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M rion County ..... <br /> #' <br /> <br />[~1~/ EEp~TC ~m PUttiNG ra~D ~[NSP~¢T~O~ ~o~ <br /> <br /> The following requirements apply to the evaluation of an existing on-site <br /> sewage system. Please select the appropriate section and fo~low the directions <br /> carefully. <br /> <br />l. ff your sewage system is le~s than five (5) yea~ old and a Certificate <br /> Of Satisfactory Completion has been issued for the system~ the septic <br /> tank does not require pumping at this time. <br /> a. Authorization Notices do not requi~e a field inspection of the <br /> system. A report can be issued based on a review of our files. <br /> b. Existing System Evaluations d~o require a field inspection of the <br /> entire system and a report will be issued. <br /> <br />2. ~f your sewage system is mo~.9 tha9 five (5) years old and the septic <br /> tank has not been pumped within the last five (5} years, follow the <br /> directions below. If you have proof that the septic tank has been pumped <br /> within th~ last five (5) years, section (al will not be required. <br /> The septic tank must be pumped by a D.E.Q. licensed septic tank <br /> pumper. <br /> b. The septic tank Dumper must complete the form below. <br /> c, Authorization Notices and Existing System Evaluations require a <br /> field inspection to verify the location ang condition of Ehe <br /> septic system. <br /> <br />COMPANY NAME: Septic Services D.E.Q. LICENSE #: 34916 .. <br />pROPERTY OWNER:.Ca~i .~ Ruby Hofman <br /> <br />PROPERTY ADDRESS: 9242 SantiamLoop~ SE <br /> Aumsville~ Oregon 97325 <br /> <br />APpROXIMAT~ SIZE OF TANK: ~0O <br /> <br />SEPTIC TANK PL%TERIAL: Concrete X ; Steel= <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes <br /> <br /> If "NO", e~plain: <br /> <br /> gallons <br /> ; Other <br /> <br />X ~ NO <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes X~; No <br /> <br />IS DISPOSAL FIELD SACKING INTO TANK? ... Yes _; No X <br /> <br /> If "Yes", explain: <br /> <br />DIAO]~( O? ~©USE AND SEPTIC TANK: (show detail wi~h measurements) <br /> <br />(503) 588-5147 s. nato, Sui[dir, g <br />,^x (503) S88-7948 220 High st. N[ · Salem, OR 97301.3670 <br /> <br /> 9/03/93 <br />DATE OF PUMPING <br /> <br /> I"SIGN~URE OF ~UMPER <br /> MC15-S1 <br /> N~V 1/9 <br /> <br /> <br />