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SITE ADDRESS: <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be ¢~pleted b,y system installer) <br /> ['fo q'~' £4 Z)c-l~.~ OF/ , ~,~= Mo. qq-~'.~? <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYST~: <br /> <br />scale: <br /> <br /> ! <br />North <br /> <br />(Show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />m~flue~at Sewer: Size:___/~_~_ Mat'l:~ <br />Dra~n£ield P~pe: Size:~__; Mm=erial: HeaderS; Perf:~ <br />T~h D~: Mini~m:~; ~xi~m:~; ~rtain Drain Depgh:~ <br /> <br />The system was installed by: <br />[ ] Property Owner (permitee) <br />W Licensed Sewage Disposal Service <br /> <br />(please print) <br /> <br /> (for Marion County use only) , ~ ---4 ' <br /> bee~ determined t <br /> The above septic system has been inspected by Marion County. The information has ~ ,o~,~ akcurate <br /> :he system is: <br /> ] Approved <br /> Approved with gor~ctions: see inspection report ~ ~ <br /> <br />MC15-S41 WHITE:Marion Countyt YELLOW:Owner/ PINK:Installer <br />Rev 4/98 <br /> <br />and <br /> <br /> <br />