Laserfiche WebLink
I love Doj -'ad <br /> 0,45 <br /> CowitrJ <br /> �I <br /> EXISTING SEPTIC SYSTEM DESCRIPTION <br /> OREGON <br /> Please answer the following questions as completely as possible,and to the best of your knowledge. <br /> 1. Y ur existing septic system consists of(check all that apply): <br /> 104 Septic Tank Disposal Trenches 0 Capping Fill 0 Sandfilter <br /> ❑ Seepage Bed 0 Cesspool or Pit 0 Unknown <br /> ❑ Other (Describe) '/ <br /> 2. When was your septic system installed? LJV 4VIvwv, <br /> (Date) (PcrmitNumber) <br /> 3. Tank material: 0 Concrete I1Steel 0 Plastic or Fiberglass 0 Unknown <br /> 4. Septic tank volume(in gallons) a S 0 <br /> 5. When was the septic tank,last pumped? /Ilio/2.0 Attach receipt if available. <br /> 6. Number of disposal trenches <br /> 7. Total length of disposal trenches (in feet) LI 0 <br /> 8. Do you propose to use the existing septic system? Yes.0 No❑ <br /> 9. Is your septic system currently in use? Yes 0 No Il If no, date of last use loix born-t-t.t Vut. J ZooO <br /> 10. If the septic system currently serves a dwelling: <br /> How many bedrooms are in the dwelling? Z How many people occupy the dwelling? 2. <br /> 11. How many bedrooms will be in the proposed dwelling? 2_, How many occupants? 2. <br /> 12. If the septic system serves a business: <br /> How many total employees are there? <br /> Type of business <br /> 13. Is there a proposed change of use of your structure(home or business)? Yes 0 No <br /> If yes,please explain <br /> 14. Provide a plot plan(sketch)on the reverse side of this form showing the best estimated or actual <br /> measurements that locate the existing septic tank and disposal trenches,property lines, easements, <br /> existing structures,driveways,and water supply. Indicate the direction of north.If you are proposing to <br /> replace the septic system,indicate the test hole location. <br /> By my signature, I certify that the above information and the plot plan on the reverse side of this form are <br /> accurate and true to the best of my knowledge. <br /> ( (Date) Signature of Property Owner or Legally Authorized Representative <br /> Office use only: Record of existing system; Yes 0 No 0 Attached [] Date Issued _ <br /> OtherNumber _Certificate of Satisfactory Completion Issued: Yes❑ Nod Initials <br /> Other file information: <br /> D <br /> _ 24-003 Cc5-1-( DEC 07 2020 C<� <br /> MARION COUNTY <br /> BUILDING INSPECTION <br />