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· DE0-23-98 NED ].0:22 Afl <br /> <br /> BOB FRINK OHEV <br /> <br />BUILDING INSP~.CTION <br />]~IS0 LANCASTER DP. NE - sUITE C <br /> <br />PH# (503)~88-S 1~1.7 <br />FAX.~(503)$ B 8 -794.8 <br /> <br />FAX NO, 5036522950 P. 03 <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 exfspng on-site sewage system. Please select the appropriate <br />section ~nd follow the directions carcfully. <br /> <br />1 <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 />y~ars, fo[tow the directions below, if you have proof that the septic tank has been pumped within the [est five (5) <br />years. (A) will notbe required. <br /> <br />A. The septic t~nk must be'PuShy a DEQ licensed septic tank pumper. <br />8, The septic tank pumper must ~mplste the form below. <br />C. A field inspection will be required by our on-site staff t,o verify the location and condition of the septic system. <br /> <br />Septic Tank Material; Concrete <br /> <br />Is Tank in Good Condition? Yes <br /> <br />Are inlet & outlet fittings in pl~ce? <br />is disposal field backing into tank? <br /> <br /> .... '- FOR SEPTIC PUMPER USE ONLY ..... <br /> Stay%on, Mill City and <br />CampanyNarne;.. S'cayton Septic Service~ DEOLcense. 37814 <br /> <br />Property Address: 145 Deer Street Detroit 0R 97342 <br />Prope~ Or, nec Charles and Marsha ,?olde= S~e efTank: 500 gallons <br /> <br /> Steel___X_._ Other <br /> X No If No, please explainl .... <br /> <br /> Yes X No <br /> Yes No X~ If Yes, explain:_ <br />Ii' an et/luent pump is included as part of the septic system, the do~ing 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 />~2/lOt9p _ <br />DATE OF PUMPING <br /> <br />SIGNATURE OF PUMPER <br /> <br /> <br />