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! <br />· INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS-BUILT PLAN OF CONSTRUCTBD SYSTEM= <br /> scale: 1" = ~'' <br /> <br />North <br /> <br />(show all details and hens;one necessary to locate all cc <br /> <br />of the system in the future) <br /> <br /> INSTALLRP~ CERTIFICATION: <br /> I ~EREBy CERTIFY THAT THE ON-SITE SEWAGE <br />SYSTEM INSTALLED AT THE ABOVE ADDRESS WAS CON- <br />STRUCTED IN ACCORDANCE WITH TEE REQUIR~4ENTS OF <br />THE PERMIT AND THE RULES OF THE ENVIROI4~AL <br />QUAL3AL~TY CO~4I$SION. <br />[~" I have tested the septic tar~ and certify <br /> it to be watertight. <br /> <br />The s rem was installed by: <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 ~i~h/'~rregtJ~: seev~nspection report <br /> [ ] Denied ~ ,~ <br /> Signed: Title: Date: Z '( ~ ~ <br />as-built.frm 4/95 WHITE:Marion County; YELLOW:Owner; PINK:Installer <br /> <br /> <br />