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0411 MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system:(installer) <br /> �•�- <br /> MARION 503-585-5147 PERMIT NO. ,-- C- t " ®05-'72. I <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspectlon I <br /> SITE ADDRESS:5 ,> /aL L�e 5E <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> I Scale: 1"_ + <br /> t <br /> North <br /> % 4-) <br /> ‘iiii, .. <br /> .....% <br /> ,.... <br /> ..., ,„.„ <br /> ki.' 1 ckt i't" 1 <br /> -, -- , . - 11/4. <br /> Or <br /> \14 <br /> 0 <br /> art ,i„ <br /> M <br /> . ii <br /> 4.h • <br /> i <br /> s <br /> 37 . <br /> _•• show all details.and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS; INSTALLERS CERTIFJCATION; <br /> �,/ a <br /> System Design Sewage Flow 1 5o Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ALCOR- <br /> TANK Size: I i b LI U total gallons X single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT ANO THE RULES [ <br /> Wet <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> '\ Manufacturer: ft! I , double compartment Q <br /> Material: C"o C yf _ [ ] flow-through pa I have tested the septic tank and certify it to be watertight <br /> Effluent Sewer: .v Header Pipe: The system was installed by: <br /> Size/Mat'I y <br /> 301 y Size/Mat'I Y 2 7z 7 1 !Property Owner(permittee) <br /> Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) s-.5- ' <br /> Rock and under pipe IX Drop Concrete DEQ License Number: <br /> ay <br /> Pipe total depth [ I Distribution [ I Plasticlt i <br /> Drainfield Material(Alternative�,/ or,Ierf.pipe) EZ Fie tt! ' /P `, DEQ Certification Number: iie rC <br /> Total Drainfleld Footage-ii Trench Depth MininunnZL( Maximum <br /> Curtain Drain Depth_ Signed: 4 !�/ ° it <br /> Effluent Pump: Pump Model a <br /> Pump cycle i <br /> times in minutes: on off Gallons per Cycle Company name: e , r LYgri �v� <br /> , ase print)ATT Make and Model <br /> Attach an additional sheet for components and materials not listed above. Date: 3-?,..to I <br /> (For Marion CountyUse Only) The above ctee' <br /> septic system has been inspected by Marion County, The iaformation has been determined to be accurate 1 <br /> and the system is: J Approved [ ]Approved with corrections:see inspection report [ ]Denied <br /> Signed: C% oft e• R, Q(Pats Title:®nom WaJ .�.) PA. S 1a e C(Gz�Ct Date: .. al 2 L 2(31 i <br /> MC:S-41 rev:3/03;4/12;5/14;11/I7 G:\Forms\Septic\S-41 As-Bui1t20I5Version20l7.doc WHITE:Marion County, MLOW:Owner•PINK Installer <br />