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Marion Count~t <br /> OREGON <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TA~VK PU~{PlNG AND INSPECTION FORM <br /> <br />Site #:. <br /> <br />.The ~ollowing 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 /> 2. 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 withis 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 ou~ on-site staff to <br /> verify the location and condition of the septic system. <br /> <br /> *for septic pumper use only* <br /> (please print) <br /> <br />APPROXIMATE SIZE OF TANK: .gallons <br /> <br />SEPTIC TANK MATERIAL: Concrete~_; Steel__; Other__ <br /> TANK IN GOOD CONDITION? . . <br />IS <br /> ........... Yes ; No <br /> If "No", explain: <br /> <br />ARE <br /> FITTINGS IN PLACE? .. Yes_~__; NO <br /> INLET <br /> & <br /> OUTLET <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes__; No~g- <br /> If "Yes", explain~ <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />MC15-S19 <br /> <br />(503~ .58P~-~147 Senator ~, 2nd Floor <br /> <br /> <br />