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Marion County <br />o. Eco o.-sz <br /> SEPTIC ~ANK P~M~ING AN~ INSPECTION FORM <br /> <br />The following requirements apply to the evaluation of an existing on-site <br />sewage system4 Please select the appropriate section and follow the directions <br />carefully. <br /> <br />If your sewage system is less than five (5) ¥pars old and a Certificate <br />of Satisfactory Completion has been issued for the system, the septic <br />tank does ~ot require pumping at this time. <br />a. Authorization Notices do not require a ~ield inspection of the <br /> system. A report can be issued based on a review of Our files. <br />b. Existing System ~valpat~ons d__o require a field inspection of the <br /> entire system and a report will be issued. <br /> <br />COMPANY Nk~E:__..M4k~ SeQt{C <br /> <br />If your sewage system is more thaD five (5) years old and the septic <br />tank has not been pumped within the last five (5) years, follow the <br />directions below. If you have proof that the septic tank has been pumped <br />within the last five (5) years, section {a) will no= be required. <br />a. The septic tank must be pumped by a D.E.Q. licensed septic tank <br /> pumper. <br />b. The septic tank pumper must complete the form below. <br />o. Authorization Notices and Existing System Evaluations require a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> *for septic pumper use only* <br /> <br /> Service Inc. D.E.Q. LICENSE #:.,.33519-P <br /> <br />PROPERTY ADDRESS: 7997 ~t~n~]d Ct. Aumsv~]]e 0~. <br /> <br />APPROXIMATE SIZE OF TANK: /~00 gallons <br />SEPTIC TANK MATERIAL: Concrete ~; Steel ~; Other <br /> <br />IS TANK IN GOOD COND%TION? ............. Yes .~ ; NO <br /> <br /> If "NO", explain: <br /> <br />AR~ INLET & OUTLET FITTINGS IN PLACF? .. Yes__~ ; No <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes ; No ~ .. <br /> <br />If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: <br /> N <br /> <br />(show detail with measurements) <br /> <br />}03) 588-5147 se~to~ ~ui~di.g <br />,(q(Iq% ~RR-Yq~,q 220Hi~,h St. N~E · Salem, OR 97301-~670 <br /> <br /> MAfllON COUNTy <br /> ~UILDItIG II~PECTiON <br /> <br /> Sepge~be~ 21, 1990 <br /> DATE OF PUMPING <br /> <br /> ~-?"~¢ l~ / ~' ""'" ' <br /> //~.:~. _.~' ' .~'.,~ '~ '1 '~% <br /> ..-/ .... <br /> S IGNATUR~ OP <br /> <br />.... / ~9 ~ ,'~' ~' ~ /',./, '~Z~' ~. <br /> <br /> <br />