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Marion Co~o.t~t <br /> OREGON <br /> <br />The following requirements apply te the evaluation of an existing on-site <br />sewage symtem. Please select the aDDrop~iate section and follow the dicectio~$ <br />aarefully. <br /> <br />%f your sewage system is less tha.n five C5) vea~ old and a Certificate <br />ct' Satisfactory Compl~i~n has b~en issued fo~ ~he system, the septic <br />tank does not require pumping at this time. <br />a. Authorization Notices 49 ~ r~quire a field inspection of the <br /> <br />b. ~xi~ting System Evaluetions d_~o require a field inspeCtiOn of the <br /> entire syst~ and a re~O~ will ~ issued. <br /> <br /> 2. If youc ~wage system is mo.~e than five {~ Veers 0%~ and the septic <br /> tank has not been p~m~ed within the last five (5) years, fellow ~he <br /> directions below. If you have pmoof that the septic tank has been pumped <br /> withla the last five (~} years, section (a) will not be r~quired. <br /> a. The septic tank must be pum~d by a D.E.Q. licensed septic tank <br /> pumper. <br /> b. The smptic tank 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 /> <br />PROPERTY OWNER. /~l~ ~Z~ <br /> <br /> APPROXIMATE SIZ~ OF TANK= /~--6~O · gallons <br /> SEPTIC TANK ~EAT~RZAL: Concrete ~ ..; Steel ; Other <br /> <br /> IS TANK IN GOOD CONDITION? ............ ~!eYes ~ i NO ........ <br /> <br />AR~ INLET & OUTLET FITTINGS IN P~CE? .. Yes ~ ; NO <br /> <br />IS DISPOSAL PIELD BACKING INTO T~K? <br /> <br />DIAG~ OF HOUSE AND SEPTIC T~: (show detail with measureme~Bs) <br /> <br /> FEB 0 6 1993 <br />BUILDIN INS?ECl <br /> <br />(503) 588-5147 Sc,~,o, s~,i;d;n~ <br />~^x (503) 588-7948 220 High $~. N~ · gal*m, OR 97]01-3670 <br /> <br />DAT~ OF PUMPINO <br /> <br />REv 1/! <br /> <br /> <br />