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P.02 <br /> <br />M~rlon Cqunty <br /> OREGON <br /> <br />SEPTIC TANK PUMPING AND INSPECTION FORM <br /> <br />The following requirements apply to the evaluation of an existing on-site <br />sewage System. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />If your sewage system is less than five (5) years old and a <br />Certificate of Satisfactory Completion has been issued for the <br />system, the septic 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 />follow the directions below. If you have proof that the septic <br />tank has been pumped within the last five (5) years, sections <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 />b. The septic tank pumper must complete the form below. <br /> A field inspection will be ~equired by our on-site staff to <br /> verify the location and condition of the septic systeM. <br /> <br />COMPANY NA~E: <br /> <br />PROPERTY OWNER: <br /> <br />PROPERTY ADDRESS: <br /> <br /> *for septic pumper use only* <br /> _ , (please prin. t) <br />S~ayton/Mill ui~y ~ Silver,on <br /> Septic Services D.E.Q. LICENSE #: 34916 <br /> <br /> James A. & Monica M..Fittlng <br /> 7928 Sherman Road, Aumsville, Oregon 97325 <br /> <br />Site #94-02157 <br /> <br />APPROXIMATE SIZE ON TANK: 1000 gallons <br /> <br />SEPTIC TANK MATERIAL: Consrete X ; Steel .; Other <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes ~ ; No <br /> <br /> If "No", explain: ,, <br /> <br />A~E INLET & OUTLET FITTINGS IN PLACE? .. Yes X ; NO__ <br /> <br />IS DISPOSAL F=ELD BACKING INTO TANK? ... Yes ..; No X <br /> <br /> If "Yes", explain= , <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br /> 6/0D/9¢ <br />~ATE OF pUMPING <br /> <br /> <br />