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OREGON <br /> <br />The ~ollowin~ <br /> <br />requirements a~ply to the evaluation of an existing on-site <br />Please select the &~oPriate section and follow the directions <br /> <br />If your sewage ~ystem is Less than five ¢~) ¥~.fl old &~d a Certificate <br />of Satisfactory Oo~pletion ha~ been issued for the system, the septic <br />tank does not require ~ping at this time. <br />a. Authorization Notices ~onot require a field i~$~ection of the <br /> system. A report can be issued based on a review Of Our <br />b. Existing System Eva~at~ons do require a field ln~ect£on of the <br /> entire system and a repo~t will be issued. <br /> <br />If you~ sewage system is m~ than .five (5] Yea~s old and ~he septic <br />tank has not b~en pum~oed within the last five (5) years, follow the <br />directions b~low. If yOu have ~oof that the septic task has been pumped <br />within the last five ($) years, section (a) will not be required. <br />a. The septic tank ~ust be DUmlged by a D.E.Q. licensed septic %ask <br /> <br />*for septic puffi~r use on~.* <br /> <br />pump~ ~. <br />The septic ~ank pumper mum~ complete the form below. <br />Authori~a=io~ Notices aed Existing ~ystem Evaluations requi~e a <br />field in~pection to verify the location and condition of the <br />septic system. <br /> <br />(show detail with ~easu~e~ents) <br /> <br /> APPROX%~TE SIZE OF TANE: /~_ , ...... ~allo~s <br /> SEPTIC TANK MATERIAL: Concrete.~ ; ~teel~; O~her ..... <br /> <br /> Z$ TANK IN GOOD CONDITION? ............. Yes. ~ ; NOr <br /> <br /> If "No", explain: <br /> <br />ARE %NLET & OUTLET FITTINGS IN PLACE? .. YeseS_; NO <br />I$ D~SPOSAL FIELD BACKING IN~O T~K? ... Yes~_; NO~ <br /> If "Ye=", explain:. <br />D%AG~ OF HOUSE ~D SZ~T%C T~K: <br /> <br /> T <br /> <br /> DEC23 199q -- <br /> <br />mAR~0N 00UNTY <br />BUILDING INSPECTION <br /> <br />SI~NATUR~E OF PUMPER <br /> <br />MClS-S] 9 <br /> <br /> <br />