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. <br /> -"i..,,, MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> `1/4-'` 5155 Silverton Rd NE <br /> =g` SALEM OR 97305 (to be completed by system installer) <br /> MARION 503-588-5147 PERMIT NO.29 --0'C) 2)1 0 <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: (I (.33 *Lit jciodt <br /> C'- u- V L yes <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ ' <br /> T <br /> �J P©�� i 4 _, , North <br /> 1 • toir-- 4-64f1/4. 1 <br /> te <br /> • <br /> 1.)XtZ <br /> • <br /> gz 9/ <br /> ems <br /> r4, l <br /> I <br /> OOc 0002— <br /> (show all et ails and dimensions necessary to locate all components of the system in the fut <br /> ure) <br /> tore) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 375 Gallons/DaySTALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: lib total gallons yf.single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: t�n. .-•� [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: (.17v`C_ [ ] flow-through [ I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: i i <br /> Size/Mat'l 1Y tD u ( The system was installed by: <br /> Size/Mat'l ( ill- 5 L Al(9 [ 1 Property Owner(permittee) <br /> DRAINFIELD , rock depth(inches) Box(es) S.Licensed Sewage Disposal Service <br /> Rock and under pipe [ 1 Drop I I Concrete DEQ License Number: '2 7D®'3 <br /> Pipe total depth p 1 I Distribution I [Plastic <br /> Drainfield Material(Alternative or perf.pipe) DEQ Certification Number: <br /> Total Drainfield Footage;]/�?'J�,q Trench Depth Minimum`e Maximum ` <br /> Curtain Drain Depth U Signed: b t^ <br /> Effluent Pump: Pump Model 9t' e, ir�5 <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle <br /> Company name:_ )\-1-"4--1—d,t Le.._ S.2. 4--.1L c <br /> Make and Model )C��?� (please print) <br /> ATT <br /> Attach an additional sheet for components and materials not listed above. Date: /'"l6, .22-/ <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: pp ed [ I Approved with <br /> Aoo ; b0IrreP0r:corrections: [ I Denied <br /> oc- <br /> Signed: Title: <br /> MC:S-41 rev:3/03;4/12;5/I4;11/17 G:\Fonns4Septic4S-41 As-Built2015Version2017.doc Date: <br /> YT'HITE:Marion County, YELLOW Owner;PINK•Insialler <br />