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The following requirements apply to the evaluation of an existing on-site sewage system. Please selec~ the appn3priate <br />section and follow the directions carefully. <br /> <br />If your sewage system is less than five (5) years old and a Certificate of Satistacto;y Completion has been issued for <br />the system, the septic tank does not require pumping at this time. A field inspection will be made of the'6ntire system <br />and a report will be issued. <br /> <br />If your sewage system is more than five (5) years old and the septic tank has not been pumped within the last five (5) <br />years, follow the directions below. If you have proof that the septic tank has been pumped within the last five (5) <br />years, (A) will not be required. - <br /> <br />A. <br />B. <br />C. <br /> <br />The septic tank must be pumped by a DEQ licensed septic tank pumper, <br />The septic tank pumper must complete the form below. <br />A field inspection will be required by our on-site staff to verify the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Company Name: <br /> <br />Property Address: <br /> <br />Property Owner. <br /> <br />Stayton, Mill City~ and <br />Silverton Septic Services <br /> <br />11495 McClellan'Lane S.E. <br /> <br /> DEQLi~nse: <br />Aumsville, Or <br /> <br />34916 <br /> <br />J.L. Poplin <br /> <br />Size of Tank: .1 0 0 0 .gallons <br /> <br />Septic Tank Material: Concrete X Steel <br /> <br />Is Tank in Good Condition? Yes X No <br />Are inlet & outlet.tifflngs in place? Yes X No <br />Is disposal field backing intotank? Yes No <br /> <br /> Other. <br />__. If No, please explain: <br /> <br />X . If Yes, explain: <br /> <br />If an effluent pump is included as part of the septic system, the dosing tank and pump assembly must be inspected and <br />cleaned when the Septic tank is pumped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br /> /9/9s <br />DATE OF PUMPING <br /> <br /> sI-rGNATU~ O~PUMP~R - <br /> \ <br /> <br /> <br />