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Marion County ON-SZTE SEWAGE SYSTEM <br /> SEPTIC TANK pUMPING AND INSPECTION FORM <br /> <br />0 R E G ON <br /> <br />The following <br />eewage system. <br />carefully. <br /> <br />requirements apply to the evaluation of an existing on-site <br />Please select the appropriate section and follow the directions <br /> <br />If your sewage system is less than five (5) years old and a <br />Certificate of Satisfactory Completion has been issued for the <br />system, the septic tank does not require pumping at this time. A <br />field inspection will be made of the entire system and a report <br />will be issued. <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not been pumped within the last five (S) years, <br />follow the directions below. If you have proof that the septic <br />tank has been pumped within the last five (5) years, sections (a) <br />and (b) will not be required. <br />a. The septic tank must be pumped by a D.E.Q. licensed septic <br /> tank pumper. <br />b. The septic tank pumper must complete the form below. <br />c. A field inspection will be re~ired by our on-site staff to <br /> verify the location and condition of the septic system. <br /> <br /> *for septic pumper use only* <br /> (please print) <br /> <br />COMPANY NAME: ~d~' .~. ~./~'~g~/~ D.E.Q. LICENSE #:_~-~3~,g~ <br /> <br /> / <br />pROPERTY ADDRE S S: ~ ~1 ~,~ ~-,- I~ ~m~ / ~ <br /> <br /> APPROXIMAT~ SIZE OF TANK: <br /> <br /> SEPTIC TkNK MATERIAL: Concrete . ..; Steel/h/; <br /> <br /> IS TANK IN GOOD CONDITION? ............. Yes 7~ <br /> <br /> If "NO", explain: <br /> <br /> ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes <br /> <br /> IS DISPOSAL FIELD BACKING INTO TANK? ... Yes <br /> <br /> ~f "Yes", explain: <br /> <br /> DIAG~ OF MOUSE AND SEPTIC TANK: <br /> <br /> ~ / <br /> N <br /> <br />MC15-S19 (503) 588-.5147 Senator Building, 2nd Floor <br />R~ 10-92 220 High St, NE' S~]em, OR 97301-3670 <br /> <br /> gallons <br />Other <br /> <br /> NO <br /> <br />No <br /> <br />(show detail with measurements) <br /> <br />DA~E OF PUMPfN~ <br /> <br /> <br />