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IriO~ COunty ON-SITE SEWAOE SYSTEM <br /> OREGO~ 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 /> 1. If your sewage system is less than five (5) years old and a <br /> Certificate of Satisfactory Comp~etion 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 /> 2. If your sewage system is more than five (5) years old and the <br /> septic tank has not' be~n pumped within 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 /> s. 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 /> *for septic pumper use only* <br /> [please print} <br /> Stayton/Mlll City ~ $ilverton <br />COMPANY NAME:, Septic Services o.E.Q, <br /> <br />LICENSE #: 34916 <br /> <br />PROPERTY OWNER: Larry & Betty ~{iller <br /> <br />PROPERTY ADDRESS: 7542 Bishop Road, Aumsville, Oregon <br /> <br />APPROXIMATE SIZE OF TANK: 1000 gallons <br /> <br />SEPTIC TANK MATERIAL: Concrete ~ ; Steel ; Other__ <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes X ; No <br /> <br /> If "No", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE7 .. Yes ~ ; No__ <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes ; No X <br /> If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />? <br />N <br /> <br /> 11/13/96 <br />DATE OF PUMPING ~ <br /> <br /> ER ' <br /> <br />MC15-S19 (50]) 588-5147 Senator Buildi¢,8, 2nd Floor <br />fLEV lO-q2 220 High SI, NE, Salem, OR 973UI-367~ <br /> <br /> <br />