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Property Owner: <br />Site Address: <br /> <br /> EXTERIOR ADDITION/ACCESSORY BUILDING <br />SITE PLAN FOR SEPTIC SYSTEM RECORD REVIEW <br /> <br />Date: <br /> <br />SITE PLAN MUST BE DRAWN TO SCALE <br /> <br /> / <br /> <br />SCALE: 1" = ~ <br /> <br />Please Show Septic tank: <br />all Details: Well: <br /> Buildings: <br /> Driveways: <br /> <br />Property Lines: Excavations: <br />Ponds & Streams: ~ ...... <br />Direction &Slope: <br /> <br />I certify that the above site plan is an accurate representation of the conditions I found oa <br />the property and accu. rately identifies the location of the septic system and proposed <br /> <br />development. <br /> <br />Signature: <br /> <br />Drawn by: <br />Name:(print) ]~/[C~x B~3f~ <br /> (licensed installer, septic consultant or owner) <br /> <br />MC15-S38 <br />REV 6/98 <br /> <br /> <br />