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~1arion County <br /> <br />OREGON <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK P~ING AND INSPECTION FORM <br /> <br /> The following requirements apply to the evaluation of an existing on-site <br /> sewage system. Please select the aDpropriate section and follow the directions <br /> carefully. <br /> <br /> 1. If your sewage system is less than five (5) years old and <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 />~ ~ ~ [~ t ~. ~ ~ your sewag'e system is more than five (5) years old and the <br />I~Hptic tank has not been pumped within the last five (5} years, <br />II~llow the directions below. If you have proof that the septic <br />~.~nk has been pumped within the last five (5) years, sections <br /> ~' ; ~ 19~ and (b) will not be required. <br /> a. The septic tank must be pumped by a D.E.Q. licensed septic <br /> <br /> b. The septic tank Dumper must complete the form below. <br /> BU[L N 1fl PE IONc. 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 pr~) .... ~ , <br /> <br />APPROXIMATE SIZE OF TANK: ./.(Y~-~ gallons <br />SEPTIC TANK MATERIAL: Concrete <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? ... Xes__; <br /> <br /> If "Yes", explain: <br /> <br />DIAGRAI4 OF HOUSE AND SEPTIC TANK: <br /> <br />NO <br /> <br />(shew detail with measurements) <br /> <br />MC15-S19 (S0.'D 588 5147 S¢.¢, o'g JinF,, 2nd Floor <br /> <br /> <br />