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BUILDING INSPECTION <br />285 CHURCH ST NE <br />S^LEF( OR 97301 <br />PH# (503)588-514-7 <br />F,~LX#(503)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> INSPECTION FORM <br /> <br />MARION COUN~ <br /> <br />The following requirements apply to the evaluation of an existing on-site sewage system. Please select the apprepdate <br />section and follow the directions carefully. <br /> <br />1. <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 />A. <br />B. <br />C. <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-sita staff to verify the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Properb~,d~r~s:~~/e' ~> t~ 0 _ ' <br />Property Owner. ~ (~(..T. ~::~c/'_ .... SizeofTank: ("~'~:~ _gallonr~ A..-~ ' s <br /> <br />Septic Tank Material: Concrete Steel <br />Is Tank in Good Condition? Yes._.~__ No <br /> <br />Are inlet & outlet riflings in place? Yes_.~ No <br />Is disposal field backing into tank? Yes_~ No <br /> <br />__ If No, please explain: <br /> <br />If an effluent pump is included as part of the septic system, the dosing tank and pump. assembly mu~t be inspected and..... <br />cleaned when the septic tank is pumped. /.Af-).~,-e~ ~:~reOl~-.~. <f~c-,,~J (~tJ~ <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />t <br /> <br />MC15-S18/REV 4-96 <br /> <br /> <br />