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.;, OREC, ON S~P~:KC ~RNI~ PUMP~E~ AN~ INsPECtIoN FORM <br /> <br />~ The following requiremeDtS apply 2o the evaluation Of an existing on-site <br /> sewage 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 <br />Certificate of Satisfactory completion has been issued for the <br />system, the septic tank does not require Dumping at this time, A <br />field inspection will be made of the entire system and S repOrt <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not been pumped within the last five (5) years, <br />follow the direstion~ below. If you have proof that the septic <br />tank has been pumped within the last five (5) yea=S, sections (a) <br />and (b) will nOt be rec/~ired. <br />a. The septic tank must be pumped by a D.B.Q. licensed s~ptic <br /> tank p~mper0 <br />b. The septic tank %~uuper must complete the form below. <br />c. A fiel~ inspe0tl~n will be re~ired ~y our On-site staff ~o <br /> verify the looa~ion and condition of the septic system. <br /> <br />*for septic ~mper use only* <br />(please ~rint) <br /> <br />APPROXIMAT~ SIZE OF TANK= W/~~t~ qallon~ <br />SEPTIC TANK ~{ATERIAL: Concrete_~; steel ; Other~ <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes~; NO <br /> <br /> If "No", explain: <br />AR~ INLET ~ OUTLBT FITTINGS IN PLACE? ,. Yes ~ : NO <br />IS DISPOSAL FIELD BACKING INTO TANK? ,.. Yes__ ; NO ~ <br /> <br />If "Yes", explain= <br /> <br />DIAGRAM O~ HOUSE AND SEPTIC TANK: <br /> <br />N <br /> <br />(show detail with ~easurements) <br /> <br /> <br />