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SEPTIC WAN~ pL~4PIHG A~D INSPECTION FOP. M <br /> <br />Th~ following ~e~i~ements apply to the evaluation of an existing on-sit~ <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />1. I~ your sewage system fs le~s ~han five (S~ years old and a C~rtificate <br /> o~ satisfactory Completion ha~ been issued for the system, t~e septic <br /> tank does ~ot r~ire pumping at th~s time. <br /> Authorkzation Notices do not re~fre a field knspaction of the <br /> system. A re~rt can be issued based on a review of our files. <br /> b. Existing System Evalgmt%ons ~ re~ire a fie~d inspection of the <br /> entire system and a report will be issued. <br /> <br />2. If your sewage system &s ~orethan five {~) yea~s old and the septic <br /> tank has not b~en pumped within the last ~ive {~) years, follow the <br /> directions below. If you have proof %hat the ~eptfc tank has been pumped <br /> w&thkn the ~ast five (5) years, seGtion (a) will not be re,ired. <br /> a. The septic tank must be pu~ped by a D.E.Q. licensed sept~c tank <br /> <br /> b. The septic tank pumper must complete the form <br /> <br /> f]~ i~s~coti~n-~ v'e~y"the-'location and co~dittoa of the <br /> septic syst~m~ <br /> <br /> *for sg~tic.pu~per usg only* <br />Stay,on, Mill C~ty ~ sllverton <br />COMPANY NA~E: $~]~%ic Services %D.E.Q. <br /> <br />LICENSE #: 34916 <br /> <br />P~OPERTY OWNER: Delmar Lambrecht <br /> <br />PROPERTY ADDRESS:___~_q3~gnn <br /> <br /> Aumsville, Ore,on 97325 <br /> <br />220 Hi~,h St. N( · Sa/em, OR. 97301-1670 <br /> <br />APPROXIMATE SIZE OF TANK: 1000 .gallons <br /> <br />SEP?IC TANK MATERIAL: Cor~orete~; Stee~ ; Othe~ <br /> <br />I$ TANK ZN ~OOD CONDITION? ............. Yes X _,_y No <br /> <br />IS DISPOSAL FIELD BACKZN~ INTO TANK~ ,.. Yes~ ~ <br /> If "~es", ~lain~ ...... ~ ~,. ~ <br />D-~-: ~ '~$~ a~D SE~C TANK: (show detail with measurements) ~ ~. <br /> <br />DAT~ OF PUMPING <br /> <br />MCI5-S] 9 <br /> <br /> <br />