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04/8i/1998 15:16 5832636223 <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />.... REALTY WORLD CANBY A <br /> <br />PAGE 02 <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 ex,stag on-sit~ sewage system. Please seJect the aPl~-opha~e <br />sect!on and follow the directions eerefully. <br /> <br />If your sewage system is less than ~e (5) yeats old ami a CertUicate of Satisfactory Completion has been iSsued for <br />the system, the oep~Jc tank. does not require pumpaqg at this t~rse. A field inspection will be made of the entire system <br />and a repo~t will be issued. ~ <br /> <br /> your sewage system is mare ~ five (5) years aid e~d the sepiic bank has rml been pumped within the last five <br />years, ~oJJew the directions b~ow'. !fyou have procl' that the septic tank has been pumped wJttlin the last Cwe <br />years. (A) will not be required. <br /> <br />The septic lank must be pumped by a DEC) licensed septic tank pumper. <br />The septic bank pumper must ¢omp~te the form below. <br />A flekl inspec(fon will be requim~ ~y our o{1-sile staff to redly the (ocatioa and condition of the septic system. <br /> <br />FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Proped. y OwneC. ' gallons <br /> <br />Sepl~c Tank MaterlaJ: Concrete ,~- Steel O{her, . <br />is Tank in Good Co~lltton? Yes ~,~ No .. . If No, pl~se e~{ain: ..... <br />Am inlel & ouUet fiffings in pl~? Y~ ~ N~ <br />is disposal ~ld bating <br /> <br />If an effluent pump ia in~ as ~ o[~e ~¢ sys~m, ~m d~ing ~k and bump assembly must be ins~e~ and <br />cleaned ~en ~e sapac ~nk ~ pureed. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND <br /> <br /> ~UILDING INSPECTION <br /> <br />) DATEOF PUMPING <br /> <br /> <br />