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site #~. <br />OREGON ON-nlT~ ~WAO~ SynTI~ <br /> <br />· The following requirements apply to the evaluation of an existing on-site <br />sewage system. Please select the app$opriate section and follow the directions <br />carefully. <br /> <br />If your sewage system is 1pas than flys (5! years old and a Certificate <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 ~o sot require a field inspection of the <br /> system. A report can be issued based on a review of our files. <br />b. Existing System Evaluat%ons d_o require a field inspection of the <br /> entire system 9nd a report will be issued. <br /> <br />If your sewage system is ~ore than fi3e (~) years old and the septic <br />tank has not been pumped within the last five (5) years, follow the <br />directions below, If you ha~e p~oof that the septic ~ank has been pumped <br />within the last five (S) years, section (a) will not be required. <br />a. The septic tank must be pumped by a D,~.Q. licensed septic tank <br /> pumper. <br />b. The s~ptic tank pumper must complete the form below, <br /> <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> *for septic pumper use only* <br /> <br /> PROPERTY OWNER: '~0~ ~/~-~ ' <br /> <br /> APPROXI~T~ SIZE OF T~K~ /~l, , gallon~ <br /> S~PTXC3T~K ~TERIAL: Concrete~ ~teel . ; Othe~ _ <br /> IS TANK IN ~D CONDITION? ............. Yes ~ No. <br /> If "No", ~xplain: <br />ARE ~NL~T & OUTLET FITTINGS IN PLACE? .. Yes~; <br />I~ DISPOS~ FIELD ,ACKING INTO T~? ... <br /> <br /> If "Yes-, e~plaln= <br /> <br />DXAG~ OP MOUS~ ~D SEPTIC TANK: (show detail wish measurements) <br /> <br />? <br /> <br /> DAT~ OF PUMPING <br /> <br />/~[GNATURE~OF PU~IPZR <br /> <br />588-5147 <br /> <br />MCl 5-$19 <br /> <br /> <br />