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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEI"I OR 9730! <br />PH# (50:~)588~5 ! 47 <br />FAX~(503)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 lees 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 />A. <br />B. <br />C. <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 /> Stayton/Mill <br />Company Name: <br /> <br />Preperbj Address: <br /> <br />Property Owner:. <br /> <br />Septic Tank Material! Concrete <br /> <br /> City & Silverton <br />Septic Services <br /> <br />12055 Neal Streeti Aumsville~ <br />Robert Hollingsworth <br /> <br />Steel. X Other. <br /> <br /> DEQ License: 34916 <br /> <br />Oregon <br /> <br />Size of Tank: ? 50 gallons <br /> <br />Is Tank in Good Condition? Yes No X If No, please explain: <br />Are inlet & outiet fittings in place? Yes No X NOTE: Replacement of tank. <br /> <br />Is disposal field backing into tank? Yes X No IfYes, explain:__~.raizzfie].d sluj~Lish <br /> <br />If an effluent pump is included as pert of the septic system, the dosing tank and pump assembly must he inspected 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 />October 15, 1996 <br /> <br /> MC15-S18/REV 4-96 <br /> <br /> <br />