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985 CHURCH ST NE <br />SALEH OR 97301 <br />PH~ (~03)588-5147 <br />F^X//(503)588-7948 <br /> <br />APR 1 $1999 <br /> <br /> ON-SI~'~ SEW~GE!:SYS~EM ~ ! <br />SEPTIC TANK PUMPINGAND ' <br /> INSPECTION FORM .: <br /> <br />The following requirements apply to the evaluation of~l~j J~J~e system. Please select the appropriate <br />section and follow the directions carefully. <br /> <br />If your sewage system is leds than five (5) years old and a Certificate of Satisfactory Completion has been issued for <br />the system, the septic tanl~does not require pumping at Ihi~ time. A field inspection will be made of the entire system <br />end a report will be issued~,' <br /> <br />If your sewage syster~ 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 pumped by a OEQ 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 />Company Name: ~f/l~ 1 l~,/2 ~, JO'S--/~, <br /> <br />Septic Tank Material Concrete ~ Steel Other: <br /> <br />Is Tank in Good Cond~ on? Yes fx~ No If No, please explain: <br /> <br />Are inlet & o~let fittings in pla~? Yes <br /> <br />Is disposal field backin9 into tank? Yes ~. ~o If Yes, <br />If an e~uent pump is included as pa~ of the septic syslem, the dosin9 ~ank and dump assembly must be inspected and <br />cleaned ~en the ~eplic tank is pumped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK . SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br />SIGNATURE OF PUMPER <br /> <br /> <br />