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1. <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ,`. 5155 Silverton Rd NE (to be completed by system installer) <br /> --7-7— -' SALEM OR 97305 ff <br /> 503-588-5147 PERMIT NO. 55%-I 1 7 V <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: 4;94`t6ti at Std <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 5,--14.4,,, <br /> CSL ar41 <br /> Scale: 1"= iG ' T <br /> North <br /> I 2 7,....,. <br /> P�vv~ <br /> IqH Govi-- <br /> Ii. <br /> V <br /> e <br /> IR.:-- ice' <br /> 617 = Lam' <br /> .40-e7= 1`71:5 <br /> cfci <br /> `l5` <br /> • <br /> • <br /> (show all detailsand dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> p�rr0 I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 1- Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> [ single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> TANK Size: ` (r1fJ0 total gallons <br /> Manufacturer: 6+1'& 4-L [ ] double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: ['anesurr.EZ <br /> [ ] flow-through n I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: a Header Pipe: The system was installed by: <br /> Size/Mat'l W elf Air-- Size/Mat'l LG fit(,RUf [ I Property Owner(permittee) <br /> Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe 6' l r Drop lR Concrete DEQ License Number: 3 gt°`b-s1 <br /> Pipe total depth /V.' <br /> . l I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative <br /> or pert.pipe) 17-44 piste. <br /> Total Drainfield Footage �7 ivf 5' Trench Depth MinimumiMaximum_17, <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model <br /> Pump cycle <br /> times in minutes: on off — Gallons per Cycle Company name:_ t3'rr<y+�— X17,-v'+—. <br /> ATT Make and Model --- O (please print) <br /> Attach an additional sheet for co •: ents and mat•rials not listed above. Date: . (r- <br /> (For Marion County :. Only) The a. e septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: • -'. ; <br />