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MARION COUNTY ON-SITE SEWAGE sYSTEM <br />BUILDING INSPECTION DIViSible[ [F"~t <br />3150 LANCASTER DR NE- S~,~ ~ ~ ~ I ~ E SEPTIC TANKPUMPINGAND <br />SALEM OREGON 97305-139~ L~j~r 3 1¢~ INSPECTION FORM <br /> <br />The following requirements apply lo [he evaluafior~J~t~J~T~wage 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 />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 />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 verify the location and condition of the septic system. <br /> <br />..... FOP, S¢:PTIC PUMPER USEONLY ..... <br /> <br />Company Name: <br />· Properly Address: ~ "~.)"'?" ~ ,~,~'( C <br />Property Owner: ' ~-~ ~ ~ ~/""~' <br />Septic Tank Material: Concrete X Steel <br /> Is Tank in Good Condition? Yes ~ No__ <br /> Are inlet & outlet fittings in place? Yes ~( <br /> is ~isposal field backing into tank? Yes __ <br /> <br />DEQ License: <br /> <br />Size of Tank: / 4//~ ,~ gallons <br /> <br /> Other:. <br /> <br /> If No, please explain: <br /> <br /> No <br />~No /'~ If Yes, explain: <br /> <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 />SIG-~ER <br /> <br />2 <br /> <br /> <br />