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Marion County ON-SITE SEWAGE SYSTEM <br /> O REG O N S~PTIC T~NK PUMPING AND INSPECTION FORM <br /> <br /> The following requirements apply to the evaluation of an existing on-site <br /> sewage system. Please select the appropriate sec~io~ and follow the directions <br /> your sewage system is less than five (5~' years old and a <br />~~tificate of Satisfactory Completion has been issued for the <br /> ~ .n~ ~tem, the septic tank does Let require pumping at this time. A <br /> U~U ] 8 1~ field inspection will be made of the entife system and a report <br /> will be issued.' <br /> MARION COUNTY ~ <br /> ~ f your sewage system is more than five (5) years old and the <br /> BUILDING ~NSP 7~0Nsepti¢ tsnk has not' be~n p~mped 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 /> ~ank pumper. <br /> The septic tank pumper must complete the form below. <br /> k field inspection will be required by our on-si~e 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: ~ , gallons <br /> <br />SEPTIC TANK MATERIAL: Concrete., ; Steel ~ ; Other <br /> <br />IS TANK IN GOOD CONDITION? ............. YeS~; No <br /> <br /> If "No", explain: <br />~ I~LET & OUTLET FITTINGS IN PLACE? .. Yes ~; NO <br />IS DISPOSAL FIELD BACKING INTO T~K? .., Yes ; No ~- <br /> <br /> If "Yes", explain: <br /> <br />DIAG~ OP HOUSE ~D SEPTIC T~K= (show detail with measurements) <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br />SIGNATUR~ OF PUMPER <br /> <br />MC15-Sl9 (503) 588-5147 Senator Building. 2od Floor <br />Rg'V 10~9~ 220 High St. NE · 5~lem, OR 97301-36F0 <br /> <br /> <br />