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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEH OR 97301 <br />PH# (503)588-5147 <br />FA.X~(503) 588-7948 <br /> <br />MARION COUNTV <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 omsite 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 />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 />A. <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 comp[eta 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 /> Stayton, Mill City & Silverton Septic Servi~)~License: 37814 <br />Company Name: <br /> <br />Property Address: <br /> <br />Property Owner:. <br /> <br />Septic Tank Material: <br /> <br />Is Tank in Good Condition? Yes <br /> <br />Are inlet & outlet fittings in place? <br /> <br />Is disposal field backing into tank? <br /> <br />6654 Shaw Highway SE Aumsville, OR 97325 <br /> <br />Ernie Piluso Size of Tank: ].000 <br />Concrete x Steel_ Other: . <br /> <br /> X No .. If No, please explain: <br /> Yes X No . <br /> Yes No X If Yes, explain: <br /> <br />gallons <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 />N <br /> <br />D/(TE OF PUMPING <br /> <br /> G.^TUFm <br /> <br /> MC 15-Sl 8/REV <br /> <br /> <br />