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<br />INDIVIDUAL
<br />
<br />ON-SITE
<br />
<br />SEWAGE
<br />
<br />(t" be c"mpleted by system installer)
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<br />lqcate all components of the system in the future)
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<br />S1:TE ADDRESS,
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<br />lOa
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<br />ß....~ì+-~.",(~)'.,d,
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<br />¡«t- : ()e~1 0 Q.
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<br />As-aUILT PLMj OF CONSTRUCTED SXSTEM;
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<br />Bcal", ,
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<br />-/2:"'"
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<br />(show all details and dimensions necessary Co
<br />
<br />S.p"<" TODk, Sb.,
<br />
<br />SYSTOK ""TBRIALS >.NJ) "'CIU""TI""S,
<br />IOOÓ9oJ. Mot'l, CO"'Cw..k.. Mfg, uJ.o...;-\.~
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<br />Do'1n~ T_, Sho,
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<br />Mat'l, Mfg,
<br />Mat'L 'þ-1¿>,?~-,.j)c....
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<br />"Uu,""" s-.. Sb.,
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<br />e,¡;1(
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<br />Box(..); [) DiBtr'.utio"; [I) Drop I [.-f Conorote, r) PÍ"'~tic
<br />DrdnUd4 Pip., Si.o,~, ""todd, He'4."~, '.r~'~
<br />To<o1 D<d~Ud4 Foo.."../50 " Rook Ð.pt.h. Total£.~Un4.r¡PiP"~
<br />Tr_h Dopt.h. Minimum,:3s:i:., Maximu., 5.2 " ""<tain Ð<ain Ð~~th'-
<br />
<br />Blnu.... -. !'ump Modol, , S..tic "e.d i"Syste., ; ft,
<br />
<br />Pomp (;yolo Timo, ; Gallons ¡PO< cyo~e¡,-
<br />A"'ch an '44Hiond ah..t tor "__n.. ...... ...."..id.~o' lh".~ ahov.,
<br />
<br />SYSTEM
<br />
<br />RECORD
<br />
<br />, PERMIT No__9'<;-:: 18/.:<'6'(-
<br />
<br />t
<br />North
<br />
<br />F"IL
<br />"IE
<br />
<br />!"STALL,"" CBRTIF!"-\TIO",
<br />, flBRE.Y C"Rnl'Y _T THE ON-s". ",WAGS
<br />SY$TEM !IISTALLSo AT THE A!;OVE ADO'EM WAS CON-
<br />$TRUCTSo IN AOOORDANCE WITH rn. REQV"EMEllTs OF
<br />TIΠ'.""!T AND THB RULES OF TH" EIIV"ONMENrAL
<br />QV¥'"", OO"","SIO"-
<br />l"1 'have teSted too Beptic tank and c<ctify
<br />it "0 be watertigbt-
<br />
<br />Tho SYB'om was 'nsta"ed by,
<br />( ) P<oper.y """0< (permitee'
<br />¡"'¡"L'o.nse~ Sew.ge oi$po..\ Service
<br />
<br />Signe~, ~Á~ ~, 76(~
<br />
<br />Comp.ny n.",c, Ke>.....,.. ~Idto~
<br />(ple... pr'nt)
<br />Date, 3/7/ <f{;
<br />
<br />(for !l:a';ion coJncy USe only)
<br />The above septic system has been inspected by Ma:åon County, T!Je information !Jas been determined
<br />to be accurate and the system is: ' ,
<br />(W Approved
<br />¡( j Approved with corrections: see inspection report
<br />[ ) Denie,&:? ¡
<br />
<br />Signed:Q'\~ .1!t-.. Title, V/Date, 3
<br />as-bullt.frm 4 95 WHITE,Manon County, YELLOW , Owner;
<br />MC-ló~S41
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