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~rion Count~ <br /> ORI~GON <br /> <br /> ON-linE SEWAGE SYSTEM <br />SEPTIC TANK pU~4PING AND INSPECTION FORM <br /> <br />The following <br />~wage system. <br />carefully. <br /> <br />requicements 'apply to the evaluation of an existing on-site <br />Please select'the appropriate section and follow the directions <br /> <br />If your sewage system is les9 th_an five ($) vears 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. Au~hbrization Notices d~, no~t require a field inspection of the <br /> sy~i~, A report can be issued based on a review of our files, <br />b. Exi~t'ing System Sv&luat%ons d~o require a field insDection of th,~ <br /> e~tLre system and a ~eport will be issued. <br /> <br />If your sewage system is mo~ethan ripe ~5~ years old and the septic <br />tank has not been pumped w,ithin the last five (5) y~ars, follow 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 s~Dtie tank pumper must complete the form b~lcw. <br />c. Authorisa~ion Notices and Existing System Evaluations require a <br /> field inspection to verify the location and condition of the <br /> s~ptio system. <br /> <br />APPROXIMATE SIZE OF TANK: ~/, ,J~)C~) _gallons <br /> ! <br /> <br />S~pTIC TANK MATERIAL: Concret ; Steel__; Other__ <br />IS TANK IN GOOD CONDITION? ............. ~es~, ~; No <br /> If "NO", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes~ ; No <br />IS DISPOSAL FIELD SACKING INTO TANK? ... Yes .... ; <br /> <br />If "Yes"~ explain= <br /> <br />/tUG, I 7 t993 <br /> <br />MARION COUNTY <br />BUILDING, INSPF..C'JLON <br /> <br />~IAGRAM OF HOUSE AND SEPTIC TANK= (show detail with measurements) <br /> <br />3) 588-5147 t,~,nator 8uildln~ <br />~{3'~% ~:;ER-?¢4aR .~.N) High St, NE · Salem, OR 97301.3670 <br /> <br />UAE OF PUMPER <br /> <br />MC15-$19 <br /> <br /> <br />