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Building Inspe~ion Division ~ Date Rec ' d: <br /> Marion County ~ ~k~J~. <br /> / ~ Site #: <br /> OREGON /J ON-SITE SEWAGE SYSTEM ~ <br /> SEPTIC <br /> TANK PI3MPING AND INSPECTION ,ORM J <br />T~e following requiremen s a ua ~on~an existing on-site <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />If your sewage system is less than five (5) years 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_9o require a field inspection of the <br /> entire system and a report will be issued. <br /> <br />2e <br /> <br />If your sewage system is more 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. The septic tank must be pumped by a D.E.Q. licensed septic tank <br /> pumper. <br />b. The septic tank pumper must complete the form below. <br />c. 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 />coMpANY Nm: IA._/ <br />PROPERTY OWNER: ./~.~/'7%?' ,~JT~._n/'~.~ <br />PROPERTY a <br /> <br />APPROXI~TE SIZE OF TANK: '~ <br />SEPTIC T~K ~TERIAL: Concrete ~ Steel ; <br />IS TANK IN G~D CONDITION? ............. Yes /; No__ <br /> <br /> gallons <br />Other <br /> <br /> If "No", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? .. <br /> <br /> If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br />(503) 588-5147 Senator Building <br />~,,x (503) 588-7948 220 High St. NF · Salem, OR 97301-3670 <br /> <br />DATE OF PUMPING <br /> <br />MC15-S19 <br />REV 1/93 <br /> <br /> <br />