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04/01/i998 iS:t6 5032636223 <br /> <br />REALTY WORLD OANBY A <br /> <br />PAGE 03 <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE- SUITE C <br />SALEM OREGON 97305-1398 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> iNSPECTION FORM <br /> <br />The ~ollowing requirements apply fl3 ~ ~valuaUon of an existing on-site sewage ~ystem. Please $~ect the appropriate <br />sec~on and follow [he directions <br /> <br />If your sewage system is less than five (5) years eld and a Certifi,~ate of Satisfactory Complelion has been issued [or <br />[he system, the septJo tank, does rmt require pumping at this ~me. A fle~d inspection will be made of the entire system <br />and a repel1 will be issued, ~ <br /> <br />i! your sewage system Is m~e then five (5) years old and the septic tank has not been pumped within the last five (5) <br />years, follow the directions below. !f you have I~oof that I~s septic lank has been pumped wRhin the last £~ve (5) <br />years. (A) will not be required. <br /> <br />A, <br />8, <br />C. <br /> <br />The septic tank must be pumped by a DEQ licensed septic tank pumper. <br />The septic tank pumper taus! Complat. the form below. <br />A ~ Inspecl~n will be requi~d by our C~l..slte staff fo ve,.t~ [he I~:ation and condition ol'the septic system, <br /> <br />..... FOR SEPTIC_ PUMPER USE ONLY ..... <br /> <br />Company Name:'~~C (.~l~,"~ JDEQ Lic~ense: ~'~--~-~ ~,. ~ <br /> <br />~p~c T~k ~1: ~n~ Steel~ O~ec <br />Is Tank in ~d C~d~on? Y~ N~ If No, please e~l~n: <br /> <br />Are in~ & ou~ fiffi~ in ~? Yas ~F' N~ <br />Is dis~sal fleM backi~ in~ ~n~ Yes -- No~ It Y~. e~l~n: <br />If a~ e~enl pu~ is Jn~ud~ as ~ o~e ~ ~sl~, [he d~g ta~'k end ~u~ assembly must ~ ins~ and <br />clean~ ~ ~ sep~ tank ~ ~mped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />'t <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br /> <br />