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Marion County <br /> <br />ORE(~ON <br /> <br />The following <br />~ewage system. <br />carefully. <br /> <br />SEPTIC TANK PUMPING AND INSPECTION FORM <br /> <br />requirements apply to the evaluation of an existing on-s'ite <br />Please select the appropriate section and follow the directions <br /> <br />~f your sewage system is less than five (3) years old and a <br />Certificate of satisfactory Completion has been issued for the <br />system, the septic tank does not require pumping at this time. A <br />field inspection will be made of the entire system and a report <br />will be issued. <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not be~n pumped within the last five (5) years, <br />~ollow the directions below. If you have proof that the septic <br />tank has been pumped within the last five (5) years, sections (a) <br />and (b) will not be required. <br />a. The septic tank must!be pumped by a D.E.Q. licensed septic <br /> tank pumper. <br />b. The septic tank pumper must complete the form below. <br />s. A field inspection will be required by our on-site staff to <br /> verify the location and condition of the septic system. <br /> <br /> *for septic pumper use only* <br /> (~lease ! print ) <br /> <br />APPROXIMATE SIZE OF T~K: gallons <br /> <br />S~PTIC T~K ~TERI~= Concrete~; Steel ; Other__ <br /> <br /> IS TANK IN G~D CONDITION? ............. ~ Yes__; NO <br /> <br />A~ INLET & OUTLET FITTINGS IN P~C~?....'~es ; NO <br />IS DISPOS~ FIELD BACKING INTO T~K? . .. :~es ; NO ~ <br /> <br />DIAG~ (show ~e=ail with ~easurements) <br /> <br />OF HOUSE AND SEPTIC TANK~ <br /> <br />? <br />N <br /> <br />MCi$-S19 (503) $88-$~47 ..... ~ <br />REV 10-92 <br /> <br /> JV[ARION COUNTY <br /> BUILDING INSPECTION <br /> <br />DATE OF PUMPING <br /> <br /> <br />