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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> . ~ (tO be completed by system i~ler) ~ <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> <br />scale: 1" = 50' <br /> <br />sho~ <br /> <br />North <br /> <br />all details and dimensioL A~a~lo~ate all components of the system in the future) <br /> <br /> SYSTEM MATERIltLS AND SPECIFICATIONS: <br /> <br />Doling Tazuk.- Size: Mat' 1: Mfs: <br />Ef£1uent S~w~r: Size: Mat' 1: <br /> <br />Box(es): [~'~Distribution; [ ] Drop / [ ] Concrete; [ ] Plastic <br /> <br /> ; Under pipe:~ <br /> <br />Tr~ D.p~, Minimum: ~¢ Il ¢0 /1 <br /> ; Maximum: . _ ; ~rtain Drain Depth:__ <br /> <br />Efflu~t ~: ~mp Model: ; Static Head in System: ft. <br /> <br /> ~mp ~cle Time: ; Gallons per ~cle: <br />A~ta~ ~ add~tio~l sheet for c~on~ts ~d ~terials not liste~ <br /> <br /> INSTALL~I~S CERTIFICATION.' <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE <br />SYSTEM INSTALLED AT THE ABOVE ADDRESS WAS CON- <br />STRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF <br />THE PERMIT AND T~E RULES OF THE ENVIRONMENTAL <br />QU~_.~ C0~94ISS ION. <br />[~' I have tested the septic tank and certify <br /> it to be watert, ight. <br /> <br />The system ' s lled~: <br />[ ] P~mperty Owner (perraitee) <br />[ ~]-'Licensed Sewage Disposal Service <br /> <br />(please print) <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> ]-be accurate and the system is: <br /> Approved <br /> Approved with ~rections: see inspection report <br /> <br /> Signe .d~_/~-~ [ ~ {I ~ Title Date: 9__ <br />~s-built.frm 4/95 ¥ WHITE:Marion County; YELLOW:Owner; PINK:Installer <br />MC-15-S41 <br /> <br /> <br />