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SITE~%DDRESS: <br /> <br />INDLVIDUAL ON- SITS' SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS-BVILT PLAN OF CONSTRUCTED ~XSTEM: <br /> <br /> SCA <br />/ <br /> <br />(show all details and dimensions necessary to locate all components of the system in the <br /> <br />Smp~ Tank: Size: J ~1'0~:~ Mar'l: Mfg: INSTAL~ED AT TH~ ABOVE ~DDRESS ~A~ CON- <br /> S~UCTED IN ACCORDANCE WITH THE REQUIHEM~NTS OF <br /> <br /> 5/" <br /> <br />Distribution; [ ] Drop / ~ Concrete; [ ] Plastic <br /> <br />1= to be watertight. <br /> <br /> (for Mar&on County use only)' <br />The above septic sysuem has been inspected by Msrion County· The information has been determined <br />~o be accuraDe and the sysuem is: <br />[ ] Approved <br />[ ] Approved with corrections: see inspection reporu <br />[ ] Denied <br /> <br />Il. Signed: <br />as-built.frm 4~95 <br />MC-15-S41 <br /> <br />Title: Date: <br /> WHITE:Marion COunty; YELLOW:Owner; <br /> <br />PINK:Installer <br /> <br /> <br />