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• 1 . I' <br /> . . . <br /> . .. . ... <br /> . . <br /> .... <br /> . . • • - . <br /> .• . <br /> • . <br /> . •• <br /> 1 -. : ..e.-• ' , .. • ' , ., . . <br /> . . <br /> . ' .. <br /> . ' <br /> . . <br /> . . <br /> . - .• . <br /> . • .. • . <br /> INDIVIDUAL ON—SITE 8EWAGE - SYSTEM RECORD <br /> IN MASIONCOUNTYBOODINGINSSBCTION ' (to'be-completed hy system installer) <br /> DIVISION ' <br /> SIS Oak S4 NE/P0&a MOO ai 0+ c„ .i <br /> , _ ; • • • Sare.OBV/3094036. <br /> SITE, ADDRESS: if /4/6 10 f b WIWI I le NA, • <br /> . • • • (50.1,5n.sw . . <br /> • <br /> • <br /> • PERMIT NO.. 63"""10 3 V). • <br /> • <br /> . • • <br /> • . <br /> AS-WILT. PLAN OF CONSTRUCTED SYSTEMi <br /> • ....wwwwwwwww. <br /> . . . . <br /> • • •. . . <br /> . t . <br /> scale:• 111 = ' 1 . <br /> • <br /> , . • • North. Nor <br /> • . <br /> • • i • <br /> ••. . <br /> .. N. . . <br /> • • N... • . • <br /> • N.,. . Ni: . . . • . <br /> -. • <br /> • N.;--?..... <br /> .0 :441 <br /> • • N. N. . <br /> . N. N. •+.7. <br /> !... <br /> . • <br /> ' "'N •. •.. . <br /> ' • ••., 1=164 -... <br /> .. ... ... . s., <br /> . • ... • .F.F. . N N. <br /> ... . . <br /> • ... ._ * N :i . ri.../ . <br /> • •. , I <br /> . :ft-% - . iN igit . •! • <br /> e . • . .a .... :i <br /> Z 1 . <br /> . : <br /> • - . 16 . ,./ t <br /> + . <br /> . i . <br /> • ' <br /> 'WOW . • • <br /> • • • D i . . • .. . , <br /> . . .. . . <br /> . . <br /> . .. <br /> . . <br /> . . <br /> . .. . <br /> . . <br /> • , . <br /> . . . <br /> . ......____ , <br /> (show, all details and 'dimensions neces.ea to locate all cc —nents of the s stem in the future) • <br /> 17- - , - . . • • <br /> . .. prinfai:Nsentasi-asm-spzezrzcwrxews: TIISTALLIPB CIISTSTiChTIONI . . . <br /> Oramm.Design Ravagg•Ipic',. • . 41,g12 Gallone/Day I HERESY CERTIFt THAT TDB ON-BITI VIM= .• <br /> WiliTEN INOTALLBD AT THE ABOVE ADDRNS13:17.8 CON- <br /> " .higitio',tank, Sin t .PAO : Mat'1: . CO44, Mfg i km ITC - 9TRucrsr,rpi AccoRDANcuABOs THE :174 Tin THE M=LOP• <br /> •- Iles4g Teak, Sizes AA. .: . Met'l: ••-•—• Mfg: 0-- . <br /> .4:104I have tee:tee:the septio•tinft.and.c.bstify <br /> • . . sffleen t ilaWarii Size'. V ii . ' , Nat.1: .443-1 . it to be watertight, <br /> • <br /> BeleIeel i "d"Distribution; I I Drop / Ole Concrete; ( I Plastic • The aratem was installed by/ • <br /> •• , <br /> .• analefiald Pipe$ size, 4'1 ' ; lista:Jai: itsadert,freit. ; pert,OSP 41E0144 p Property.sewaegr e(flt speXgral t)Series • <br /> Total'Dreier/old rootegat 46t';.Rock DOtlii Thtal:421..tt Under pipe: dit';' DBQ Licence liumberi 2123 I%. . • <br /> • • Alternative Draintield X.atettalar•p5p .40 hizstiA Pile • <br /> Si' gned: . A 440445 . . <br /> • Trench. Depth/ minierniniAt2 l'.. ,/•mssinium.. tia''' ,/ Curtain Drain Depth/ itifel <br /> .grinimt Ptinp. Pmp u model: 164-.,2 • Static Head in system) *---- Ft. OtINiallY Tame: 40144iatliiiii. natt•.. . .6. <br /> . . • . A ' . • (please print) <br /> pimp cycle Tiaies..ip.i. • i .. / Clallone.per Cycle: ...- • ....' ..,.--1 <br /> Date. . <br /> Attach"an additional sheet fac.,,..,. :'•• •at and matariala not listed above. • <br /> wewsani _ imams.. • . <br /> .. • • <br /> • • • •• , .. • <br /> •• -• .. ' . . . . <br /> (for Marian County use only) I <br />. • • • . <br /> The roved jx,teepp septic.syetem has been inspected by Marion County. The information has. been.de,termined to be accurate and <br /> • <br /> t system is: • .. . <br /> . <br /> _,_. -i: . .- .- . . • <br /> I I Approved with correctimnj.see inspection report1:4\ . <br /> I I Denied ' •• -I. • •:'• •. • • <br /> 4440f.i;foci <br /> . ., . <br /> •." . <br /> . ..• . -. • e,--2,+.0072 <br /> . <br /> . . .. <br /> . <br /> . . . .. - Nis- <br /> Eagand1).• t.4 Tie, ''. Date; <br /> . . . <br /> .11C: S-4I . . S. • . . .':•'•' MR/TD:harion County; IETAOW:Owner; PINKtImptallor <br />