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/S <br />carefully V ~ <br /> <br />i- Zf your ~ewage ~y~em i~ L~.~ ~y~ (5) years old and a ~k~t~ <br /> <br /> a. Authorization Notices do not tequit~ a fiead in~p~c:L0n 0f th~ [~0~ <br /> <br /> entire system and a re~== will be issued. <br /> <br />2. If your sewage system is ~ore than five {5) years old an~ the ~eptic <br /> tank h~s not beer D~m~d within the last five (5) years, follow the <br /> directions below. If you ~ave proof tha: :he septic :a~X has been pumpeO <br /> within the las% five (S) years, section (a) will not be re, ired. <br /> a. The septic tank mus= be~ pum~d by a D.E.Q. licensed septic =ant <br /> <br /> c. Authorization Notices and Existing System Evaluations require a <br /> field inspection to ~erify ~he location and condition of the <br /> septic sys~e~. <br /> <br /> Stayton/Mill City & Silver,on <br /> D.E.Q. LIOENSE $: 34916 <br /> <br />Ma (On County <br /> <br />¢0M~¥ NA~E: SePtic S~rvicez <br /> <br />PROPERTY OWNER:__ Je~rv Johnson <br /> <br />PROPERTY ~D~SS= 210 p,at~on RO~ <br /> <br /> · ,',.- Detroit,, 0reqo~ <br /> <br />APPROXI~E SiZE OF <br /> <br /> 9734g .... <br />500 ........ gsl~ens <br /> <br /> ; Steel.,,X ; othe~ <br /> <br /> SEPTIC TANK MATER%AL: concrete <br /> ~$ TANK IN GOOD ~ONDITION? ............ . Yes X ; No <br /> <br /> If 'No", expiate:, <br /> <br />ARE INLZT & OUTLET FITTING~ IN PLA~? .. Ye~ ~ ; NO, <br />IS D~$POSAL FIELD BACKING INTO TANK?,,.. YeS .... ; . No ~ ,,, <br /> <br /> If "~e~", explain: <br /> <br />DIAGRAM OF ~OUSE AND ~EPTIC TANK: (show detail with measurements) <br /> <br />(503) 588-7948 .'uo )'(JSh $,, NE · ~lcm. OK 97~1-~S7O <br /> <br /> 4/26/95 <br />DATE OP PU~PING <br /> <br />SIGnATUrE OF~UMPER/ <br /> <br /> MC15-$19 <br /> REV 1/93 <br /> <br /> <br />