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'Marion County site #: <br /> OREGON ON-SITE SEWAGE SYSTEM <br /> <br />The following rec~irements apply to the evaluation of an existing on-site <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />1. If your sewage system is less than five (5) yearq old and a Certificate <br /> of Satisfactory Completion has bee~ iscued 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 /> · ystem. A report can be issued based on a review of our files. <br /> b, Existing System Evaluations do ~equire a field inspection of the <br /> entire system and a report will be issued. <br /> <br />2. If your sewage system is more ,~han 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 tank pumper must complete the form below. <br /> Authorizaticn Notices and Existing System Evaluations require a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> · ~or sgpt~o pumper ucc only* <br /> S%ayton/Mill City ~ ~llverton <br /> D.~.Q. LICgNSE ~: 34916 <br /> <br />COMPANY Nk~E: septic Services <br /> <br />PROPERTY OWNER: W.R. Luallin <br /> <br />PROPERTY ADDRESS: 8832 Holmquist <br /> <br /> · . Aumsville, Oregon <br /> <br />APPROXIMATE SIZE OF TANK: 1000 <br /> <br />SEPTIC TANK ~AT~RIAL~ Concrete X ; steel <br /> <br />~$ TANK IN GOOD CONDITION? ............. Yes <br />If "No", explain: <br /> <br /> ·gallons <br />Other <br /> <br /> NO <br /> <br />ARE INLET & OUTL~T FITTINGS IN PLACE? .. Yes X ; No <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes ; NO , X <br /> <br /> If "~es", explain: i <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK= (chow detail with meacurements} <br /> <br /> RECEIVE <br /> <br />MARION COUNT'~ <br />BUILDING INSPECTION <br /> <br /> 3/02/95 <br />DATE OF PUMPING <br /> <br />SI gATUR/ eu PB <br /> <br /> MC] 9-$i19 <br /> REV 1/93 <br /> <br />(503) 588-5147 Senator §uildia$ <br />r^x (503) 588-7948 220 High S~, NE · Salem, OR 97301-~670 <br /> <br /> <br />