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'~ INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> {to be completed by system installer) <br /> <br />A~-BUILT PLAE OF CONSTRUCTED SYSTEM: <br /> <br />scale: 1" = ' <br /> <br />_5y$ · <br /> <br />North <br /> <br />(show all details and dimensions necessary to locate all co~ <br /> <br />Hox(es) l ~Di~tribution; [ ] Drop / ~Concrete; <br /> <br />[ ] Plastic <br /> <br />TEfaX Drainfield ?ootage=~9; ~ock Depth: Total:*[*~; Under pipe:l <br /> <br />~onents of the system in the future) <br /> HEREBY CERTIFY THAT T~E ON-SITE S~WAGE <br /> <br /> I have tested the septic tank and certify <br /> DEQ bicense Nu~er: ~7 ~& <br /> <br /> (£or Marion County use only) <br />The above septic system has been inspected by Marion County. The information has been determined to be accurate and <br /> is: <br /> <br /> see inspection report <br /> [ ] Deni ~ <br /> Title~~ Date:. <br />MC15~S41 WHITE:Marion County; yELLOW:Owner; <br />Rev 4/98 <br /> <br /> <br />