericlaRepth Minimum Maximum • <br /> Curtain Drain.Depth Signed: <br /> Effluent Pump: Pump Model . <br /> ,Pimp cycle <br /> •times in minutes: an off Gallons per.Cycle . Company name: , <br /> '.ATT•Make ant Model • •• <br /> (pleise print) <br /> l'Attach an additional sheet for components and materials not listed above. • Date:__ t-4- i..- <br /> (Foe Marion COunty,Use Only); The above septic system has'been inspected hy J%/lariiirt County. The infotipation ha.S.beett deteriniried th:be aCcurate <br /> and the syStern is; .MApproved .f 1 Approved with corrections:see:inspection report t I Denied <br /> Title: .)-k'3-r toz3-b- 1...3.-a- Date: ctictiz-4 <br /> mr.q.4, __,...n.„.dill•c124-iiv, nAp..........., ......:..., .A .1.....0...:1,111.1C1.1.....Z.--.A,Z.1-.... TMTVP11.V. •- •.• . VI•••••ATI••••• ••••,,••••• •'..-7-- <br />