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~ INDIVIDUAL ON-SITE <br />' ~ (to be completed by system installer) <br /> <br />SITE ADD .SS: <br /> <br />AS-~UILY PLAN OF CONSTRUCTED SYSTEM: <br /> <br />(show all details and dim, <br /> <br />.MATF. RIA~S LIST FOR SYSTEM,,: <br /> <br />SEWAGE SYSTEM RECORD <br /> <br /> ,,~ PE~M~'r NO. ~5-- ~,'5~7 <br /> <br /> MARION COL <br />E~LIILDING INSPECTI <br /> <br />tsions necessary to locate all components of the system in the future} <br /> <br /> Material:. <br /> Manufacturer: ~-~ <br /> <br /> Matarial;~&~30~/ <br /> <br /> Material: <br />~ead~r Pipe: Size:_, ~ <br /> <br />Dist=ibut~on Pipe=Size: ~'~ <br /> <br />Drain Media~ Depth: <br /> <br />,INSTALLERS CERTIFICATION~ <br /> <br /> I ~R=BY CERTIFY THAT T~E ON-SITE SEWk~E <br />SYSTEM INSTALLED AT THE ABOVE ADDRESS WAS CON- <br />STRUCTED IN ACCORDANCE WITE T~{E REQUIREMENTS O~ <br />TEE PERMIT ~LND T~E RULES OF TKE ENVIRONMENTAL <br />QUAL..~TY CO~ISS ION. <br />[~ I have tasted the septic tank and certify <br /> it to be watertight. <br /> <br /> (for Marion County use only) <br /> <br />The above septic system has been inspected by Marion County. The information has been determined <br /> <br /> to be accurate and ~he system is: <br /> [~ Approve~ ~~ <br /> [ ] ADproved w ection <br /> [ ] Denied <br /> <br /> Signed~ ,,, <br />~s-buil~.frm 3/95 <br /> <br />reDort <br /> <br /> <br />