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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 /> MARION 503-588-5147 PERMIT NO. 555 - 19- OOo202-PR IAT <br /> COUNTY http://www.co.marion.or.us/PWBuildingtnspection U+Z kd <br /> SITE ADDRESS:Z35Z1 E <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> A—STCL=11' FLUSh caru <br /> B—S7CL=Sfi' 1 tV E-C.TICN ParNI� ' ✓� <br /> 76' E1 g <br /> a—Pod n=Zo 5 <br /> JaJ t. e a <br /> B—Pod CI=58' 76' 8 <br /> STCL—Pod CL=10' ad <br /> C-LAWN B = <br /> OX 52 ..7 _. VI OPenTrench G <br /> no old drain <br /> -- Venn" 4 <br /> sleeve \?? <br /> \?? <br /> \?? <br /> / }' <br /> : 1000 gal WCP ST x ----- X� <br /> STCL--F/0#1=144' a'y Elevation 4'2" <br /> CID <br /> Pod CL—F/O#1=202' ,-.,o <br /> y„ zr� <br /> / <br /> STCL—VP#1=192' MI 0' Driveway (,fk� ° <br /> STCL-1/P#1=200' G r ��- <br /> STCL—F/O#2=202' <br /> 1 <br /> Pod CL—F/O#2=210' <br /> I <br /> STCL—VP#2 200' <br /> Pod CL—VP#2=208' ��11 <br /> e <br /> SfCL-1./8=-12W <br /> Al <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALSANDAND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow SU Gallons/DayI HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUL tE1)IN ACCOR- <br /> TANK Size: I total gallons of single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> e., <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: rum [ ] flow-through Df l I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: 1/ it Header Pipe: it The system was installed by: <br /> Size/Mat'l ) /2, S_ J1 Y t� Size/Mat'! / SLA 5l 8 j j Property Owner(permittee) <br /> 0(1 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) t <br /> Rock and under pipe 1 1 o I j Concrete DEQ License Number:3E2A`F' <br /> Pipe Y3+�.t <br /> total depth OrDistribution l 1 Plastic r r <br /> (AlternativePe pipe) a./ P !"1 !G M J 1 yy),(t�EQ Certification Number: A,L a�j 1 �(j p� <br /> Drainfield Material or rf: i I. Pen <br /> .ft <br /> Drainfleid Footage ) So Trench Depth Minimum )Q Maximum_ 19- t <br /> N <br /> Curtain Drain Depth_ Signed:_ 1/h.e.. <br /> Effluent Pump: Pump Model Pro Q_'`� <br /> Pump cycle y <br /> times in minutes: on er 1 off 19.7 Gallons per Cycle p c Company name: 'r'ef\C S' Dr, si-le.. <br /> { ATT Make and Model )r.er p VDer <br /> (please print) <br /> t Attach an additional sheet for components and materials not listed above. Date]—+.5— <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is:134 Approved [ ] Approved with corrections:see inspection report [ I Denied <br /> Signed: a...ea ..4,4- a,kzU e 6-7-/ S Title:_✓t.4.--te (A)adtevate'L ]...C.4 acat Date: <br /> MC:S41 rev:3/03;4/12;5/14;11/17 G:\FormsSeptic\S-41 As-Built2015VeIsion2017.doc W7fITE:Marion County;YELLOW Owner;PINK:Instoller <br />