10512764 - Laserfiche WebLink

Home Browse Search

[ I I--Ze,"- "71 • ' rcau v EXISTING SEPTIC SYSTEM DESCRIPTI ti la E9 OREGON DEC 2 4 2020 MARION COUNTY Please answer the following questions as completely as possible,and to the best of 'dIRIO NOPECTI®N 1. Yojr existing septic system�cists of(check all that apply): .2-0^��ct��G Dr Septic Tank LA Disposal Trenches 0 Capping Fill 0 Sandfilter ❑ Seepage Bed 0 Cesspool or Pit 0 Unknown ❑ Other (Describe) 2. When was your septic system installed? (Date) (PermitNumber) 3. Tank material: 0 Concrete [v"Steel 0 Plastic or Fiberglass 0 Unknown 4. Septic tank volume(in gallons) 1 0 5. When was the septic tank, last pumped? I am vzo Attach receipt if available. 6. Number of disposal trenches ii- 7. Total length of disposal trenches (in feet) GoHcoc 1e+at- 8. Do you propose to use the existing septic system? Yes ki No❑ 9. Is your septic system currently in use? Yes 0 No ll%If no, date of last use 10. If the septic system currently serves a dwelling: How many bedrooms are in the dwelling? How many people occupy the dwelling? ,,�� • 11. How many bedrooms will be in the proposed dwelling?___ _9i How many occupants? o� 12. If the septic system serves a business: How many total employees are there? Type of business 13. Is there a proposed change of use of your structure(home or business)? Yes 0 No❑ If yes,please explain 14. Provide a plot plan(sketch)on the reverse side of this form showing the best estimated or actual measurements that locate the existing septic tank and disposal trenches,property lines, easements, existing structures,driveways, and water supply.Indicate the direction of north. If you are proposing to replace the septic system,indicate the test hole location. By my signature, I certify that the above information and the plot plan on the reverse side of this form are accurate and true to the best of my knowledge. !2/2:3121:92-v fes' . ,,,,A., (bate) Signature of Property Owner or Lege ly Authorized Representative Office use only: Record of existing system: Yes 0 No 0 Attached 0 Dateissued Permit Number Certificate of Satisfactory Completion Issued: Yes❑ Nod Initials Other file information: