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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />kS-BUILT PLAN O~ CONSTRUCTED <br /> <br />(SHOW all details and dimensions necessary to locate system in the ~uture) <br /> <br />~ATERIALS LIST FOR SYSTEM: <br /> <br /> Material: <br />Manufacturer: <br />~ffluent Sewer~ size: <br />Materlal: <br />~ox(ee): Type= <br /> Material: <br />Hea~er Pipe: Size: <br /> Material: <br />Distribution Pip~:Size: <br /> Material: <br />Drain Media: Depth~ <br /> <br /> INST/tLLERS CERTI~ICATION: <br /> I ~ERE~Y CERTIP¥ THAT T~ ON-SITE SEWAGE <br />SYSTEM INSTALLED AT THE ABOV~ ADDRESS WAS CON- <br />STRUCT~D IN ACCORDANCE WITH THE REQUIREMENTS OF <br />THE PERMIT AND THE RULES OF T~E ENVIRONMENTAL <br />QUALITY COMMISSION. <br /> [ ] I have tested the septic tank and certify <br /> it ~e 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 />to be accurate and the system is: <br />[ ] Approved <br />[ ] Approved with corrections: see inspection report <br />[ ] Denied <br /> <br /> Signed: Title: Date: <br />as-built.rrm 3/95 <br /> <br /> <br />