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sEP-~e-~e N~D $$:~$ ~M ~T~¥TON SEPTIC <br /> <br />P.02 <br /> <br />/ga~ion Court t~j <br /> <br /> ON-SI~ SEWAGE SYSTEM <br />SSPTIC TA~K PUMP~NO AND INSPECTION FOP~ <br /> <br />The following requirement~ apply to the evaluation of an ~xisting on-sate <br />sewage system. Pleage select the appropriate section and follow the directions <br />carefully. <br /> <br />1. If your sewage system is less than five ~) years old and & C~rtif£cate <br /> of Satisfactory Completion has been issued for the system, the septic <br /> tank does not require pumping at this time. <br /> a. Authorization Notices ~.g not require ~ field inspection of =he <br /> system. A report can be issued based On a review of our files- <br /> b. Z×isting System Evaluations d__o require a field inspection of <br /> entire mystem and a report will be issued. <br /> <br /> If your sewage system is more than five {5} Yea~s old and uhe ~ep~ic <br /> tank has not been pumped within the last five (5) years, follow <br /> directions be~ow. If you have proof that the septic tank has been pumped <br /> within the last five (5) years, section (a) will not be required. <br /> The septic tank must be pumped by a D,E.Q. licensed septic tank <br /> pumper. <br /> b. The Septic sank pumper must complete the ~orm be~ow. <br /> c- Autho~izatlon Notices and ~xisting System ~valuation5 require a <br /> field inspection to verify the location and condition of the <br /> <br /> atayton, <br /> Septic Services D.$.Q. LICEN$~ ~:34916 <br /> <br />COMPANY NAMe: <br /> <br />PROPERTY OWNER: <br /> <br />PROPERTY ADDRESS: <br /> <br />Bernard G. Jueden <br /> <br /> 330 Clester Street <br /> <br />Detroit, Oregon <br /> <br />APPROXIMATE SIZg OF TANK: 1000 <br /> <br />S~PTIC TANK ~AT~RIAL: Concrete, X ; Steel__; <br /> <br />IS TARK IN C~DOD CONDITION? ............. yesX; <br /> <br /> If "No", explain: <br /> <br />ARM INLET & CUTLET FITTINGS IN PLACe? ,. Yes ~ ; <br />IS DISPOaAJ~ FIELD SACKING INTO TANK? ... Yes ; <br /> <br />DIAGRAM OF ~OUS~ ;%ND SEPTIC TANK= <br /> <br />gallons <br /> <br /> Other.__ <br /> <br />(show detail with measurements) <br /> <br />'>ATE o~ PU~PrN¢ <br /> <br /> <br />