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Marion County <br /> <br />ORI~GON <br /> <br />The following <br />sewaqe system. <br />carefully. <br /> <br /> site #; <br /> <br />req~irement~ apply to the evaluation of an existing <br /> select the appropriate ~ection and follow the directionz <br /> <br />COMPANY NA~LE: Septic Services <br /> <br />PROPERTY OWNER: Evelyn & Desmond Pusen <br /> <br />PROPERTY ADDRESS: 9284 Golf Club Road <br /> <br />If your eewage system is less 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 require a field inspection of the <br /> system. A report can be issued based On a review of our files. <br /> Existing System Evaluations d__o re~ire a field inspection of the <br /> entire system and a report will be issued. <br /> <br />If your sewage system is more than 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 the last five (5) years, section (a) will not be required. <br />a. The septic tank must be pumped by a D.E.Q. licensed septic tank <br /> pumper. <br />b. The septic sank pumper must complete the form below. <br />c. Authorization Notices and Existing System Evaluations require a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> *for seeptic pumper use only" <br /> Stayton, Mill C~lty ~ $ilverton <br /> D.E.Q. LICENSE #: <br /> <br /> Aumsville, <br /> <br />APPROXI~iATE SIZE OF TANK: 1000 <br /> <br /> 97325 <br /> <br /> gallons <br /> <br /> ; Other__ <br /> <br /> x ; <br /> <br />__; No <br /> <br />Ore~on <br /> <br />SEPTIC T~NK M3~TERIAL: Concrete_~; Steel <br /> <br />IS TANK IN C~DOD CONDITION? ............. Yes <br /> <br /> If "NO", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes <br />IS DISPOSAL FIELD SACKING INTO TANK? ... Yes <br /> <br />DIAGR)kM OF ROUSE AND $~PTIC TANK= (show detail wi=h measurements) <br /> <br /> 10/22/93 <br />DATE o~ PUMPING <br /> <br /> MC1 ';-S19 <br /> REV I/93 <br /> <br />~^~ (503} 588-7948 220 High SL N[ - ~alem, OR 97~01-3670 <br /> <br /> <br />