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BUILDING 1NSP£CTIC <br /> <br />S^L£H OR 97~05 <br />PH# (505)58~-$ ! 47 <br />FAX~ <br /> <br /> 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 dire~ons carefully. <br /> <br />If your sewage system is less than five (5) years old and a Ce~cate of Satisfactory Completion has been issued for <br />the system, the se~c tank does not require pumping at this time, A I1eld inspection will 13~ made of the entire system <br />and a- rep(3rt will be issued. <br /> <br />rf your sewage system ~ mere than ,five (5) years eld and the sept~ tank has not been {3umped within the I~st 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 />A~ <br />B. <br />C. <br /> <br />The septic tank must be 0umped by a DEQ licensed septic tank pumper. <br />The septic tank pumper must complete the form 13elow. <br />A f!elcJ inspec~on will be r~luired by our on-sits staff ~ verify the Ioc~tion and condition of t~a septic System. <br /> <br /> ,, - .... FOR SEPTIC PUMPER USE ONLY - - -- - ~ -~J' <br /> <br />ProperS' Addr~: . · <br />Prope~ O~e~ S~e of Tank: ~ ga~ons <br />Septic Tank Material; Con~ete _ steel, ~ O~er <br /> <br />~e inlet & outlet fi~ings in ~? Y~ ~ No ~ / ~lids [~el in ~nk? No.al ~' ~ive ~ <br />Is ~is~sal ~ld bacfing into ~nk? Y~ No ~ if Yes, ex,sin ~ <br />If an effi~p is in~ es ~ of ~e septic sys~m, ~e d~ng rank and pu~ assembly ~st be ins~ and <br />~eaned~e septic "nk'is ~mped.. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />S <br /> <br />DATE OF PUMPING <br /> <br />~IGNII~TURE OF PUMPER <br /> <br />5-$19/REV 4-99 <br /> <br /> <br />