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BUILDING INSPECTION <br />28S CHURCH ST NE <br />SALEM OR 97301 <br />PH# (503)S88-S 147 <br />FAX//(S03)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-s~ sewage system. Please select the appropriate <br />seCtion and folksy 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 lhan five (5) years olti and the septic tank has not been pumped within the last five (5) <br />yearn, 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 />The septic tank must be pumped by a DEQ licensed septic tank pumper. <br />The septic tank pumper must compleba the form below, <br />A field inspection will be required by our on-site staff to verify the location'and condition of the septic system. <br /> <br /> ..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Company Name: DE.Q License: ~'~ <br />Property Address: <br /> <br />Property Owner: Size of Tank: /'O..__.~QC) gallons <br />Septic Tank Material: Concrete~ Steel._.~ Other:~ <br />Is Tank in Good Condition? Yes....-~ No~ If No, please exp[ain:~ <br />Are inlet & outlet fittings In place? Yes_.~ No~ <br />Is disposal field backing into tank? Yes __ No.4~ 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 lank is pumpecl, <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br /> <br />