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i <br /> 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 <br /> 503-588-5147 PERMIT NO. 18- 00 72S 4 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection C. <br /> SITE ADDRESS: ��� L.14 k-� �14� ],� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=.9d' T <br /> 7/0 — . North <br /> 41,0#44A <br /> • <br /> 6 p <br /> p <br /> 04 <br /> 114't <br /> 64k ijt <br /> W <br /> a b <br /> V. Tr L' <br /> 1s `7 g - <br /> V <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 /> LISZ� Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 45-00 C°' /total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: (.0-4.44-,,`5- <br /> p-1,double compartment <br /> Material: CO KIC_ • [ 1 flow-through itot I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'I / /i fhrG Size/Mat'l [ I Property Owner(permittee) <br /> [ I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) I tl <br /> 9 C� <br /> Rock and under pipe ] ]Drop ] I Concrete DEQ License Number: <br /> Pipe total depth [ I Distribution ] I Plastic a '3 <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum D.,,,....... �Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model Q 30 • <br /> Pump cycle ]T► � e-4- e S� C_ <br /> times innminutes: on l b off 3o Gallons per Cycle �V Company name:_ '1 <br /> (please print) <br /> ATT Make and Model I Q <br /> Attach an addition• sheet for corn.on• is and materials not listed above. Date: / 31-- 1 — <br /> (For Marion fou i • se 0 vl The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system ,,�'' • ! oved [ ] Approved with corrections:see inspection report [ ]Denied e. <br /> ..i� 1L9,S Date:,y1� 1 <br /> Signe.. / Title: <br /> MC:S-41 r--:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE.•Marion County;YELLOW:Owner;PINK:Installer <br />