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'~ BUILDING INSPECTION <br /> 285 CHURCH ST NE <br /> SALEI"I OR 97301 <br /> <br />o,,~o~ PH# (503)588-5147 <br /> FAX#(503)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIG TANK PUMPING AND <br /> IN$PEGTION 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 SatisfactoP/Completion has been issued lor <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: L;L.' <br /> <br />Property Owner:. <br />Septic Tank Material: Concrete._~ Steel Other: <br /> <br />Is Tank in Good Condition? Yes...~ No__ If No, please explain: <br />Are inlet & outlet fittings in place? Yes X' No <br />Is disposal field backing into tank? Yes__ No/~ If Yes, explain: <br /> <br />DEQ LicenSe: 3~'C'~ <br /> <br />S~e of Tank: Z ~ gallons <br /> <br />If an effluent pump is included as paFt 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. SH{ <br /> <br />MARION COUNTY <br />RU!LDING INSPECTION <br /> <br /> <br />