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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. .555 —F o'o�412c- <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: 3�1-/U' CC/+--44-, �' Al r <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ $D " T <br /> ;, North <br /> at , <br /> -0, , ,,./ -r/ -'3 <br /> -7/ <br /> . <br /> 1 i � <br /> / I <br /> 10. ti 2 <br /> k'L. f, <br /> 42b20 y'y <br /> \, <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 44% Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /f566 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: G.kai-e_ <br /> [ 1 double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: (CA,10,,,ek_ fifflow-through faI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'1 i 1/4-1 `' l Size/Mat'l I ]Property Owner(permittee) <br /> 10.Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) '.3 9.6_' <br /> Rock and under pipe 4 t I I Drop I I Concrete DEQ License Number: <br /> Pipe total depth H" J ]Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) areedg55 [..i/ ekA.,.12vf <br /> Total Drainfield Footage I ( Trench Depth Minimum it", Maximum_ 12 <br /> Curtain Drain Depth - - Signed:_ r <br /> Effluent Pump: Pump Model <br /> Pump cycle 0,--4-4A- <br /> times in minutes: on -- off -- Gallons per Cycle — Company name: (�rCQ ,e A. _See .4' `I` LLC_ <br /> ATT Make and Model 0 4-/, - ,G 41( 210OJ (please print)�i <br /> Attach an additional sheet . components a • materials not listed above. Date: . 1_5 —/O <br /> (For Marion Count nlv) T.- above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: ,;'e <br /> ove, [ ] Approved with corrections: see inspection report [ ]Denied p <br /> Signed: Title: Date: 9' & 6 <br /> MC:S-41 rev:3 y3;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YEL 0 :Owner;PINK:Installer <br />