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Building Inspection Division Site #: <br />'" --II~lar.~on Coun~_y , o.-sz'~ s~.w~ <br /> SYSTEM <br />'-- ~ .EPTIC T~ P--IN~ ~ INSPECTION FO~ <br /> <br /> The following retirements 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 />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 />2 o <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not' be~n 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 (bi 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 />PROPERTY ADDRESS: <br /> <br />APPROXIMATE SIZE Tm .' /OC-O <br />SEPTIC TANK MATERIAL: Concrete ~ ; Steel <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes <br /> <br /> gallons <br /> <br /> ; Other__ <br />__; No <br /> <br /> If "No", explain: <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACE? .. Yes ~ ; No <br />IS DISPOSAL FIELD BACKING INTO TANK? ... Yes ; No~ <br /> <br />If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: (show detail with measurements) <br /> <br /> MARION COUN~ <br /> BUILDING INSPECTION <br /> <br />DATE OF PUMPING <br /> <br />SIGNATURE OF PUMPER <br /> <br />MCl5-Sl9 (503) 588-5147 <br />REV 10-92 <br /> <br /> <br />