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BUILDING INSPECTION <br />3 ! 50 LANCAST'EP~ DJ~ NE - SUITE C <br />SALEI~I OR 97305 <br />PH//(503)588-5147 <br />FAX//(503)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPINGAND <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 Satisfacto~ 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 pumpedwi~cijl~j~/e (5) <br />years, (A) will not be required. <br /> <br />A. The septic tank must be pumped by a DEQ licensed septic tank pumper, fi <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 condjJi/~j~e~i~/:[~Ystem. <br /> BUILDING INSPECTIOE <br /> <br />..... FOR SEPTIC PUMPER USE ONLY ..... <br /> <br />Property Owner: ,._~:;,Z~,:,,~_~ <br /> <br />Septic Tank Material: Concrete <br /> <br /> Steel <br />Is Tankin Good Condition? Yes / No <br />Are inlet & outlet fittings in place? Yes ~ No <br /> <br />Is disposal field backing into tank? Yes __ No__ <br /> <br /> DEQ License:~..~& <br /> <br /> Size of Tank: ~ gallons <br /> Other: <br /> <br />__ If No, please explain: <br /> /~lf 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 />cleened when the septic tank is pumped. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br /> DATE OF PUMPING <br />~'~-ATORE OF PUMPER <br /> <br />MC15-S19/REV 4-98 <br /> <br /> <br />