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.-stt. INDIVID-UAL ON-•S ITE SEWAGE SYSTEM RECORD $'�7 gS :g <br /> ♦ i <br /> (to be completed bysye3teln installer) <br /> SITE AppRESS=- . `1 i �P.'n -/ / '. f'c�-1 .PERMIT NO.. <br /> AS-BUILT PLMN .OF -CONSTRilCTED SYSTEM: , ` <br /> • <br /> scale: i1" Sa . ' . North <br /> 000% <br /> T • <br /> l . . <br /> -- F 1 LE <br /> , , <br /> (show all details and dimensions: necessary to locate all components. of the system. in the future) <br /> SYSTmt"MATISIALS'AND=SPACI7ICATIOBS: DTSTALLssi.CYSTIFICATIUM, <br /> t I HERBBT CBRT1FY TEAT THE OK-SITE SEWAGE <br /> Septic Tank: Size:: TPA"( Nat'1': t!Orkt, 0.6. Nig; l..t)/f.i t STRUM INST11tdan AT nit um ss.,waS eOD1- <br /> ie ' STRUM) IK,accoa mit THE ftliQUIW F <br /> Dosing Tank: size: Mat'1: ,' - Nfgi - 'lits rM01 T.7O+.THE I Mx!Or'•lift`A .• <br /> it <br /> f - QUALITY =MISSION, <br /> iffluant:.S. .c' Size; Mat'1: IIC.in CIQ I have tested the septic tank and certify <br /> it to be watertight. <br /> Aosies)s 1 Distribution: 11' Drop / 0 ConCrete: t l Plastic <br /> i. : L'r r ^��a Ite system 's installed by: <br /> Drainild rip. Size: 7 r llat.rialr Reader: t Perti oe 7 I I Property-owner (peswitee) <br /> r�i (7Y Licensee! Sewage Disposal Service. <br /> Total Drainfi.ld Tootles: : O :. flock Depths Total:ia,_: Snider.pipe s5 <br /> Trench Depth: Miniwnem: 1 8 Maximum 2 : curtain'Drain Depths. Signed/% ~ . <br /> »+1 1 <br /> Weipant pup, plan, Model:ii�! .t r-4 : Static Read in Systems 5 tt.. many Mine ebei.L�h Cel aef,n:. <br /> (please print) ' <br /> Iin <br /> Poop Cycle Time: .:. SSSS<<t.tialions per Cycles 9a.?S <br /> Attach an additional:abeam or components and.materials pot listed' above. �` Date:: A2,---... 0-94• - <br /> (for Marion County uo. only) - <br /> The above septic system has been inspected by Marion. County. The information has 'been determined <br /> to. be accurate and the system is: <br /> I rApproved <br /> Approved with corrections: see inspection report <br /> O Deie� 0, �' • tl j f r <br /> Title-.,:..coi'. .. '..e`i Lad/ - <br /> fg <br /> Si-ne•r _ Date• — —__.. <br /> ... SJNITR-t:1Jar.:eti "a atnhv,.•. V51.1ust.".wn�...-.ottdet-.Tr,.I. :1rr• <br /> at=•ult:. ]Cm 4!"95 <br />