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SITE ADDRESS: <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYST.EM: <br /> <br /> scale: 1" = bO ' <br /> <br />(to be completed by system installer) <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> <br />North <br /> <br />,I <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />BOx(,m): [~Distribution; [ ] Drop / [~C/oConcrete; [ ] Plastic <br /> <br />Dxa~nfi.ld FootaSe, .~; ~ock Depth: Total:~]/~; Under pipe:~ <br /> Minimum: ~ ; Maximum: ~ ; Curtain Drain Depth:__ <br /> <br />The syste~ was installed by: <br />[ I Property Q~ {permitee)~//~ <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 />[ ] Denied <br /> <br />Signed: <br /> <br />Title: Date: <br /> <br />'is-built.frm 4/95 WHITE:Marion County; YELLOW:Owner; PINK:Installer <br />MC-15-S41 <br /> <br /> <br />