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N%w 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 �i <br /> 503-588-5147 PERMIT NO.. gS"— a-a - oS97 f <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection7�3 1� <br /> SITE ADDRESS: S"I-Cf.C- h <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=Lb .3 T <br /> North <br /> do t. <br /> w�' <br /> roc" 0, — -- - <br /> a DELAVAN,WI <br /> ll :AA-RITE <br /> )c. <br /> Z <br /> COMOS}:7nffl MO512111.01 <br /> c� SUBMERSIBLE EFFLUENT AND POTABLE WATER �. <br /> t) HP ii2 1 U VOLTS 115 AMPS 10.5THZ 6u S.F. <br /> u 22E1 Hr <br /> 1.2 <br /> CAUTION;RISK OE ELECTRIC SHOCK <br /> • <br /> LI <br /> III <br /> �' DO NOT REMOVE CORD AND STRAIN RELIEF. C�IUS <br /> s:.C. DO NOT CONNECT CONDUIT TO PUMP. <br /> THERMALLY PROTECTED ',WO.]3 <br /> 5I11nC IM ITAI V <br /> IYIMUL 115 I I HL I <br /> (show all details and dimensions necessary to locate all compone: ,J <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow LJSO Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: >po® total gallons J 'single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: d <br /> lL [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: [$p h',re.i.G [ 1 flow-through have tested the septic tank and certify it to be watertight. ,1,,,--. <br /> Header Pipe: The system was installed by: <br /> Effluent Sewer: I /y Sa ] JProperty Owner(permittee) <br /> /`I Ell 1 �� Size/Mat'l I 1 P Y (P ) <br /> 'Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) — • <br /> 4tv7% DEQNumber:3 0/ <br /> Rock and under�e�64S �rop ( ]Concrete License Numbe <br /> Pipe total depth I I Distribution I I Plastic �' <br /> DEQ Certification Number:1 S I? <br /> Drainfield Material(Alternativeorperf.pipe) tr l� -fin// <br /> Total Drainfield Footage ✓C t Trench Depth Minimun / Maximum J✓ <br /> � � <br /> �✓ <br /> Curtain Drain Depth_ pet Signed`-J��a����� �"`_ <br /> i <br /> Effluent Pump: Pump Model �t e-A <br /> Pump cycle : t5 DO MO "Ir21 �O <br /> times in minutes: on off Gallons per Cycle 35-- Company name: (`i7r' ,/-�-- <br /> ATT Make and Model t 2 _ ' <br /> A S 506 (please print <br /> Attach an additional sheet for co .onents and materi s not listed above. Date: 3.72 "'/19 <br /> (For Marion Count - e Only) The abov- eptic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: 1.4,,,..• : f�, Approved with corrections:see inspection report [ I Denied <br /> i <br /> Signed. --"v;411 Title:i2"''" _t <br /> Date: L'f <br /> MC:S-41 rev: o3;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; LOW.•OJner;PINK:Installer <br />