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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEI'4 OR 97301 <br />PH# (503)588-5 ! 47 <br />F,'eOG~(503)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> INSPECTION FORM <br /> <br />The following requirements apply to. the evaluation of an existing on-site 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 />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-site staff to vedfy the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Property Address: /~'~'~ ~-~<~' ¢'~'J <br />Property Owner: ~.P; /~--~ ~"~'~:-~ ,~J <br />Septic Tank Material: ':* Concrete ~ Steel__ <br />Is Tank in Good Condition? Yes ~X~ No <br />Are inlet & outlet fittings in place? Yes /J~ No <br /> <br />Company Name: ~',~¢~ <br /> ,,,20,"0,"4, <br /> <br />DEQ License: ~ "~ ~'~¢¢'~' <br /> <br />Size of Tank: /~ gallons <br /> <br /> Other: <br />__ If No, please explain: <br /> <br />Is disposal field backing into tank? Yes No ~' if Yes, explain: <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, i_~.~.~[-~ [[~l~a!~ <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUR <br /> <br /> ' N JUN - q 1996 <br /> $ MARION COUNTY <br /> S BUILDING INSPECTION <br /> <br /> <br />