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B U IL~/L[N G INSPECTION <br />315(J; L~,NCASTER DP, NE - SUITE C <br />SALEI~I OP, 97305 <br />PH# (503)$88-5 t~7 <br />FAX//($O~)$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 on-site 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 />The septic tank must be pumpe;d 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 vedfy the location and condition of the septic system. <br /> <br />.... '- FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Properb/Owner: ~.~,,/~/-.¢~¢.-- 0{ ~ ~ i/ <br />Septic Tank Material: Concrete ~ Steel Othen <br /> <br />Is Tank in Good Condition? Yes. / No If No, please explain: <br />Are inlet & outlet firings in place? Yes ~ No <br />Is disposal field backing into tank? Yes __ No / If Yes, explain: <br />If an effluent pump is included as pa~ of the septic system, the d~sing tank and pump assembly must be inspected and ~. <br />cleanedwhenthe septictankis pumped. ~,~ ~ /~ /;~ ~ ~,~,~3~"/:~ ~ f~'~ ~-~ <br /> <br />DIAG~M OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />DEQ License: ~ <br /> <br />Size of Tank: ~ gallons <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br /> <br />