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!INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />A~-BUILT PLAN OP CONSTRUCTED SYSTEM: <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />Effluene Eew~r: Size:___~_~__ Mst'l:__ <br /> <br />Eox(es}: [~ Distribution; [ ] Drop / [~ Concrete; [ ] Plastic <br />Drlin£ield Pipe: Size:__~___; Maker,&l: ~eader: ~ ; Pe~f:~v~ <br /> , ~" <br />Total D=ai~f~e~4 Foota~e, ~7~ ; ~k D~ Total: ~Z" ; ~der pipe:__ <br /> 2 ' <br /> <br /> Pump ~cle Time: ~I/A ~ ; Gallons per ~cle:~ <br /> <br />HEREBY CERTIFY THAT TH~ ON-SITE SEWAGE <br />system was installed by: <br /> <br />Company name:~c <br />(please print) <br /> <br /> (for ~ion County uss only) <br /> The above septic system has been inspected by Marion County. The information has <br /> the syste~ is: <br /> [ ] Approved <br /> [ ] Approved with corrections: see inspection report <br /> [ ] Denied <br /> <br /> Signed:-- <br /> <br />Rev 4/98 <br /> <br /> and <br /> <br />Title :__ O~ <br /> WHITE:Marion County; <br /> <br /> <br />