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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ~ ~ ~ ~ <br /> <br />scale: 1" = <br /> <br />(~ <br /> <br />North <br /> <br /> ! <br /> / <br />/ <br /> <br />F/L £ <br /> <br />all details and dimensions necessary to locate all components of the system in the future) <br /> <br /> SYSTEM M~TERZALS AND SPICIFICATIONS= <br /> <br /> Size: ; ~terial: Header: ~ ; Perf: <br /> <br /> Hini~m: ~ ; ~iaum: ~P ; ~r~ain Drain ~pCh: <br /> ~ ~del:~; Static Head in System: <br /> ~ ~cle Time: L'~ ~'b , Gallons per <br />attio~l aheet for c~n~ts ~ --terials ~t <br /> <br /> INSTALLEI~S CERTIFICATION= <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE <br />SYSTEM INSTALLED. AT THE ABOVE ADDRESS WAS CON- <br />STRUC-r~u IN ACCORDANCE WITH THE REQUIREMENTS OF <br />THE PERMIT AND THE RULES OF THE ENVIRONMENTAL <br />QUALITY CO~giISS ION. <br />[~I have tested the septic tank and certify <br /> it to be watertight. <br /> <br />p4roStem waa installed by: <br /> perrY' Owner (permitee) <br />[ ] I~icensed Sewage Disposal Service <br /> <br />(please print) <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 with corrections: see inspection report <br />S~i]gn~~F _~_~ _~ Tit le: ~~/Z~~~Date: <br /> <br />as-built.frm 4/95 WHITE:Marion County; YELLOW:Owner; PINK:Installer <br />MC-15-Sdl <br /> <br /> <br />