Laserfiche WebLink
APR--I~--9~ TUE 09:05 PM S~v~onSeP~ i¢~¢onssru¢~n $0~ 769 $892 P.02 <br /> <br />SITE ADDRESS <br /> <br />AS-BUILT P O <br /> <br />±I m£VIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> <br /> North <br /> <br />(show all d dimensions necessary to locate all components of the system in the future] <br /> <br /> SYSTEM MAT~IAL$ A~D $PECI~ICATION$~ <br /> <br />Distribution; [~ Dro~ / [ ] Concrete; [ ] ~lastic <br /> <br /> ~mp M~ei: ; Static ~ead tn Syseem: f~. <br /> ~mp ~cle TAme: . ; Oallons per ~cle; <br /> <br /> I ~./~EBY CERTIFY T~AT T~E ON-SITE <br />SYST~ ~NST~D AT ~ ~0~ ~D~SS W~ ~N- <br />S~ED IN A~ WI~ ~ REQUI~S OF <br />~ PE~IT ~ ~E R~E. OF ~ ~XRO~ <br /> <br /> I ~ve tested the septic ta~ and certify <br /> It zo be watertight. <br /> <br />The system was installed by: <br />LLropertyOwner Cpermltee) <br /> icensed Sewage Diesel Service <br /> <br />(pie se p=l ~- ....... <br /> <br /> (for Marion County use only) <br />The above septic sy~tam ha~ be~n ingpected by Marion CouB~y, Th~ 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 :. <br /> <br />Date: <br /> <br /> <br />