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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEH OR 97301 <br />PH# (503)588-5147 <br />FAX,-9(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 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 />A. The septic tank must be pumped by a DEQ licensed septic 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 verify the location and condition of the septic system, <br /> <br /> ..... FOR SEPTIC PUMPER USE ONLY ..... <br /> Stayton, Mill, City & Silverton <br />Company Name: Sept I c Services DEQ License: 34916 <br /> <br />Property Address: _ ' umsville, Ore~on <br /> Jay ~ She ~1 rime. ~ <br />Property Owner. aay-,~ ~be'r~l Orime~ ~ Size of Tank: 1000 gallons <br />Septic Tank Material: Concrete X.___~ Steel Other: <br />Is Tank in Good Condition? Yes XX No If No, please explain: <br /> <br />Are inlet & outlet fittings in place? Yes XX No__ <br />Is disposal field backing into tank? Yes No XX If Yes, explain: <br /> <br />If an effluent pump is included as part of the septic system, the dosing tank and pump assembly must be 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 /> BEC 5 1 96 <br /> <br />BUILDI[~G INSPECTION <br /> <br />11121196 <br /> <br />DATE OF PUMPING <br /> <br /> <br />