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. MARION COUNTY BUILDING INSPECTION INDIVIDUAL OPT-SITE SEWAGE SYSTEM RECORD <br /> taki5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 <br /> 503-588-5147 PERMIT NO. 5cc 21 d 000 222. J1)I f MT <br /> ‘IGIARION_ <br /> ,,COUNTY . http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: 2 52 „‘"infittiai gti 11 SY <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 4 del S! ek <br /> _ <br /> Scale: 1"= J 4/ 1/ .0s Pr.vale- AO6 c Is <br /> North <br /> 4,60v 1m 0Gt� a 12024 t <br /> fern G o �RG�` frU/ L�11 f i''7 I' thl j 1/ C -fI —— g^, 1 <br /> Co ty/015, . 151-lop (3o3%) ! <br /> 070-44) r om d ��C49 i i , ••i4e-e- IA / <br /> X/ r-9' -( i <br /> a , -D5 till %i ....------------ <br /> i WM 4"ife5eV' ro r, <br /> *.- ,r) A -11 ies.60,46 wSiteAtA It <br /> 'll <br /> �4Pl�G j�►,,� Q <br /> V. ) <br /> Nr 14l <br /> ac Imo. <br /> me+ 1.3 <br /> siie- <br /> /� /_ / L -J- / <br /> 1r /400 st-l$�• home elt.Sl�ifalieet iA. igeetat 1 k- y`rG. /O /Tow <br /> "N 5a,4I--?.flag ISf Ve <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: / 00 0 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> J OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: [ I.double compartment <br /> Material: 0,0Y1 ere.4- [ ] flow-through I ] I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: >i Header Pipe: f9 The system was installed by: <br /> Size/Marl 4 PSG Size/Mat'l 4 Pile__ Property Owner(permittee) <br /> 1 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe I I Drop IA Concrete DEQ License Number: <br /> Pipe total depth - 0 Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum <br /> Curtain Drain Depth �, 1 Signed: <br /> ti--444-. ilerlfr <br /> Effluent Pump: Pump Model /V l - <br /> Pump cycle a97��/�- l <br /> times innminutes: on off Gallons per Cycle Company name:_ <br /> ATI'Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: <br /> (For Marion Conn Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system i : Approved I I Approved with corrections: see inspection report I I Denied <br /> Signed: Title: '�5 Date:�-' V./ __ <br />