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OREG:ON <br /> <br /> The following requirements apply tQ the evaluation of an existing on-~ite <br /> sewage system. Please select ~he appropriate section and follow the directions <br /> carefully. <br /> <br /> 1. If your sewage system is ke~s than five (5) v~ars old and a Certificafe <br /> of SatisfaCtory ~ompletien has been issued for the System, the septic <br /> tank does not ~quire pumping at this ti~ae. <br /> Authorization Notices ~o not require a field ins~¢tion of the <br /> syst~, ~ re~=~ can ~ issu~ bas~ on a ~eview of our files. <br /> b. Existing Sy~ Eva%~at%onS d~ ~e~ire a field ins~ction of the <br /> entire ~yst~ and a re~rt will ~ issued. <br /> <br /> If your sewage Syst~ is mo~e than ~ve ($) vears old and the septic <br /> tank ha~ not been p~ within the last five (5) years, follow the <br /> directions ~low. If you have p=o0f that ~he septic tank has been pumped <br /> within the last five (S) years, ~e~tion {a) will no~ be re~ired. <br /> a, The Septic ~ank mus~ be ~m~ by a D.E.Q. licensed ~eptic tank <br /> pum~r. <br /> b. The septic tank p~r must c~plete the fof~ below. <br /> Autho~izatio~ Notices and Existing Syst~ Evaluations requir~ <br /> field ins~ctlon to verify the location and condition of the <br /> septiO system. <br /> <br /> *for septi= pum~r ume only* <br /> <br />COMPANY N~E:~M~k~S Segt~c Service I~c. D.E.Q. LICENSE $:, 33519-P <br />PROPERTY OWNER: Ken Allen <br /> <br /> APPROXIMATE '~ZBE OF TAMK: /~0 gallons <br /> SEPTIC TANK MATERIAL: Concrete_~; Steel__; Other,__ <br /> IS TANK IN ~D CONDITION? ... .......... Yes~ ; N~ <br /> <br />AR~ INLET m OUTL~T FITTINGS XN ~CE? .. Yes <br /> <br />IS DISPOSAL FIELD BACKING INTO T~K? ... Ye~ ; <br /> <br />DIA~ OF HOUS~ ~D ~EPTIc T~K: <br /> N <br /> <br />(show detail with measurements) <br /> <br />;03} 588-5147 Sen~Jor Building <br />~ (~R~ ~RR-7q~R 220 M~Rh St, N~ · S~lem. OR 97301-3670 <br /> <br /> MAI~iON COUNTy <br /> 6UILDING INSPECTION <br /> <br /> -- <br /> SIGNATURE OF PUM~ <br /> <br />.... /~.~ /~,~ ..... · <br /> <br /> <br />