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BUILDING INSPECTION <br />3t50 LANCASTER DP. NE - SUITE C <br />SALEI'4 OR 97305 <br />PH//(503)588-5147 <br />FAX//(503)588-7948 <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 Certil'icate 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 betow, if you have proof that the.s~ptic tank has been pumped within the last five (5) <br />years, (A) will not be requim~:L <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 stalf to vedfy the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Stayton, Mill City and Si[verton Septic Services <br />CompanyName: DEQLicanse#: <br />Pmpe~Addmss: 7878 Barbara Lane S E Aumsville OR 97325 <br /> <br />37814' <br /> <br />Property Owner:. Jeff Albee Size of Tank: ],, 500 gallons <br /> <br />System currently sen/es: Residence :~ (# of bedrooms $ ) Commemial (# of employees ) <br /> <br />Septic Tank Material: Concrete X Steel Other <br /> <br />Is Tank in Good Condition? Yes X No __ If No, explain: <br />Are inlet & ouOet fittings in place? Yes X No__ / Solids level in tank? Normal X Excessive__ <br />Is disposal field backing into tank? Yes __ No X If Yes, 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 /> 09/22/99 <br /> <br />181(~N'ATORE oF PUM'PE/~ <br /> MC t5-S 191REV 4-99 <br /> <br /> <br />