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• <br /> _ INDIVIDUAL ON-SITE SEWAGE SYSTEM REC. <br /> '°^"3O11CO1"'`n"a�ganarscnmv (to be completed by system installer) <br /> DIVISION <br /> • <br /> sfitmmsNarrono.lnw y/ /n�.�.,t� ry� y_ <br /> 1=3 3-51in SITE ADDRESS: 2 �'-3'� Ar-7-s�¢ r^,n.JV/^^9' /{/ .E X <br /> PERMIT NO.0 J L <br /> AS-BUILT PLAN OF CONSTRUCTEt SYSTEM: <br /> scale: 1^ - 1 <br /> ' North <br /> • <br /> 6.1)61 ) <br /> dad r <br /> /// j e O <br /> • <br /> !! /00 //0�4. <br /> Pa K.l y )64 t, - L1'jj<r + sSe- <br /> • <br /> • b Oa h._ <br /> 'tlitr -� S}3N4tA.f <br /> lei <br /> • <br /> RtskQm : „al /s g9�1s/a +°s� Mr <br /> ry/ Jr' b <br /> . : <br /> • �, e !(.7d411. ]:�*ANY f. <br /> CEO Al Air Nil +I 4- J P e <br /> (1�0nc/sn ` a'd <br /> (show all details and dimeNsions necessary to locate all components of the system in the future) <br /> sflm f'+samas tan aaecxrlcarzofs, IfSMxnme CORT.I 1[n1011l <br /> ante.resign Sesy. new: Canons/Coy 19a128SY CERTIFY THAT 'VIE an-SITE 6aNMGa <br /> / I RESTER) INSTA=LZL AT T/E TEM .=aa RES Cti- <br /> > septic Task: Site; /4 mat.).: Q*nt M(g: if SCRUMP IS ACD7SD1tPS WIT8 SRCsS]UIEMIINN'TS oS <br /> THE Pi:MIT AND T16 WI LE OF MIS ERVtE MIZI^[AL <br /> tenting Tra Sit.: "YGO Mail: fig: /^A>c: /c QUALITY COMISSION. <br /> /_ .t I I have tested the septic.ta k men certify <br /> stalest sewer, size,�[ �r Metal: Cr4r• JtVC5 eebt- ac to lee watertight: <br /> anr(eal: I 1 alstr'3ef�)4? Drop / 1`4 concrete; 1 I plastic The eyeree wee installed by: ' .. <br /> Y. r / ri ' [ 1 Property Owner fpermlteel <br /> DnSaxi.id pipe: Sim: > -I : „eternal; Raader:T S :rrpe,r''t����: �� ZTw�/ /��1 licen.ea sewage plspaeei service <br /> • <br /> Total 1`-al,...teis eentseadin 1 seta LRtL, metal.: £ Z aaef4., \ Pip Unease <br /> Tract septa: Minimum' 7 u : Mariiaan, a.2 : Curtain Drain Depth, /y 0 signed: ,I 1( �/ <br /> Exava[ pomp: amp xodel: r{(.,i. s static seP.d in Eyecw: �F (pCp a Conlon prre:�e(G, G poi//I1((/ATT'{'1(1:. <br /> 3print s 9 c�U <br /> Dump Cycle Time: 5'�N'P+';'�Ilom par Cycle: Dates .�' O <br /> - <br /> Etta). an additional Mutt tareap®eote an&teeteriala not listedebeva.. -I _ 'i <br /> (tar Marion County Ilea only) <br /> the o septic, system has been inspected by Marion cam m ty. The iafentiee ham.been eterntjs OWea o be accurate Si + <br /> [h system is: .P .. I 1 <br /> l Apptovte <br /> 17 Approved with corrections: see inspection report <br /> I 1 Pealed C{��)/� c y/�.}{'�'J,��� OW <br /> `` ' ry :/R� <br /> Signed ej J•1 1 i tie girt . <br /> 1J Tit)i��e:: ` " �7 Detet G� V - 6 <br /> MC; S-dl '-SCI!TE;Haraoa t Oumer; PSNF:IDatafer <br /> rev s/00,6/O1 .. • <br /> -- - - <br />