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BUILDING INSPECTION ON-SITE SEWAGE SYSTEM <br />315;0 LANCAS"rER DP. NE- SUITE C SEPTIC TANK PUMPING AND <br />SALEM OR 97305 <br />PH# (503)588-5147 INSPECTION FORM <br />FAX# (503)588-7948 <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 di~%-tions carefully. <br /> <br />If your sewage system is less than five (5) yearn 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 mere than five (5) years old and the eapfic tank has not been pumped within the last five (5) <br />years, follow the directions below. If you have proof that the s~pflc 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-site staff to verifi/the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Company Name: <br /> <br />Property Address: <br /> <br />Syst~ ~n~ sewes: <br /> <br />Septic Tank Material: Concrete <br />Is Tank in ~ood Condition? Yes <br />Are inlet & outlet fittings in place? <br />Is disposal field backing into tank? <br /> <br />~/',/_,/~. DEQLicanse#: ~or~ ~) <br /> ('",~ U,"'n ~ <br /> <br /> Size of Tank: ~'~/_~ gallons <br /> <br /> · . (# of bedrooms J ) Commercial , (# of employees ) <br /> ~ Steel Other <br /> <br />Yes__ No ~( / Solids level in tank? Normal ~ Excessive <br />Yes__ No )4~ IfYes, explain: <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 />DATE OF PUMPING <br /> <br /> F PUMPER L.) <br /> <br />MC 15-S1 g/REV 4-99 <br /> <br /> <br />