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SEPTIC ~AN~ pUHPI~¢,~-N~ I~SP~ClION ~01~4 <br /> <br />The following requirements apply to the evaluation of an existing on-site <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />1. If your sewage system is ~.ess than five (~) year~ old and a Certificate <br /> of Satisfactory Completion has been issued for the system, the septic <br /> tank does not require pumping at this time. <br /> a. Authorization Notices do not require a field inspection of the <br /> system. A report can be issued based on a review of our files. <br /> b. Existing System Evaluations d__o require a field inspection of the <br /> entire system and a report will be issued. <br /> <br />2. If your sewage system is m.ore than five (5) years old and the septic <br /> tank has not been pumped within the last five (5) years, follow the <br /> directions below. If you have proof that the septic tank has been pumped <br /> within the last five (5) years, section (a) will not be required. <br /> a. ~he septic tank must be pumped by a D.B.Q. licensed septic ~ank <br /> pumper. <br /> b. The septic tank pumper must Complete the form below. <br /> s. Authorization Notices and Existing System Evaluations require a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> *for septic pumper use only* <br /> <br />APPROXIMATE SIZE OF TANK: /- _gallons <br /> <br />SEPTIC TANK MATERIAL= Concrete <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br /> If "No", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? <br /> <br /> If "Yes", explain=.. <br /> <br />Other <br /> <br /> .. Yes ~; No. <br />... Yes .; No. ~ <br /> <br />DIAGRAM OF MOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br /> f <br /> N <br /> <br />(503) 588-5147 Senator ~,uiidln8 <br /> <br /> <br />