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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS~UILT ~I.~N 0~' CONSTRUCTED <br /> <br />FIL <br /> <br />(show all details and dimensions necessary to, locate all components of the system in the futuF¢) <br /> <br />~{AT~RIALS LIST FOR, <br /> <br />Septic Tank: Size: <br /> Material~ <br /> <br />Efflumn~ ~ewert Size: <br /> <br /> Material: <br />Header Pipe: Size: <br /> Material: <br /> <br /> Material: <br />Drain Media: Depth: <br /> <br /> I~ST~L~HS C~TiPICATIO~:, <br /> I HEREBY CERTIFY T~T THE ON-SITE SEWAGE <br />SYST~ INST~LED AT THE ~OVE ~DRESS W~ CON- <br />STRU~ED IN ACCORD~CE WIT~ T~E REQUIR~ENTS OF <br />T~E PE~IT ~D THE RULES OF THE E~IRO~E~ <br />QU~ITY COMMISSION~ <br />[ ,] I.have t~Sted the septic ~a~ and certify <br /> i= to be wa:er=i~h~. <br /> <br />Company nam¢~ ~Z?~ ~ $ , <br /> <br /> (for Marion County use only) <br /> <br />The above sep=ic system has b=¢n inspected by Marion Coun=y. The information has been determined <br /> <br />to be accura=e and ~he system is: <br />[~Approved <br /> Approved with co~eo~ions: see inspection <br /> / / 3-,. re or <br /> <br />Title:~ <br /> <br /> <br />