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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEI~'I OR 97)01 <br />PH# (503)588-S14'7 <br />FAX~(503) 588-7948 <br /> <br />SEPTIC TANK PUM iN'( :AND <br /> INSPECTION' FORM <br /> <br />The following requirements apply to the evaluation of an existing on-site sewage system. Please select the apprepdate <br />section and fellow the directions carefully. <br /> <br />If your sewage system is less than five (5) years old and a Certificate of Satisfactory Completion has bean 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 />~L <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 redly the location and condition of'the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Prepe. Owne . Er'T S eofTank: ga,ohs <br />Septic Tank Material: Concrete '//-- Steel Other: <br /> <br />Is Tank in Good Condition? Yes ~ No If No, please explain: <br /> <br />Are inlet & outlet fittings in place? Yes ¢ No__ <br /> <br />Is disposal field backing into tank? Yes __ No ..,,z. if Yes, e×plain: <br />if an effluent pump is included as part of the septic system, the dosing tank and dump 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 /> s 2 6 1997 <br /> MARION COUNTY <br /> <br />DATE OF PUMPING <br /> <br /> <br />