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rion :~N-SITE SEWAGE' SysTEM <br />OREGON sz~TIc Tram pu~mzxa ~ Z~s~Z~OX ~o~ <br />The fo~o~L~ ~en~s apply ~o ~he evaLuatiOn of an ~LS~:~ q <br />se~aqe ~Y~, ~leg~ ~elec~ ~he approp~a:e section and fo~o~ ~he ~irec~Lo~s <br />carefully, ~ <br /> <br /> 1, ~ ~our eewage eyre:em ~s ~e~ =ban five (5) years .o~d an0 a <br /> C~lficate of Sauiefac=ory compleuiO~ ~as been issu~ for <br /> ~v~em~ %he septic tank does not re,ire pumping a% %h%s u~me. <br /> ~e[d inspectkon will 5e made of the entire system aflo a report <br /> wfl~ be issued. <br /> <br />"""" 2. ~f your sewag6 system ~s more ~han five ~5) years o~d 9no the <br /> SSp~IO tank has not been pumped w~thin ~he ~as~ five {5) years. <br /> ~O~ow ~he d~rec~lons below. If you have proof =ha~ =he septic <br /> ~ank has been pumped within tnt kas% five (5) years, seotions {ap <br /> an~,-(~) will no~ bS red,red. <br /> a, The septlo tank taus& be pumped Dy a D.E.Q. licensed septic <br /> b. The septic tank pumper musu complete =he [orm Oe~ow. <br /> c. A 'fi.eld i~s~ctio9 wk~l De re, ired by our on-sl~e staff <br /> verify =h~ ~oca=ion and' condition of the septic System. <br /> <br /> *for septic pumper use only' <br /> (please print) <br /> <br />PROPERTY <br /> <br />APPROXIMAT~ SI~E OF TANK: ~O~ gallDns <br />SEPTIC T~K ~TERI~: Concrete~.; Steel _; Other Yes <br /> <br /> ~ IN~ET R OUTLET FITTINGS IN p~CE? · <br /> IS DIS~O~ ~IELD ~AOKIN~ INTO T~K? ... <br /> <br /> DIAG~ D~ HOUS~ ~D SEPTIC T~K. (Show de~ai/ with,measuremonZs)~e~ <br /> <br />~,~ MC15-S19 <br /> <br /> ~natof Building, 2nd Floor <br />r~t~3~, ...~ B 8 -,ql 4 7~,*~ -~,-,~, .......... <br /> <br />DAT'~ 9F ~UMpING <br /> <br /> <br />