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BUILDING INSPECTION <br />285 CHURCH ST NE <br />SALEI'~ OR 97301 <br />PH# (503)588-5147 <br />FAX/I(503)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMP lNG 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) yearn 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) yearn old and the septic tank has not been pumped within the last five (5) <br />yeere, follow the directions below. If you have proof that the septic tank has been pumped within the last five (5) <br />yearn, (A) will not be required. <br /> <br />A. <br />B. <br />C. <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 ~ 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 />Septic Tank Material: Concrete <br />Is Tank in Good Condition? Yes '~ <br />Are inlet & outlet fittings in place? Yes. <br /> <br />Is disposal field becking into tank? Yes <br /> <br />Company Name: ~-Cj~ <br />Propert~ Address: <br /> <br />Pre~ ~ne= <br /> <br /> DEQ License: ~"~ /C~ <br /> <br /> Size of Tank: _...~1~ gallons <br />Other:. <br /> <br /> No, IfNo. please explain: -'/'l'~ ~-~ t~Jf~L ~,~ ,>t.J <br /> "~ No <br /> No. '--/ If Yes, explain: <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 />DATE OF PUMPING <br /> <br /> <br />