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(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />rf your sewage system is less than five (5) years old, and we <br />have an approved recold o'f the system, we can proceed without <br />any further action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we <br />do not have a record of an approved installation of the system: <br /> or; <br />If your sewage system is mor__e than five (5) years old or has not <br />been pumped within the last five years: <br /> <br />a. You must have the septic tank pumped. <br />b. Have the septic tank pumper complete the form below. <br />e. A field visit will be required by the Sanitarian to <br /> verify the location and condition of the septic system. <br />d. 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: ........... Stayton Septic Service <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WHERE TANK PUMPED: <br /> <br /> DEQ LICENSE NO; <br /> <br />Mrs. Barney Whelen <br />10241 Leverman Rd. <br />Aumsville, OR <br /> <br /> 350 concrete <br /> _gallons <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />34916 <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />X~ YES; NO <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> The tank has not been used in <br /> if yes, explain; <br /> <br />DIAORA~ OF HOUSE AND <br />LOCATION OF T~¥K: <br /> <br />EX~PLE: <br /> <br />Septic Tank <br /> <br />v, 3/s6 <br /> <br /> YES; iX NO <br /> 15 yeaus.--~T~:fere was no %ate~ in i%~ only <br />sludge at bottom. There does not a~pear to be any c~acks <br />or areas w~ Wa.ret ~s escaping. <br /> <br /> <br />