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BUILDING INSPECTION <br />3150 LANCASTER DR NE - SUITE C <br />SALEI"I OR 97305 <br />PH# (S03)S88-S 147 <br />FAX# (S03)S88-7948 <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 I 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 <br />the system, the septic tank does not require pumping at this time. A field inspection will <br />and a report will be issued. <br /> <br />n has been issued for <br />ade of the entire system <br /> <br />2. If your sewage system is more than rive (5) years old and the septic tank has not within the last five (5) <br /> years, follow the directions below. If you have prcof that the septic five (5) <br /> years, (A) will not be required. <br /> <br />The septic tank must be pumped by a DEQ licensed septic tank pu <br />The septic tank pumper must complete the form below. <br />A field inspection will be required by our on-site staff to verif <br /> <br />condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER US <br /> <br />Company Name: <br /> <br />Property Address: <br /> <br />Property Owner: <br /> <br />System currently serves: Residence <br /> <br />Septic Tank Material: Concrete <br /> <br />Is Tank in Good Condition? Yes <br /> <br />Are inlet & outlet rittings in place? Yes __ <br /> <br />Is disposal field backing into tank? Yes __ <br /> <br />If an effluent pump is included as part of the <br />cleaned when the septic tank is pumped. <br /> <br /> Steel <br /> <br />No <br /> <br />License #: <br /> <br /> Size of Tank: gallons <br /> <br /> Commercial __. (# of employees__ ) <br />Other <br /> <br /> / Solids level in tank? Normal Excessive __ <br /> <br />__ If Yes, explain: <br /> <br /> the dosing tank and pump assembly must be inspected and <br /> <br />DIAGRAM OF HOUSE AND <br /> <br />TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />DATE OF PUMPING <br /> <br />SIGNATURE OF PUMPER <br /> <br />MC15-S 19/REV 4-99 <br /> <br /> <br />