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BUILDING INSPECTION <br />28S CHUR.CH ST NE <br />SALEI¥1 OR. 97301 <br />PH# (503)588-5147 <br />FAX~(50~)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> INSPECTION FORM <br /> <br />The following requirements apply to the evaluation of an existing on-site sewage system. Please select the appropriate <br />section and follow the directions carefully. <br /> <br />If your sewage system is less than five (5) years old and a Certificate of Satisfactory Completion has been issued for <br />the system, the septic tank does not require pumping at this time. A field inspection will be made of the entire system <br />and a report will be issued. <br /> <br />If your sewage system is more than five (5) years old and the septic tank has not been pumped within the last five (5) <br />years, follow the directions below. If you have proof that the septic tank has been pumped within the last five (5) <br />years, (A) will not be required. <br /> <br />The septic tank must be pumped by a DEQ licensed septic tank pumper. <br />The septic tank pumper must complete the form below. <br />A field inspection will be required by our on-site staff to verify the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Company Name: ~11 City, & Silverton Septic DEQ License: Ct 34916 <br />PropertyAddress~ervices 8272 Little Road Aumsville, Oregon 97325 <br /> <br />Property Owner: Tami Yea~er <br /> <br />Septic Tank Material: Concrete <br /> <br />Is Tank in Good Condition? Yes <br /> <br />Are inlet & outlet fittings in place? Yes__ <br /> <br />Is disposal field backing into tank? Yes X <br /> <br /> Size of Tank: 750 gallons <br /> <br /> Steel Other: ~le 1; a 1 <br /> <br />No~ IfNo, please explain: Tank has holes in sides <br /> <br /> No ~._~._. <br /> <br /> No IfYes, explain:Water is gettlng into tank <br /> <br /> · . Do, ssible ba~ dr~nfield <br />If an effluent pump is included as part of the septic system, the dosing tanK an(~ pump assemo~y mus: oe ~nspected and <br />cleaned when the septic tank is pumped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />May 25, 1996 <br /> <br />DATE OF PUMPING <br /> <br /> <br />