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Marion CountM . ~1~ ~fi~s <br /> <br />~h~ io~o~ing re~i~emenes apply ~o ~he eva~ua~ion <br />~ewage system. Please ~elect the appropriate section and follow the direction~ <br />carefuk~y. <br /> <br />1. If your sewage syste~ is i~sS than five,,, (5) veers old and a C~rtifi~ate <br /> of Satisfaotory Completion ha~ be~n issued for the system, the septic <br /> tank does no% re, ire pumping at this ti~e. <br /> a, Authorization Notices do qpt 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 ~ re~ir~ a field inspection of the <br /> en%ir~ system and a repo~t will be <br /> <br /> If your ~ewage system is mo~ than fiv~ (5) years old and the septic <br /> ~ank has not been pumped within the las% five (5) years, follow the <br /> directions below. If you hav~ proof that the septic tank haz been pumped <br /> w~thin the last five {5) years, section (a) will not be re~ired. <br /> a. The septic tank must be pumped by a D.~.Q. licensed septic tank <br /> pumper. <br /> ~. The septic tank pumper muBt <br /> Authorization Notices and Existing System Evaluatioas ~qui~e a <br /> field inspection to verify the location and condition of the <br /> septic syste~.. <br /> <br /> *for sept~o ou~r use only* <br /> Stayton/Mill C~y ~ ~lve ~on <br />COMPANY NA~: Septic Services ...... D,~,Q. L~CENSE #: .... <br /> <br />34916 <br /> <br />P~OPERTY OWNER: Gloria Johnson <br /> <br />PROPERTY ADDRESS:,,, ]1485 Ja~es Way <br /> <br /> Aumsville, Oregon 97325 <br /> <br />APPROXIb{ATE SIZE OF TANK: 1200 .gallons <br /> <br />SEPTIC TANK ~TERIAL: Con~rete~,X ; St~el~; Other <br /> <br />IS TANK IN GOOD CONDITION? ............. ' Ye~ X ; No <br /> <br />~f "NO", e~plain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes X ; No <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... ~es., ; No X <br /> <br />If "Yes", explain: <br /> <br />DIAGRAH OF HOUSE KND SEPTIC TANK: (show detail with measureme~lts) <br /> <br /> / __ <br />DATE OF PUNi NO <br /> <br />~3) 588-5147 5er, s,~o,' 8uiJdilJg <br /> <br /> <br />