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Marion County site # ~ __ <br /> OREGON ON-SIT~ SEWAGE SYSTBM , ,.,~',~ <br /> <br /> of satisfactory completien has been issued ~0r the system, the <br /> <br /> ~the <br /> <br /> b. Existing System Evaluations d__o ~equire a field inspection of the <br /> <br />2. If your sewage syste~ is more than five (~) year.~ old and the septic <br /> tank has not been pumped within the last five (5) years, follow the <br /> <br /> within the last fiv~ (5) years, section (a) will not be required. <br /> <br /> field inspection to verify the location and condition of the <br /> <br /> Stayton, Mill City & Silverton <br />COMPANY NAME: Ceptic Se_~ices D.B.Q. LICENSE ~: 34916 <br /> <br />PROPERTY OWNER: t~ob~/t & Kathervn <br />PROPERTY ADDRESS: 1067 Stayton <br /> Aumsville, Oregon 97325 <br /> <br />APPROXI~LATE SIZE OF TANK: 500 <br /> <br />SEPTIC TANK ~TERIAL: Concrete .... ; SteelX; <br />IS TANK IN G~K)D CONDITION? ............. Yes X <br /> <br />.gallons <br /> <br />Other <br /> <br />; No <br /> <br /> If "NO", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes ; NO X <br /> <br />IS DISPOSAL FIELD BACKING INTO TA/~K? ... Yes__; No ~ <br /> <br />HAS BAD INLET BA~'r'kE <br /> AND LID <br /> <br />If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> N <br /> <br />(503) 588-5147 Senato~ Building <br />r^x (503) 588-7948 2~0 High St, NE - Salem, OR 97301-3670 <br /> <br /> June 25, 1990 <br />DATE OF PUMPING <br /> <br /> F ~MPER/ <br /> <br /> MC15-S19 <br /> REV 1/93 <br /> <br /> <br />