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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALElq OR 97301 <br />PH# (503)588-5147 <br />FAX~(503)$88-7948 <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 omslte 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 moro 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-s!te staff to verify the location and condition of the septic system. <br /> <br /> ..... FOR sEpTIC PUMPER USE ONL, Y .... <br />Stayton, Mill City and Silverton Septic Services <br />Company Name: DEQ License; 3 7 8 14 <br />Pr0padyAddress: 115 Lake Crest Detroit OR 97342 <br /> <br />Property Owner: Dan Iverson <br />Sepfic Tank Material: Concrete Steel <br /> <br />is Tank in Good Condition? Yes X No <br />Are inlet & outlet fittings in place? Yes x , No <br />la disposal field backing into tank? Yes No X <br /> <br /> Size of Tank: ? 5,0 , gallons <br /> X Othe: <br /> <br />-- if No, please ;xpl~in: <br /> <br />If Yes, expm ~: <br /> <br />If an effluent pump is included as part of the septic system, the do~-~ing tank and pu.mp assembly mUst be inspected and <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASU <br /> <br /> N <br /> <br />MARION COO <br /> <br />DATE OF PUMPING <br /> <br /> <br />