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Date Kec'd: <br /> <br /> Site <br /> ON-SITE SEWAGE SYSTEM <br /> 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) ..yea~s old and a Certificate <br /> of Satisfactory Completion has been issued for the system, the septic <br /> tank does not require pumping at this tame. <br /> a. Authorization Notices do not require a field inspection of the <br /> system. A report can be issued based on a review of our files. <br /> b. Existing System Evaluations d__o require a field inspection of the <br /> entire system and a report will be issued. <br /> <br /> If your sewage system is mere than five (S) year~, old and the septic <br /> tank has not been pumped within the last five {5) years, fellow the <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 Existing System Evaluations requi~e a <br /> <br /> *for septic pumper use only* <br /> <br />COMPANY NAME~ <br /> <br /> ! <br /> <br /> APPROXI~TE SIZE OF TANK: ,/~ gallons <br /> SEPTIC TANK ~TERIAL: Concrete ; Steel ~; Other <br /> <br /> IS TANK IN GOOD CONDITION? ............. Yes ..; No <br /> <br />D.E.Q. LICENSE <br /> <br /> If "NO", e×plain= <br /> / <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes.. ; <br /> <br />No <br /> <br />1995 <br /> <br />MARION (DUNI'¥ <br />BUILDING INS?EGTION <br /> <br /> If "Yes", explain: <br /> <br />DIAGRA/~' OF HOUSE AND S~PT~C TANi~.; (show detail ~,;ith ,~.e&suzaments} <br /> <br /> , , , ......... <br /> <br />DA~ OF PUMPING <br /> <br />(503) 588-5147 Senator Building <br /> <br />MC15-S19 <br /> <br /> <br />