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°u ON-SITE SEWAGE SYSTEM <br /> ' SALE~ OR 97301 ~)~ SEPT C TANK PUMP NG AND <br /> INSPECTION FORM <br /> <br /> ~A ,Yg~ date <br />The following requiremen, apply to the evaluation of ~~g~.em. Please ,el.~ ~e appmp <br />s~on and ~llow the dir~ions careMly. -"~O'/NSp~/vr~ <br /> <br />1. If your sewage system is less than five (5) yearn old and a C~ of Satis~cto~ Completion has been issued for <br /> the system, the septic tank does not require pumping at this time. A field insp~on will be made of ~e entire system <br /> and a repo~ 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 tive (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 />Company Name: ' ' DEQ License: ~ ~.~*~ ? ~* <br /> <br />Septic Tank Material: Concrete~ Steel Other: <br />Is Tank in Good Condition? Yes__~ No If No, pleas~e explain: <br />Are inlet & outlet fittings in place? Yes_~ No <br />Isdisposal field backing into tank?. Yes__ No_.~_._ If Yes, explain: <br />If an effluent pump is included as part of the septic system, the d~sing tank and pump assembly must be inspected and <br />cleaned when the septic tank is pumped. <br /> <br />DIAGRAM OF HOUSE AND sEI~TIC TANK. SHOW DETAIL ~MEASUREMENTS: <br /> <br />DATE OF PUMPING <br /> <br /> MCI 5-S18/REV 4-96 <br /> <br /> <br />