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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br /> 70 ~13 ~,'~1 ~. ~D, ~u,'lla .~,~ ~r NO. ~' <br /> / <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> <br /> FEB <br /> <br /> MARION COUNTY <br />J~LOIN(~ INSPSCTION <br /> <br />~ X <br /> <br />North <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />[ ] Drop / [ ] Concrete; [ ] Plastic <br /> <br /> ,; Ro~k Depth: Total: ; Under pipe: <br /> <br />; ~aximum: ; Curtain Drain Depth:.__ <br /> <br />~ Model:~O~~', Static ~ead in Syste~: ~ ft. <br /> <br />Pump Cycle Time: ; Gallons Der Cycle: ,~ <br /> <br />[ ] Property Owner (permitea) <br />Signed:~~9~~~icensed Sewage Disposal~ice <br />(please print) <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The infoITnation has been determined <br /> to be accurate and the system is: <br /> [~ Approved <br /> Approved with corrections: see inspection report <br /> Denied ~ /%~ ~ . ~ ~ ~ <br /> ,i~ed~ .~y ~'~'g~ Title~' ~ Date: / / <br />as-built.fm 4/95 J WHITE:Marion County; YELLOW:Owner; PINK:Installer <br />MC-15-S41 <br /> <br /> <br />