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Klickitat County On‐Site Sewage System As‐Built Record Property Owner: Tax Parcel Number: Phone Number: Installer: Site Address: Mailing Address: Dwelling InformaƟon Number of Bedrooms in Primary Residence AddiƟonal Number of Bedrooms Total Number of Bedrooms Maximum Gallons Per Day + = System Details SepƟc Tank Manufacturer: Capacity: Material: Pump Tank (if any) Manufacturer: Capacity: Material: Drainfield Type Gravity Pressure Trench Type: Model/Material : Width of Trench: Distance between Trenches: VerƟcal SeparaƟon: Total Linear Feet: Orifice InformaƟon (if any) Size of Orifices: # of Laterals: # of Orifices: Provide well, building, and property line setbacks in your drawing below. Installers I cerƟfy that the informaƟon and the drawing above are true and accurate, and that the onsite sewage system was installed according to the permit requirements.