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SESPEXIS - 1456511
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SESPEXIS - 1456511
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Last modified
2/12/2010 11:23:31 AM
Creation date
7/21/2004 11:21:30 AM
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Permits
Permit Address
21845 BOONES FERRY RD NE
Permit City
Aurora
Permit Number
555-96-06833
Parcel Number
041W11CA03000
Permit Type
SESPEXIS
Permit Doc Type
Permit Document
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· Marion Countg ON-S~TE SEWAGE SYSTEM <br />' ' OR~GON SEPTIC TANK PUMPING AND INSPECTION FORM <br /> <br /> The following requirements apply to the evaluation of an existing on-site <br /> sewage system. Please select the appropriate section and follow the directions <br /> carefully. <br /> <br />If your sewage system is less than five (5) years old and a <br />Certificate of Satisfactory Completion has been issued for the <br />system, the septic tank does not require pumping at this time. A <br />field inspection will be made of the entire system and a report <br />will be issued. <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not been pumped withi~ the last five {5) years, <br />follow the directions below. If you have proof that the septic <br />tank has been pumped within the last five (5) years, sections (a) <br />and (b) will not be required. <br />a. The septic tank must be pumped by a D.E.Q. licensed septic <br /> tank pumper. <br />b. The septic tank pumper must complete the form below. <br />c. A field inspection will be required by our on-site staff to <br /> verify the location and condition of the septic system. <br /> <br />MC15-S19 <br /> <br />*for septic pumper use only* <br />(please print) <br /> <br /> D.E.Q. LICENSE <br /> <br />PROPERTY OWNER: <br /> <br />PROPERTY ADDRESS: <br /> <br />APPROXIMATE SIZE OF TANK: ~ gallons <br />SEPTIC TANK MATERIAL: Concrete 7~; Steel ; Other <br />IS TANK IN GOOD CONDITION? ............. Ye~ ; No <br /> <br /> If "No", explain: <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes ~ ; No <br /> <br />IS DISPOSAL FIELD BACKIN~ INTO TANK? ... Yes ; NO <br /> <br /> If "Yes", explain:. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br /> N <br /> <br />('503) S~,~-S147 ~S~.~.~!~r ?~.ildiO.~, 2. n.d Fio?~ <br /> <br />DATE. OF PUMPING <br /> <br />~IGNATURE (HF~P~MPER <br /> <br /> <br />
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