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3150 LANCASTER DR NE - SUITE C <br /> SALEI~ OR 97305 <br />o,, ~ o. PH# (503)588-5147 <br /> FAX# (soz)s88-7948 ~h¥ ~ I 1999 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> INSPECTION FORM <br /> <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, fo,ow 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 vedfy the location and condition of the septic system. <br /> <br />..... FOR SEPTIC PUMPER USE ONLY- - -- - <br /> <br />Company Name: · <br /> <br />Property Owner:. _L(~l.~r'c_~c e pt~,eF~.~'."~ <br />System currently serves: Residence ~ (# of bedrooms <br />Septic Tank Material: Concrete Steel <br /> <br />DEQ License #: <br /> <br /> Size of Tank: / ~ gallons <br /> <br /> Commercial (# of employees__ ) <br />Other ,/P~ 4d~())~r~ ~,i~5 <br /> <br />Is Tank in Good Condition? Yes ~ No <br />Are inlet & outlet fittings in place? Yes <br />Is disposal field backing into tank? Yes I <br /> <br /> If No, explain: / <br />No / Solids level in tank? <br /> No ~/'~ If Yes, explain: <br /> <br />Normal Excessive <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. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br />RECEIVED <br /> <br /> HAY ~ 1999 <br />MARION C0UNTY <br />BUILDING INSPECTION <br /> <br />DATE OF PUMPING <br /> <br />S G fUF E OF PUM 'T <br /> <br />MC 15-S 19/REV 4-99 <br /> <br /> <br />