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SEPTIC TANK P~/~ING AND INSPE~ION FORM <br /> <br />The following requiremente apply to the evalua%ion of an existin~ en~ite <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />10 If your sewage system is l~s than five ~ old and & <br /> of Satisfactory completion has been issued for the system, the <br /> tank does not require pumping at this time. <br /> a. Authorization Notices do no__t require a field inspection of the <br /> mystem. A ~eport ~an be issued base~ on a review of our files. <br /> b, ~xi~ting System Zvalustions do require a field inspection of the <br /> en~i~e system and a report will be issued. <br /> <br /> If your sewage ~ys=em is ~n five ~ears old and the septic <br /> tank ha~ ~ot been pumped within the last five (5) years, follow =he <br /> directions below. If you have proof that ~he septi~ tank ha~ been pumped <br /> within the las% five (~) yea=s., section (a) will not be required. <br /> s. The ~epti¢ tank must be pumped by a D.E,Q. licensed septic tank <br /> p~mper. <br /> D- The septic ~ank pumper must o0mplete the form below. <br /> <br /> field ins~G~iQn =o we'rify the location a~d oondition of the <br /> septic system. <br /> <br /> S%ayton/Mill C~ty <br />comPlY N~: S, eptic Service~ D.S.Q. LIO~N~ ~: 34916 <br />PROPERTY OWNER: W.R. Luallin <br />PROPERTY ~D~SS: 8832 Holmquist <br /> <br />Aumsville, 0r~gon <br /> <br />APPROXIMAT~ SIZ~- OF TANK: 1000 <br /> <br />.gallons <br /> <br />~EPTIC TANK M3%TERIAL: concre:e <br /> <br />~S TANK IN GOOD CONDITION? <br /> <br /> If "No", e~plain: <br /> <br />AR~ INLET & OUTLET ~ITTINGS IN ~LAC~? .. Yes X ; No. <br /> <br />IS DISPOSAL FIELD ~ACKING INTO TANK? ... Yes ; N~... X <br /> If "~s", explain: <br />DIAGRAM OF HOUSE AND SEPTIC TANK: <br /> <br /> N <br /> <br />(~how detail with measurements} <br /> <br />~,-:=,.,, ..... <br />588-5147 SenatOr ~ulldio$ <br />(503) 588-7948 220 High 5~, NE · S,leto. OR 97~1-~70 <br /> <br />RECEIVE[I <br /> <br /> JUL 0 7 <br />i~1ARION COUNTY <br />BUILDING INSPECTION <br /> <br /> <br />