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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS,BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> <br />North <br /> <br />FIL £ <br /> <br />(Dhow all details and dimensions necessary to locate all co~ <br /> <br />Sys=e~ Des~ Sewage Flow: ~O Gallons/Day <br />S.~t:L. ~,,.~, size: /~' ~at'i: <br /> <br />DOS~ T~: Size: <br />· fflu~t S~r: Size: ~'~ Mdt'l: ~V~ <br /> <br />~(eS): [ ] Distribution; [ ] Drop / [ ] Concrete; [ ] Plastic <br /> <br />Drainfield Pipe: Size: ~'f ; Sa~erial: Header: ~"P~, Perf: ~'~ %~ <br />To~l Dra~nfimld F:~t&,e.~ ~: R~ck Dep=h: Tota~; Under pipe: ~/~ <br />Trench De~t~: Minimum: ;%"; Maximum: ~": C~rtain Drain Depth: N <br />D~Zl~nt Pu~: PU~ Model:~9~5 ~ Static Dead in System; .~ Ft. <br /> Pump Cycle Time: ~ ; Gallons per Cycle: ~' <br /> <br />)onents of the ,~stem in the future) <br /> <br />SYSTEM INSTA~ES AT TDE ABOVE ADDRSSS WAS CON- <br />STRUC~D IN ACCORDANCE WITH THE RSQUIRSM~NTS OF <br />T~E PERMIT AN~ THE RULES OF TDE ENVIRONMENTAL <br /> <br />[~ I have tested ~he septic tank and certify <br /> it to be watertight. <br /> <br />The system was installed by: <br />[]~] roperty Owner (permitee) <br />[~Licensed Sewage Uisposal Service <br /> <br /> Date: <br /> <br /> (for 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 /> the system is: <br /> [ ] Approved <br /> Approved with Corrections: see inspection report <br /> <br />MC~5-S-41 ~ <br />Rev 4/98 <br /> <br />W~ITE:Marion County; YELLOW:Owner~ PIN~: Installer <br /> <br /> <br />