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~larionCoun£,g sit, ~:_ <br /> <br />Tho following <br />carefully. <br /> <br />reqUirements apply ~o =he evaluation of an eMisting on-siTe <br />Pleas~ select th~ apprOpriaTe sec=ion and follow thc di=e0~ions <br /> <br /> stayton, Mill City & $~ver~on <br /> COMP~NY NAME:. Sep~ Services i <br /> <br /> PROPERTY OWNER- Dillard Montgomery <br /> <br /> maopEaTx ADDRES$=. 9453 Per,er Road, <br /> <br /> :-~' Aumsville, Ore. os <br /> <br /> APPROXIMATE SIZE OF TANK~ 500 gallons <br /> <br /> SEPTIC TAME MATERIAL: Concrete X ; Ste~i~; other .. <br /> <br /> ~S TAI~K IN GOOD CONDITION? ............. Xes X ; NO. <br /> If "No", e~p~ain:_. . · ~ ..... <br /> <br />ARE INL£T & OUTLET YITTIN~S IN PLA~E? .. Yes__ ; <br /> <br />IS D~$POSAL PI~LD SACKIN~ ~NTO TANK? ... Yes__ ; <br /> <br />DIAGPJ~4 OF ~OUSR AND SEPTIC TANK: <br /> <br />of Satisfactory CompletiOn has been issued fo~ th~ system, the septic <br />~ank does ~et require pumping at This ~ime. <br /> AuthorizaTio~ Notices ~ono~ requi~e a field inspection of the <br /> SyStem. A report can be issued bas~ ~n a r~view of ou~ fi~es. <br />b. Ex%sTing SysTem Svalua~lons ~o require a fiel~ inspection Of the <br /> entire system and a report will be is,ued. <br /> <br />If your sewage system is mO=~ than five {5) years old and the septic <br />tank has not been pum~e~ within the last five (5} years, fol~ow the <br />directiens b~low. If you have proof tha~ the septic tank has been pumped <br />within The last five (5) years, section (a) will not be requi~ed. <br />a. The septic tank mu~t be pumped by a .D.~.Q. licensed septic ~ank <br /> <br />b. The septic ~a~k pumper must =Qmpl~e the fO~m below. <br /> <br /> field inspection ~O verify the lo~ati~ and ~ondi%ion of <br /> sep~iO system. <br /> <br />D.t.Q. LICENS~ ~: 3491~ ~ <br /> <br /> No X <br /> <br />(shOw de,ail with measurements) <br /> <br />503) S88-5147 ~,eni,o, Buildinl~ <br /> <br /> At time of pumping <br />__ Inlet baffle was ~issin. <br /> <br />DATE OF PUMPING <br /> <br />MCIt-S~9 <br />REV i/93 <br /> <br /> <br />