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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (~e be completed by System installe~) <br /> <br /> / <br /> / / <br />¥ <br /> <br />(show all 4e~ails and dimensions ~¢c~ssary to loca~ all comDonents of the system in ~he futurel <br /> <br /> Material: <br />~o~(os) ~ Type:, <br /> <br />Header Pipe: Size: <br /> Material: <br />Di~ribution Plpe~$ize: <br /> <br />D~ain ~edia! <br /> <br /> INSTALLER~ ~RTIFICATION: <br /> I H~REBY CERTIFY TFAKT THS ON-SITE SEWAGE <br />SYSTEM INSTALLED AT T~E ~OVE ADDreSS WAS CON- <br />STRUCTED I~ ACCORDANCE WITH THE REQUIREMENTS OF <br />TKE PEP. MIT AND T~ R~ES OF ~E E~RO~NTAL <br />Q~I~ CO~I$SION. <br /> [ ] I have tested the septic, ta~k ~ ~"~-t~-~'~- <br /> it to be waterti~ht.~ <br /> <br />Company name:~~ f~ <br /> <br /> (for Marion County use only) <br /> The above ssp~ic system has been inspected by Marion County. Th'e informa~ion has bean determined <br /> to be accurate and =he System is: <br /> <br /> [ ] Approved ~h ~orrect~: s~ <br /> <br />~s~uilt. frm 3/95 r ''~ .... <br /> <br />Title: ~%~ Date <br /> <br /> <br />