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Marion Couut. y <br /> <br />ORffGON <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TAh'K PDq41~ING ARD INSPECTION FORM <br /> <br />Site #: <br /> <br />The following requirements app].y to the evaluati, on of a:% existing on-site <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />If your sewage 9ystem is le~ than five (5) years old and a <br />Certificate of Satisfactory Completion has been issued for the <br />~y~tem, the fleptic tank does not require pumping at this time. A <br />field inspection will be made of the entire system and a report <br />will be issued. <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not been pumped within the last five (5) years, <br /> <br />f°ll°w thc directions below. If you have proof that the septic <br />tank has been pumped within the last five (5) years, sections (a) <br />and (b) will not be required. <br />a. The septic tank must be pumped by a D.E.Q. licensed septic <br /> tank pumper. <br /> The septic tank pumpe~ must complete the form below. <br />c. A field inspection will be required by our on-site staff to <br /> verify the location and condition of the septic system. <br /> <br /> -for septic pumper use only* <br /> i[~lr~e r t on <br /> Stayton/Mill C i [~ls~s~ int) <br />COMF;%NY NAME: Septic Services % D.E.Q. LICENSE #: 34916 <br /> <br />PROPERTY OWNER: Danny E. Bartosz <br /> <br />PROPERTY ADD9/~SS: 7276 Sherman Drive <br /> <br />Aumsville, OR 97325 <br /> <br />APPROXIMATE SIZE OF TANK:__ 1000 <br /> <br />SEPTIC TANK MAT~RI;tL; Concrete_XX.; Steel. . <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes XX ; <br /> <br /> ~f "NO", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Ye~ <br />~S DISPOSAL FIELD BACKING INTO TANK? ... Yes ; <br />~f "Yes", explain~ <br /> <br /> gallons <br />Other <br /> <br /> No_____ <br /> <br />No <br /> <br />No XX <br /> <br />DIAGR;tM OF HOUSE AND SEPTIC TANK~ (show detail with meaeurements) <br /> <br /> <br />