Laserfiche WebLink
' MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> --. ..:. - SALEM 503-88 OR 97305 PERMIT NO. "5 5 "- f e ( z I(11 <br /> MARION <br /> COUNTY <br /> http://www.co.marion.or.us/PW/BuildingInspectionSITE � <br /> SITE ADDRESS: ,,, ,52..3��� Lulu -LLAL <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> , <br /> Scale: 1"=30 ' <br /> - No th <br /> = s- <br /> a ev 4 <br /> 4a=45-1 6' f <br /> I <br /> , 1 <br /> AF -1t3r5Cr d <br /> \--WI C. 501 <br /> , /IZ <br /> ---.?g /3 / <br /> 741 1 <br /> in <br /> yy(( 1 <br /> li <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 /> 5 Gallons/Da I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM System Design Sewage Flow Y IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I 5� total gallons e'single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: LAMP [ ] double compartment <br /> Material: ('ainGi/SG{e-- <br /> [ ] flow-through la I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: , its Header Pipe: 1 J t( The system was installed by: <br /> Size/Mat'1 '1 Pile ? Size/Mat'l t{ P1�yd3et I ]Property Owner(permittee) <br /> )Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) } ,�o �j <br /> Rock and under pipe s lx Drop I Concrete DEQ License Number: 3Q-4tF✓E <br /> Pipe total depth 12„ I I Distribution I I Plastic <br /> n DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) P�" nt) <br /> Total Drainfield Footage I / <br /> g �rj'Q Trench Depth Minimum�L� Maximum�� <br /> Curtain Drain Depth_ Signed:_ ir <br /> Effluent Pump: Pump Model "— <br /> Pump cycle <br /> times in minutes: on off "'' Gallons per Cycle Company name: (� Q/nJ'ee — P-•-r� <br /> ATT Make and Model (please print) <br /> �/ <br /> Attach an additional et for co' ponents and materials not listed above. Date: G TgfLr t .K <br /> (For Marion 'ou tv Use I nlv) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the syst- ? , , i roved [ I Approved with corrections:see inspection report [ ]Denied <br /> 7 <br /> Signed: Title: Date:`//(o 111 <br /> MC:S-41 re .3/03;4/12;5/14;11/17 G:\Fonns\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOW:Owner;PINK:Installer <br />