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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—/6 — O (c,523 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: 859 -r,ruGG D r. <br /> 6 co tts ri'i/& ,,Q 9'73 7- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1' = • T <br /> North <br /> • <br /> b, �'\\9 <br /> • <br /> • <br /> PN <br /> n <br /> 00 _ • <br /> i <br /> • <br /> (show all details-and dimens ons necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: - INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow 145421 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- ' -- <br /> l _ — STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size /0'0 0 gallons Nigel d nCre.'k. Mfg �� DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size • gallons Mat'I Mfg <br /> idyl have tested the septic tank and certify it to be watertight. <br /> ATT Make and Model/ +V4, fps A t. o RTN Box(es): <br /> l Distribution The system was installed by: <br /> Effluent Sewer:Size Mat'l S ")D 1)1 Drop <br /> ]Concrete ] I Property Owner(permittee) <br /> Drainfield Pipe:Size 't! l lx}Plastic ] ] Licensed Sewage Disposal Service <br /> Material:Header Pipe 27 2.9 Perforated Pipe DEQ License Number: 37 0 0 3 <br /> Total Drainfield Footage 150' Trench Depth Minimum,?,y u Maximum 3 dd q DEQ Certification Number: RI la C. <br /> Rock Depth:Total Under Pipe Curtain Drain Depth ) <br /> Signed: 1•Pj‘14 <br /> C Lam!,A.lY"'" a <br /> Alternative Drainfield Materials L—zF/0,,,,7 57,14 Tk1 • <br /> Effluent Pump: Pump Model_ _ • Company name_L 0{R.(end Cane,. c cC O1t c CS1 lr1 G <br /> Pump Cycle minutes minutes (please print) <br /> Time on off Gallons per Cycle - <br /> Attach an additional sheet for components and materials not listed above. Date: <br /> (For Marion Count • S nly) <br /> The above septic sy• em has .-en inspected by Marion County.The information has been determined to be accurate and the system is: • <br /> ✓-] Approved/[ ,• pproved with corrections: see inspection report ] ] Denied <br /> Sign n. /' - Title: e611.5 Date: si ll i n <br /> MC:S-41 rev:3/03;4/. ;5/14 WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />