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~MarionCoun~ Site #: <br />S~PTIC TANK PUMPING AND INSPECTION FORM <br /> <br /> The following requirements apply to the evaluation of an existing on-si, re <br /> ~ewage 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 Certificate <br />of Satisfactory Completion has been issued for the system, the septic <br />tank does not require pumping at this time. <br />a. Autherization Notices do not require a field inspection of the <br /> system. A report can be issued based on a review of ou~ files. <br />b. Existing System Eva~gat~ons d__o require a field inspection of <br /> entire system and a report will be issued. <br /> <br />If your sewage system is mere than five (5) years old and the septic <br />tank has not been pumped within the last five (5) years, follow ~he <br />directions below. If you have proof that the septic tank has been pumped <br />within the last five (5) years, section (a) will not be required. <br />a. The septic tank must be pumped by a D.E.Q. licensed septic tank <br /> pumper. <br />b. The septic tank pumper must complete the form below. <br />c. Authorization Notices and EX-fs~ing "Sys~em"-'Evalu~{ions requi~e a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> *for septic put,per use o~ly~ S~ 4~qS <br /> <br /> APPROXIMA~ SIZE OF TANK: //~3 gallons <br /> SEPTIC TANK MATERIAL: Concrete~ ; Steel ; Other <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes~ ; NO <br />If "No", ~xplain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACe? .. Yes .; No__ <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes__; No ,~. .... <br /> <br />If "Yes", explain: <br /> <br />DIAGRA/4 OF ~OUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />aug t 7 1995 <br /> <br />MARION COUNIY <br />BUILDING INS?ECII.ON <br /> <br />(503) 588-5147 Senator Dui[din§ <br /> <br />SiGnaTURE OF PUMPER <br /> <br />MC15-S19 <br /> <br /> <br />