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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEH OR 97301 <br />PH# (503)588-5147 <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-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 />Company Name: Septic ger¥ice~ <br /> <br />Property Address: 9517 Snoddv Drive SE <br /> <br />Property Owner: Todd & Rqxanne Bishop <br /> <br />Septic Tank Material: Concrete Steel <br />is Tank in Good Condition? Yes No X <br />Are inlet & outlet fittings in place? Yes, X No <br /> <br />Isdisposal field backing into tank? Yes X No <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 /> ^. The septic tank must be pumped by s DEQ licensed septic tank pumper. ~"~ [U '-- <br /> B. The septic tank pumper must complete the form below. <br /> C. A field inspection will be required by our on-site staff to verify the location an~nditi,~r~(~)~he septic system <br /> <br />........ ...... FOR SEPTIC PUMPER USE ONLY - ~i~iII.~i$~.O'I'IO~_~.--~RIO~I OOU~'I <br /> Stayton, Mill City, & 811verton <br /> <br /> DEQ License: #34916 <br /> <br /> Size of Tank: 1000 <br />Other: Metal <br /> <br />gallons <br /> <br />IfNo, please explain: Has holes tn lid <br /> <br /> IfYes, explain: Water level t9 ~igh <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 />N <br /> <br />MC15-Sl~REV 4-96 <br /> <br /> <br />