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OREGON ON-linE 8;~WAGE S~STEM <br /> SEPTIC TAN~ PUM~IN(; AND INSPECTION FORM <br /> <br />carefully. <br /> <br />requirements apply to the evaluation of an existing on-site <br />Please ~elect the appropriate section and follow the directions <br /> <br />If your sewage system is less than five (5) years old and a Certificate <br />of Satisfactory Completion has been issued for the system, the septic <br />tank does uot require pumping at this time. <br />a. AuthorizatLon Notices do not require a field inspection of the <br /> system. A report.can be issued based on a review of our files. <br />b. Existing System Evaluations d~o require a field inspection of the <br /> entire system and a report will be issued. <br /> <br /> Stay,on, <br />COMPANY NAME: Septic Services <br /> <br />PROPERTY OWNER: <br /> <br />PaOEEPTY AEO~ESS: 520 Highw. ay 22 <br /> <br /> Detroit, Oregou <br /> <br />If your sewage system is ~ore than ~.ive (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 eot 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 />¢. Authorization Notices and Existing System Evaluations require a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> Mill City &*~8~pumPer use only* <br /> D.E.Q. LICENSE #: 34916 <br /> <br />APPROXIMATE SIZE OF TANK: ~.0©© gallons <br />SEPTIC TANK MATERIAL: Concrete... ; Steel X_~_; Other__ <br /> <br /> IS TANK IN GOOD CONDITION? ............. Yes X <br /> ~; No <br /> <br /> If "No", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes X ..; No <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes ; NO..~/ <br /> if "Yes", explain: <br /> <br />DIAGRA/4 OF MOUSE AND SEPTIC TANK; (show de,ail with measurements) <br /> <br />i503) 58,5-5147 <br /> <br />,^~ (503) 588-7948 ~20 Hish ~,, NI · Salem, OR 9730]-3670 <br /> <br /> 6/28/94 <br />DATE OF PUMPING <br /> <br /> ~ MCi 5-S19 <br /> REV 1/93 <br /> <br /> <br />