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BUILDING INSPECT/C <br />31 $0 LANCASTER DR NE - SUITE C <br />SALE~ OR 97~0S <br />PH# (503)$88-$147 <br /> <br /> Or 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 CerfJficate of Satisfactory Completion has been issued for <br />~he system, the sonic tank does not require pun~ing at this time. A ~qe~ inspection ~ll ~ ma~e of the entire system <br />and-~report will be issued. <br /> <br />If your seWage system is more than five (5) years old and the septic tank has not been pum~eq within the Iast five (5) <br />years, follow the directions below. If you have proof that the septic tank has ~en pumped witllJn the last five (5) <br />years, (A) will not be required. <br /> <br />The septic tank must be pumped by a DEQ lic~qsed sep~ tank pumper. <br />The Septic rani( pumper must ~omptete the form below. <br />A field inspection will be required by our on-site staffto verify the location and condition of the septic system. <br /> <br /> ..... FOR SEP.TIC PUMPER .USE ONLY ..... , ...... <br /> <br />proper~ Address: <br />Property Owner. Size of Tank:. ~ gallons <br />Septic Tank Material; Concrete Steed ~ Other <br /> <br />Areinlet&outtetf~tingsinptace? Yes._~ No ! $olids level in tank? Normal ' Excessi_ve ~X~ <br />Is disposal field baclfing into tank? Yes No ~ If Yes, explain: <br />tf an eff.~b is included as part of the septic system, the dosing tank and punic assembly must be inspected and <br />cleane~e septic tenl('Js pumped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK , SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br />SIGN~'URE OF PUMPER <br /> <br />FILE <br /> <br />MC15-$19~REV <br /> <br /> <br />