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Build!ng Inspeclion Di~$ion <br />Hariorz Countou <br /> <br />OREGON <br /> <br />SEPTIC T~ PUMPING ~ INSPECTION <br /> <br />Site #: <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 />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 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 been pumped within the last five (5) years, <br />follow the directions below. If you have proof that the septic <br />tank has been pumped wi.thin 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 />c. A field inspection will be required by our on-site s6aff to <br /> verify the location and condition ofthe septic system. <br /> <br /> *for septic pumper use only* <br /> (please print) <br /> <br />co.P Y <br /> <br />PROPERTY OWNER: <br /> <br />PROPERTY ADDRESS: <br /> <br />.gallons <br /> <br />APPROXIF~TE SIZE OF TANK: <br />SEPTIC TANK MATERIAL: Concrete~'/~''.' Steel ; Other <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes '~ ; No <br /> <br /> If "No', explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes--~ ; No. , . <br /> <br />tS DISPOSAL FIELD BACKIN~ INTO TANK? .... Yes ; -No ~ <br /> <br />RECBVED' <br /> <br /> 'JUl.: 5 1W6 <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br /> If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />MC15-S19, <br /> <br />(503) $BS-5147 -~..a.?.Sujldi.nF .27:1 Fie?. <br /> <br />D~PUMPING _ <br /> <br />SIGHArURE~F~PUI~ER <br /> <br /> <br />