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BUILDING INSPECTION <br />31 SO LANCASTER DR 'NE · SUITE C <br />SALEM OR 97305 <br />PH//(503)$B~-$14.7 <br />FAX//(503)588-7948 <br /> <br /> ON-SITE SEWAGE SYSTEM <br />SEPTIC TANK PUMPING AND <br /> INSPECTION FORM <br /> <br />The fot~c~ing requirements apply to the evalustion of an existing on-site sewage system. Please lsetact the appmpflate <br />section and follow the directions carefully. <br /> <br />1. If your sewag~ 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 tflan five (5) years old and the septic tank has not been pumpecl within the last five (5) <br /> years, ~ollow the directions below, if you have proof that the septic tank has been pumped within the last five (5) <br /> years, (,6.) will r, ot be required. <br /> <br />The septic tank must be pumped by a DEQ lioe0sed septio tank pumper. <br />The septic tank pumper must complete the form below. <br />A field inspection will be required by our on-site staffto vedfy the location and condition of the septic system. <br /> <br />Property Owner: ~.?,,-,.'v~. <br />Septic Tank Material: Concrete Steel. <br /> <br />- - --- FOR SEPTIC P.UMPER USE O.,N.,L¥ .---. <br /> <br />Size of Tank: ~O O <br /> <br />Is Tank in Good Condition? Yes ---.--., No . . <br />Are inlet & outlet fittings in place? Yes ~ <br />Is ~isposal fie~d backing into tan~ Yes ..~ <br /> <br />gallons <br /> <br />If an effluent pump is included as pat'[ of the septic system, the dosing tank end 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 />S <br /> <br />DATE OF PUMPING <br />SIGN~I~E'OF pLTM P E R <br /> <br />MCtS-$19/REV <br /> <br /> <br />