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BUILDING INSPECTION~~(~ <br /> 285 CHURCH ST NE <br /> <br />'PH# (50I)588-5147 <br /> FAX~(501)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> INSPECTION FORM <br /> <br /> JUN 1 ? <br /> <br />The following requirements apply to the evaluation or an ite sewage system. Please select the appropriate <br />section and follow the directions carefully. <br /> <br />If your sewage system is less than five (5) years old and a Certificate of Satisfactory Completion has been issued for <br />the system, the septic tank does not require pumping at this time. A field inspection will be made of the entire system <br />and a report will be issued. <br /> <br />If your sewage system is more than five (5) years old and the septic tank has not been pumped within the last five (5) <br />years, follow the directions below. If you have proof that the septic tank has been pumped within the last five (5) <br />years, (A) will not be required. <br /> <br />Ao <br /> <br />The septic tank must be pumped by a DEQ licensed sePtic tank pumper. <br />The septic tank pumper must complete the form below. <br />A.field inspection will be required by our on-site staff to vedfy the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Company Name: .,,~/~/~"' <br />Property Address <br /> <br />Property Owner:. <br /> <br />Septic Tank Material: Concrete <br /> <br />Is Tank in Good Condition? Yes <br /> <br />Are inlet & outlet fittings in place? Yes <br /> <br />Is disposal field backing into tank? Yes <br /> <br /> Size of Tank: Jz:::~::~ gallons <br /> <br /> Steel Other: <br /> <br />No If No, please explain: <br /> <br /> No X If Yes, explain: <br /> <br />If an effluent pump is included as part of the septic system, the dosing tank and pump assembly must be inspected and <br />cleaned when the septic tank is pumped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />! <br /> <br /> SIGNATURE OF PUMPER <br /> <br />MC15-S18/REV 4-96 <br /> <br /> <br />