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SEPTIC TANK PUMPING AND <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />ON-SITE SEWAGE SYSTEM <br /> <br /> INSPECTION FORM <br /> <br />The following requirements apply to the evaluation ofar~ existing or,-site sewage system. Please select the appropriate <br />section and fo[tow the dimctibns caretuliy. <br /> <br />If your sewage system is less than five (5) years old and a Certificate of Satisfacto~ Completion has been issued for <br />the system, the septic tank does not require pumping at this time. A field inspectron wilt 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 las! five (5) <br />years, follow the directions below, if you have [~roof that the septic tank has been pumped within the last five (5) <br />years, (A) will not be required. <br /> <br />The septic ta'nk must be pumped by a DEQ licensed septic tank pumper. <br />The septic taAk 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 />..... FOR SEPTIC PUMPER USE 'ONLY ..... <br /> <br />Company Name: ~.,A/~2/, ,~'~.~,z <br />Property Address:~.~C ~7~ <br />Prope~ OwneE ~ ~,.~',' <br />Sepdc Tank Matedai; Concrete <br /> <br />Js Tank in Good Condition? Yes <br />Are inlet & ou~et fi~ngs in pla~? Yes. // No_ <br /> <br />DEQ License: <br /> <br /> Size of Tank: /,¢.,3~ __ gallons <br /> <br /> Steel Other: <br /> <br />No If No, please explain: <br /> <br />Is disposal field backing into tank? Yes -No / If Yes. explain: <br />If an effluent pump is included as part of the septic system, tile dosing tank and pump assembly mu~t be inspected and <br />cleaned when the septic tank i5 pumpea. <br /> <br />DIAGRAM O~ HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br />;NATURE OF PUMPER <br /> <br /> <br />