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BUILDING INSPECTION <br />3,150 LANCASTER DP. NE - SUITE C <br />SALEI'4 OR 97305 <br />PH//(503)588-5147 <br />F^X//(503)588-7948 <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 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 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) 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 />Septic Tank Material: Concrete rZ.~'~'' Steel <br /> <br />Is Tankin Good Condition? Yes ~" No <br />Are inlet & outlet fittings in place? Yes /.,,/ No <br />Is disposal field backing into tank? Yes __ No <br /> <br />DEQ License: <br /> <br />Size of Tank: ,~ gallons <br /> <br /> Other: <br />__ If No, please explain: <br /> <br />//'if 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 />cleaned when the septic tank is pumped, ~e,,,-g,g "~.,.~, ,'~ /~ g,,-~,,,J u,-J~,/,;.,3 c.o..,,~..'~.~,--, ,:~,v~,~.,~ <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br /> DATE OF PUMPING <br /> <br />,~Ri: O~F ~:~IPER <br /> <br /> <br />