Laserfiche WebLink
SITE ADDRESS: <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br />,~~ ,~~~~ sy~em installer) <br /> <br />AS-BUILT PLAN O <br /> <br /> scale: 1" = ~C' ~/~ ~-~ <br /> <br />North <br /> <br />(show all details~Dd dimensions necessary to locate all components of the system in the future) <br /> <br /> SYSTEM MATERIALS A/qD SPECIFICATIONS: <br /> <br />septic ~'~:~.. size: <br /> <br />Dosing Tank.' Size: <br /> <br />Zf£1uent Sewmr: Size: Mar'l: <br /> <br />B~x(es): [ ] Distribution; [~ Drop / [ ] Concrete; [ ] Plastic <br /> <br />Tot&l Dr&infield Foot&ge:~OC~ ~J~l:__'~'~ ~ /~ ~'~ ; U~%der pipe: <br /> <br />Trench <br /> Mlnlmum <br /> <br />· ffluent Pum~: Pump Model: ~ [~ ; Static Head in System: <br /> ~mp ~cle Time: 4'~;~ ; Gallons per ~cle: <br />At~m~ ~ add~=ional sheet for c~on~ts ~ ~ter~als not liste4 <br /> <br />ft. <br /> <br /> INSTALLERS 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 THE RULES OF THE ENVIRONMENTAL <br />QUALITY CO~94ISSION. <br />[~'~I have tested the septic tank and certify <br /> it to be watertight. <br /> <br />The system was installed by: <br />[ ] _property Owner (permitee) <br />~"Licensed Sewage Dis~D. Qstal Service. __ <br /> <br /> (for Marion County use 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 />[ ] Approved <br />[ ] Approved with corrections: see inspection report <br />[ ] Denied <br /> <br />Signed: Title: Date: <br /> <br />as-built.frm 4/95 WHITE:Marion County; YELLOW:Owner; PINK:Installer <br />MC-15-S41 <br /> <br /> <br />