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BUILDING INSPECTION <br />.3150 LANCASTER DR NE - SUITE C <br />SAL£M OR 97~05 <br />PH# (503)588-5147 <br />FAX//(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 apprepdate <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 />A. <br />B. <br />C. <br /> <br />The septic tank must be pumped by a OEQ licensed sepUc tank pumper. <br />The septic tank pumper must complete the form below. <br />A field inspection wilt 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 />~tayton, Mill City and Silverton Septic Services <br /> ompanyName " DEQkicense#: <br /> <br />Pmpe~Address: 185 S~ntiam Avenue Detroit OR 97342 <br /> <br />Preperty Owner: Jim Cook <br /> <br />System currently serves: Residence <br /> <br />Septic Tank Material: Concrete <br /> <br />Is Tank in Good Condition? Yes <br /> <br /> X (# ol bedrooms 2 ) <br /> <br /> Steel X <br />X No If No, explain: <br /> <br />37814 <br /> <br /> Size of Tank: 5 0 0 gallons <br /> <br /> Commemial (# of employees__ ) <br />Other <br /> <br />Are inlet & outlet fittings In place? Yes x No __ / Solids level in tank? Normal __ Excessive __ <br />Is disposal field backing into tank? Yes__ No X 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. <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK. SHOW DETAIL AND MEASUREMENTS: <br /> <br />N <br /> <br /> 09/23/99 <br />DATE OF PUMPING <br /> <br />~I~ri~A:rL~E 0 Jr-~1~ M~ <br /> <br />MCI5~S19/REV 4-9g <br /> <br /> <br />