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Marion County ON-SITE SEWAGE SYSTEM <br /> SEPTIC ~]~IK PU~ING ~ INSPECTION FO1~f <br /> <br />OREGON <br /> <br />The following <br />sewage 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 (5) 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 required 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 />PROPERTY OWNER~~',~ <br /> <br />APPROXIMATE SIZE OF TANK:__ff~O <br /> gallons <br /> <br />SEPTIC TANK MATERIAL: Concrete ~; Steel ; Other <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes~; No <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 />No <br /> <br />If "Yes", explain: <br /> <br />DIAGPd~M OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />MC15-S19 <br />REV 10-92 <br /> <br />(503) 588-5147 Senator Building, 2nd Floor <br /> 220 High 5L NE, Salem, OR !)7,3(.)1-')670 <br /> <br />~RE OF PUMPER .... <br /> <br /> <br />