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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEFI OR 97301 <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 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 more than five (5) years cid and the; ..ic tank has not been pumped within the last five (5) <br />years, follow the directions below. If you have proof that the set,tic 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 verify the location and condition Of the septic sy~te~n. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Stayton, Mill City and Silverton <br />Company Name: , <br /> <br />Property Address: <br /> <br />Property Owner:. <br /> <br />Septic Tank Material: <br /> <br />Is Tank in Good Condition? Yes <br /> <br />Ars inlet & outlet fittings tn place? <br /> <br />Is disposal field backing into tank? <br /> <br />325 Clester Street <br />Betty Ramage <br /> <br /> Concrete,,, <br /> X <br /> <br /> Yes <br /> <br /> Yes <br /> <br /> Septic Services <br /> 37814 <br /> OEO License:~ <br /> Detroit OR 97342 <br /> <br /> Size of Tank: 500 <br /> ~. gallons <br />Steel X Other: <br />No If No, please expl;dn: __ __ <br />No <br /> <br />No X If Yes, explains: <br /> <br />If an effluent pump is included as part of the septic system, the dosing tan a;~d pump assembly must be inspected and <br />cleaned when the septic tank is pumped. NO?g: T.id repaired and 'replaced back on tank. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />S <br /> JUL 5 t998 <br /> MABION COUNT'/ <br /> BUILDING INBPEC'rlON <br /> <br />MC15-818/REV 4-g6 <br /> <br /> <br />