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' -1 ! • <br /> 4 . <br /> . ' - . • • —.7.4,.....-.:.-..... .......:-.-7- . -• • -• . . . . . - <br /> . . <br />,.., . <br /> 6INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> - . <br /> . (to be completed by system installer) <br /> - • . <br /> • SITE ADDRESS: gs iii iiipety. / ti-0Y Lay SE IL ; PERMIT NO. 91-0 g w c <br /> • <br /> • <br /> 1 . • <br /> AS-BUILT PLAN Q.F. CONSTRUCTED SYSTEM: <br /> ' ' . . . • <br /> . . . . . ....... . . <br /> t J <br /> scale: 1" - lb • . - . <br /> • . <br /> 211111111C • • <br /> • - <br /> . .. <br /> • - • , <br /> • • • • <br /> . . <br /> . • • . <br /> • • <br /> . . . . - <br /> • , <br /> , • <br /> • - '0 . <br /> • . <br /> -. •IC ." Ix . <br /> ' . 19 • ''' , LEI *,}.. • . . . <br /> ••••••• •,.. ... / It S. <br /> • • , • R. ,I, i <br /> • - . 4 7 4 ‘---------Nr;i ,k74‘' . : <br /> • % ..t or <br /> . - • <br /> • . . *._% <br /> . % • <br /> • ....„... <br /> - - • • <br /> • • <br /> - ---------------0 <br /> . , <br /> 1 liA54.1' <br /> • <br /> - • • <br /> • : <br /> - • - , <br /> • <br /> • . - . ., <br /> . , . - . • . <br /> . . . <br /> • - <br /> - . • • <br /> . ... • •• <br /> . . <br /> .. <br /> --................-4=1: - <br /> • ..e • <br /> . . . <br /> . . <br /> . . <br /> .... .. <br /> (show all details and dimensions necessary to locate all components. of the system in the. future) <br /> , . <br /> .• <br /> • <br /> . /MIMI aummvu,a ma SeeCIVICATDDIS: • , INSTALLERE CERTIFECA.TI.ON: <br /> I HERM' CERTIFY TEAT THE-ON-SITE SEWAGE <br /> • <br /> . ' Septic Tank& Size: ISM/ Nat'l: 414/416. Mfg: 449-iiii SYSTEM INSTALLED AT THE mon=DRESS WAS CON- <br /> • STRUCTED IN ACCORDANCE WITH THE-REQUIREMENTS Or <br /> Doeing.Tenk: Size: 00. Nat'l: - C..404Ce ' ' Mfg: LA,Ofleiriar THE PERMIT AND MS./IDLES OF TSB ENVIRONMENTAL <br /> 1 . - <br /> QUALITY COMMISSION. <br /> Effteent Sewers Size:. V.!L Mat31: i Ave- or I have tested the septic tank and certify <br /> it to he watertight. <br /> . • Henteld: I I DP3tributiOn; 1 ] Drop / teConcrete; [ 1 Plastic • <br /> . . <br /> 4.9i - Opiii‘e...„ The system was installed by: <br /> Dreinfield Pipe; Sizek, At° ; Material: Header:£1 Perf: I ] Property Owner (permitee) . . <br /> .,=„1 pipe: toes. ' parLicensed Sewage Disposal Service <br /> • <br /> . , Total.Ds'sinfield FOotagez 4 I Tow. ; Rock Depth: Total: /XI; Under • . <br /> Trench Depth: Minimum: ;Ate; Maximum: /4j1 ; Curtain Drain Depth: , Signed:Z.:40"„,...,dedlt°-',6/1 * •' <br /> • <br /> " 4. g Nil <br /> • <br /> Effluent Sov <br /> Ps Pump Model: erla44 Static Head in System: IP). It. Company name: 14F7701 Aten0/50970411, <br /> . • . . (please print) <br /> • • . Pump Cycle Time: I-AM 1 Gallons-per Cycle: 70 . • <br /> Attach en additional abase for coaPonente and material:: not listed above. • Date: 7— <br /> • <br /> • • <br /> . • . . <br /> — . . <br /> . • • . <br /> . - (for Marion County use only) <br /> • The above septic system has been inspected by Marion County. The inf a o has en determined • ; <br /> , . to be accurate and the system is: <br /> (10 Approved • . ' <br /> - • ] Approved with corrections: see inspection report . • . <br /> • - r ] Denied, . <br /> . . • ii <br /> • <br /> , • <br /> Signe,Ap4 . <br /> -4 of . Title' — .., . Ayr Date:S/ /4r4Lc___L___ ' <br /> ...... _ <br /> • as-btu. . rm.4/95 • ' - • -: . MHITE:Marion County; YELLOW:Owner; INK:Installer <br /> MC-15-S41. . . . - • . <br /> • <br /> . . . . . <br /> . . : <br /> . • • . • <br /> .. , • . <br /> . • • <br /> . - . . . . <br /> . . <br /> . . <br /> .. <br /> . . <br /> . , <br />