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AUTHORZZATION NOTICE <br />(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage <br />information will be necessary: <br /> <br />rf your sewage system is less than five ($) 9 <br />have an approved record of the system, we car <br />any further action on your part. <br /> <br />If your sewage system is less than five (5) <br />do not have a record of an approved installa <br /> or; <br />I~ your sewage system is more than five (5) <br />been pumped within the last five years: <br /> <br />b. <br /> <br />You must have the septic tank pumped. <br />Have the septic tank pumper complete the form e ~ . <br />A field visit will be required by the Sanitarian to <br />verify the location and condition of the septic system. <br />If you have proof that your septic tank has been <br />pumped within the last five (5) years, sections a & b <br />will not be required. <br /> <br />-For SePtic Tank Pumper Use Only- <br /> <br />COMPANY NAME: <br /> <br />PROPER~Y OWNER: <br /> <br />Stay:on Septic Service <br /> <br />7727 Sherman Rd., ,' <br /> <br />ADDRESS WHERE ~ANK PUMPED: <br /> <br /> Aumsville, OR ~ <br /> <br />~PROXIMATE SIZE OF SEPTIC TANK: 12~0 gallons concrete <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />XX YES; NO <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />~YES; NO <br />YES; XX NO <br /> <br />If yes, explain; <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br />Septic Tank <br /> <br /> <br />