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a <br /> iiis AfARI0NC0UMYBU1tAL4GlNSPERIOK installer) <br /> ON-SITE SEWAGESYSTEM RECORD <br /> DIVISION <br /> Ito be completed by system <br /> .141.% 555 Curt St5E/POeoc Ii500 <br /> cW°xr- Sacra OR 9730)3036 SITE ADDRESS: 741gS SU4nNy5Se forol S . .59/e" a <br /> tsa3)sts-ala <br /> PERMIT MO. 0Y-a°6114 <br /> s-BO=LT PLAN OF CONSMICTED SYSTEM: <br /> l T <br /> scale: 1° = �� f 1 <br /> 01.0 — 1601 North <br /> 8'k'X01. I <br /> C-Hz Po) <br /> D-H a lois ' .A I <br /> f-N z�e2• ;.i sea I <br /> G'h s /16' (�, wt/6r <br /> A.V " Soy 'I <br /> -. ,f; <br /> 4=to2 s i �a <br /> sa/olS 4 <br /> EI l d1 .34 <br /> S <br /> f �,,: f <br /> �G n �,se t.., arivavRy <br /> pi 22 <br /> t s^23, 44 <br /> / '-"----T-----n <br /> Ti.G-ZSo N .s <br /> ' <br /> PHI"Sas i Lis 1`� <br /> N.-K2 4 r- <br /> ( c c <br /> c is 75 19 /5\ 75 <br /> 11- eL <br /> (show all details and dimensions necessary o ocate all components of the system in the future) <br /> MGM Sg1TCRma AND gaPVCIFICATIDNAr =MMUS CZATtrleATIOLr <br /> ayetset Design sewage neve 4$0 Gallons/Day I HEREBY c2RPIFY THAT THE O.'7-SITE SEWAGE <br /> SYSTEM ItiStALLFO AT THE ABOVE ADDRESS WAS COH- <br /> septic.Teak: Sizes /800 -Marl: _God lug! (,f/ti¢/ STROCTED IN ACCORDANCE WITH THE REODIRSIIITTS OF <br /> L�*� THE PERMIT AHD THE Rums OF TEE lE IR DRIC AL <br /> nosing Tanks Site: <br /> s7� Nat'l: ("n0 Mfg: &Afi _ CWSIISSION. <br /> Effluent Sear: Size: 3rl Net'1: OTC I ithto be watertightotic tank agd certify <br /> Loxtss). I I Distribution; IirDrop / I ) Concrete: 13 Plastic s/ The system van installed by: <br /> t I Property Owner Ipernitee) <br /> Duiafield Pipe. Size: lef . ;Material: Header: : Porf:_--,^7 CM"Lieanad Sewage Disp001 Service <br /> . <br /> Tote/.Dzaiallt+ICZio4taSp: So ; Rack Deptbr o lT,n i_�;-Under-piper APq-Lieease-tSrber:— <br /> alternative grainfield MeterieL: '7 pV�VLI, Q,� . <br /> d a fl Signed: Tvr`- <br /> Trenoh Depth.ltiniruc:: Zy Z7 - Curtain/t� Drain Dayth:_ss �� Lam/ .,L' <br /> sTflnsnt Papp: Pump Kodel:�� :Stec AeSd in System Pt: Company rime: D#0efek le'e YA <br /> Peep Cycle Time:_ /0,Sift ; Gallons per Cyclo: 1 (please print) / <br /> Date: S [T <br /> //- 0 <br /> Attach am sdMitiaaal.sheet for end aateriels not listed shove. <br /> (for Marian County use oniy) <br /> The above septic system has been inspected by Clarion County. Tho information has been determined to be accurate and <br /> the system is: <br /> IN Appro <br /> Appro ed with o .ons: see inspection report <br /> ( l Deni-• <br /> f `` <br /> Signed: ,.` � Title: Date: LV <br /> ;C: S-41 WHITE:Marion County; YELLOW:O-sner: PINK:Installer <br /> ev: 8/00,6/01 <br />