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SITE'AQDRESS': <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (tO be completed by system installer) <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> <br />f <br /> <br /> '~ ipI , <br /> <br />North <br /> <br />(shoW all details and dimensions necessary to locate all components of the system in the future) <br /> <br />Tank, Size:_~~ Mat'l:~2~__ Mfs: <br /> <br />~s~ Ta~k~ Size: Mar'l: Mfs: <br /> <br />If£1ue~t Sew~r~ Size: Mar'l: <br /> <br />B~x(eS), ~ Distri~tio,; [ ] Drop / [~ Concrete; [ ] Plastic <br /> <br />Drs~f~eld P~pes Size: ; ~te~al: Header: ;Perf:__ <br /> <br />~ Dept~, Minimum:~; Maximum:~; Curtain Drain Depth: <br /> <br />B£fluent Pu~s ~ ~el: . ; Static Head in System: <br /> <br /> ~ ~cle Time: ; ~llo~.per ~cie:__ <br />At~ ~ a~t~l .beet for c~tm '~ mt~al~ ~t 1imt~ ~. <br /> <br />ft. <br /> <br /> I HEREBY CERTIFY THAT TH~ (]Iq-SITE SEWAGE <br /> <br />~ IN A~ WI~ ~ ~~S OF <br />~ P~T ~ ~ R~ OF ~ ~IRO~ <br /> <br />[ ] I ~ve tested the septic t~ ~d certify <br /> It to ~ watertight. <br /> <br />~ ~stem was f~talled ~: <br />[ ]_ ~rty ~er (pe~tee) <br />[~ Licked Sewage Dis~sal Semite <br /> <br />(please print) <br /> .,., <br /> <br /> (for Marion County use only} <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> tp~be accurate and the system is: <br /> [ ~ Approved <br /> [/] Approved with corr~ions: see inspection report. <br /> <br /> /'/ <br />as-buil~<.frm 4/95 W~ITE:Marion County; YELLOw:owner; ~F/NF~.Installer <br />MCvlS-S41 <br /> <br /> <br />