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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> ; PERMIT N0.~O'2V~b <br /> <br />AS-BU~L~ BLAN OF CONSTRUCTED SYSTEM: <br /> <br />No=.th <br /> <br />(show all <br /> <br />to locate all components of the system 'in the future) <br /> <br />~o~, ~ xen~, Siz <br /> <br />~(as}, [ ]: D[stribu~k~n; ~ Drop / ~. [ ]:/~lastic <br />~a~lold P~, Size: ; hter~al: Heade~f ~', ; "Parr: <br /> <br />I~flu~ ~, ~ ~del: -- ; Static Head in S~tem: ~ f=. <br /> ~ ~cle Time: ~ ; Gallo~ per ~cle: ~ <br /> <br /> INSTA~ CI~TIFICATIO~': <br /> <br /> I ~ve tested ~he septic t~ and certify <br />"'~ It to ~ watertight. <br /> <br /> ~st'em was i~alled by: <br /> ~rty ~er (petites) <br /> Sewage Dis~sml Se~lce <br /> <br />(please <br /> <br /> (for Marion County use only) <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 ~h corr~ct~on~: se~ report <br /> <br /> Signed: ~ '~ f;/l~,l'~:~ Title: Date: <br />aslbuilt.frm 4/95 WHITE:Marion County; YELLOW:Owner; PINK:Inst~ller <br />MC-15-S41 <br /> <br /> <br />