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(Supplemental Form) <br /> <br />In order to properly evaluate your existinO sewage system, the following <br />Information will be necessary: <br /> <br />Ff Hour sewage system is ness than five (5) gears old, and we <br />have an approvsd record of the system, we can proceed without <br />any further action on your parr. <br /> <br />If your sewage system is ~$s than five (5) gears old, and we <br />do Dot have a record of an approved installation of =he system: <br /> or; <br />If your sewage system is more than five (5) years old or has not <br />besn pumpe~ within the last five years: <br /> <br />a. You must have the septic tanR pumped. <br /> ;lave the septic tank pumper complete the form below. <br />c. A field visit will be required bg the Sanitarian ~o <br /> verify the location end condition of the septic system. <br />d. If you have proof that your septic tank has been <br /> p~mped within the last five (5) years, sections a & b <br /> will no~ be required. <br /> <br />COMPANY NA~E: <br /> <br />PROPERTY OWNER=.. <br /> <br />ADDRESS WHERE TANK PUMPED; <br /> <br /> -For Septic Tank"Pumper Use Only- <br />Stayton Septic Service <br /> <br /> DEQ LICENSE NO: <br /> <br />Rodney & Ma~ia Coakley <br /> <br />5785 Shaw Hwy. <br />Aumsville, OR <br /> <br />34916 <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS JN PLACE? <br /> <br />ZS DRAINFIBLD BACKING UP INTO TANK? <br /> <br /> If yes, e~platn; <br /> <br />DIAOR;~ OF HOUSE AND <br />LOCA-~Id~¥ OF TA~¥K: <br /> <br />EX.~;PLE : <br /> <br />Tank <br /> <br />1000 <br /> <br />_gallons <br /> <br /> xx <br /> YES; <br /> <br /> Xx <br /> YES; <br /> <br /> YES; <br /> <br />concrete <br /> NO <br /> NO <br /> NO <br /> <br />........ <br /> <br /> <br />