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°ems ,.`: . MARION•COUNTY BUILDING.INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM <br /> 5 3-588 OR 97305 PERMIT NO._555'N-0Q'7f/,2,1p"!—PRAT— 01 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: <br /> 'AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= 50' Is <br /> North <br /> I Shop <br /> ell New House Footprint Ilk <br /> Y� * I <br /> 3 FAIL <br /> Cur in D .in <br /> ro , o Well <br /> . <br /> �` .I <br /> i CID , <br /> ♦ '` Mobile Home <br /> ♦♦ <br /> I , ♦♦ 6� I . <br /> Sep n <br /> • <br /> ♦• <br /> 1 I Le ch mes <br /> • 1 a A <br /> I 41 ,03 <br /> 1 q 1�, I <br /> 1 All5 <br /> IFuture Repair Area <br /> Power Pole ~----________Li66vL"---7________ < \--I <br /> / <br /> ' . <br /> \Property Line <br /> Diveway <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 (377,5" 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: /019O t tal gallons [)single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: Snf/ r [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: pt,/y [ ] flow-through og I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: lI /I Header Pipe: The system was installed by: <br /> Size/Mat'l �l 1/pVt. 5L.h "7�Size/Mat'I li/p�(C 5cA I-�� A Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) _ Box(es) • <br /> Rock and under pipe ID ii x Drop IgConcrete DEQ License Number: <br /> Pipe total depth c J/n II I I Distribution i i Plastic <br /> Drainfield Material(Alternative or perf.pipe) ' / f ah e d, Alt �rr n DEQ Certification Number: <br /> Total Drainfield Footage 3 75 Trench Depth Minimum 2 Maximum, J <br /> Curtain Drain Depth_CIO rl Signed: • <br /> Effluent Pump: Pump Model NA LL . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ <br /> AN ( ase print) • <br /> ATT Make and Model � �� 7,,?Y <br /> Attach an additional sheet for components and materials not listed above. Date: <br /> (For Marion Count Use Only) The above septic system has been inspected by Marion County. The in rmation has Keen determined to be accurate <br /> and the system is: [Approved [ I Approved with corrections: see inspection report [ ] Denied <br /> Signed j Title: C _5 tons Date: R I)_(Z // <br />