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* O'REGON SEPTIC TANK PUMPINO AND INSPECTION ~ORH <br /> <br />The following requirements apply to the evaluation of an existing on-site <br />sewage system. Please select the appropriate section and follow the directions <br /> <br />carefully. <br /> 1. <br /> <br />If you~ sewage system is lass than fiw~ (5) years old and a <br />Certificate of Satisfactory Completion ha8 been issued for the <br />system, the septic tank does eot 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 />If your sewage system is more than five (5} years old and the <br />septic tank has not been pumped within tile last five (5) years, <br />follow the directions below. If you have proof that the septic <br />tank has been pumped within 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 /> <br /> ,- . (please print) <br /> <br />APPROXI~TE SIZE OF T~K: /~ gallons <br /> <br />SEPTIC T~K ~TERI~: Concrete ; Steel ~ ; Other <br />IS T~K IN G~D CO~ITION? ............. Yes .~. ; <br /> <br /> If "No", explain: <br /> <br />~ INLET & OUTLET FITTINGS IN P~CE? .. Yes~ ; <br />IS DISPOS~ FIELD BACKING INTO T~K? Yes <br /> If "Yes", explain: <br /> <br />DIAGPJuM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />MC15-S19 <br /> <br />(503) SSR-5147 .S~.n.a!~r .BujIc~i?_8, .2n? Ffo?r. <br /> <br /> MAY 2 t ISS7 <br /> <br />MARION COUNTY <br />BUILDING INSPECT)ON <br /> <br />DATE OF PUMPING <br /> <br /> <br />