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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ' ~ (to be completed by system installer) <br /> <br />AS-BUILT PLA~ OF CONSTRUCTED SYSTEM: <br /> <br />scale: 1" = ' <br /> <br /> North <br /> <br />BUILDING INSPECTION <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />Box(es}: [ ] Distribution; ~ Drop / [~ Concrete; [ ] Plastic <br /> <br />Dratnfield P~pe: Size: ~;I 4 <br /> I' <br />T.e~ch Dept~: Minimum: =4 ; Maximum: 30 ; Curtain Drain Depth: <br /> <br /> INSTAL&ERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE <br />SYSTEM INSTALLED AT THE ABO~E ADDRESS WAS CON- <br />STRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF <br />]!HE PERMIT AND TNE RULES OF THE ENVIRONMENTAL <br />Q~UA~ITy COMMISSION. <br />[%~' 'I have teared'the septic tank and certify - <br /> it to be watertight. <br /> <br />The system was installed by: <br />~ ~ Property Owner (permitee) <br />~-~'Licensed Sewage Disposal Service <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> t.ofbe accurate and the system is: <br /> [gQ Approved/~ <br /> [ ] Approved/w~hF~orl/~c~q~s: s~ inspection report <br /> <br /> Signed: Title: Date: ' <br />as-built.frm 4/95 W/4ITE:Marion County; YELLOW:Owner; PINK:Inst~ller <br />MC-15-S41 <br /> <br /> <br />