HomeMy WebLinkAboutMiscellaneous Septic Tank 2010-3-18
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SEPTIC TANK DECOMMISSION
(ABANDONMENT)
Township
Range
Section/1/4 Section
Tax Lot
'.4\i.,
If you are connecting to an area-wide sewage collection system or you are replacing your septic tank,
please don't forget to properly decommission your septic system. An unattended and forgotten septic
tank can become a serious danger for everyone's safety. Present Oregon regulations require you to
properly decommission the septic tank as described below. Please have this form signed by the
appropriate people and return the completed form to:
LANE COUNTY SUBSURFACE SANITATION PROGRAM
Public Service Building 125 East 8TH Ave Eugene, Oregon 97401
Name of Property Owner
Septic tank located at 't~ 5
Pumped of sludge on '3// 'ii11D
(Date)
[ g "p
o~ 2--- 'SJ-ezrr. ~f'~I.vG: F.&'-D , ot'2.
by ~~-?l1~
1J. ' I !.Sign~tu~ of Licensed Operator)
LeNl\J:.;h;, UR..A/"-l. :::8-~es
License # jC,OS' ~
The septic tank located at
backfilled with sand or clean bank run gravel after being pumped of sludge on
was
(Date)
~'...
Signature of Operator (may be owner)
Oregon Administrative Rules (OAR) 340-71-185 Decommissioning of Systems.
,
1. The owner shall decommission a system when:,
a. A sewerage system becomes available and the building sewer has been connected
thereto, or
b. The source of sewage has been permanently eliminated.
2. Procedures for Decommissioning:
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S~ptjc & D~'ain Cleaning
2140 Primrose St.
EUGENE, OREGON 97402
(541) 688.6018 998.1383 726.77"32
CUSTOMER'S ORDER NO. [PHONE
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TAX
RECEIVED BY
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All claims and returned goods MUST be accompanied by this bill.
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