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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 <br /> 503-588-5147 PERMIT NO. 5-a - 60 3 <br /> MARION <br /> COUNTY http:/lwww.co.marion.or.us/PWBuildinglnspection <br /> SITE ADDRESS: I314,4r, 0re4a <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: s,1",/ 0 W.. �r75Y <br /> Scale: 1"_ T <br /> North <br /> ) tiltilig- <br /> Is. r <br /> \, ` 51^-1 <br /> — ^ _0, ;., <br /> r rc AL- cif° <br /> ®23`� lr. - 76SI <br /> S,r 13G - I1 , <br /> a <br /> ws QQ_ WI <br /> w,s` cp - q / <br /> 4.11 <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 ) Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size• . t total gallons 5,dsingle compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer. (.Vq1" L] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: rok. [• ] flow-through VI I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer. r, Header Pipe: The system was installed by: <br /> Size/Mat 44 i¢i t_ Size/Mat'l �t�/2/JC J I Property Owner(permittee) <br /> f,Licensed Sewage Disposal Service <br /> DRA INFIELD rock depth(inches) Box(es) <br /> Rock and ' under pipe do.r Drop MConcrete DEQ License Number gy(of <br /> pipe .. c. <br /> total depth iZ ( ]Distribution I I Plastic DEQ Certification Number. Zr [lo/ <br /> Dtainfield Material(Alto native or pelf pipe) <br /> Total Dramfield Footage t Trench Depth Minimum Z f Maximum`'4 <br /> Curtain Drain Depth •-- Signed: <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off "-- Gallons per Cycle Company name: V'K K �7 cures-4- vrew Erne <br /> ATT Make and Model pl (v(pleasee print) <br /> Attach an additional sheet for components and materials not listed above. Date: [— -'vZ.4! <br /> (For Marion Conn se 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 [ J Approved with corrections:see inspection report I ] Denied <br /> ISigned: Title: O'N-43T IOI-2,3 Date: olr Jt' kM <br /> MC:S41 rev:3/03;4/12;5/14;I1/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:;bfarionCounty;IELLOW"Owner;PIA'K:lnstaller <br /> ' S <br />