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'. 2/86 <br /> <br />(Suppl'emen~al Form) <br /> <br />In order to prop~rlH evaluate wour existing sewage sp$tem~ the following <br /> <br /> 1. r£ gout sewage $~$~em ~$ le~ th~ fiv~ [5) ~ars old, <br /> have an approved reco~d Of =h~ s~s~em, we ~an proceed without <br /> ang further ac=ion ~ gout <br /> <br /> ~ your sewage system ~s mor~. than five (5) Hears old or has not <br /> <br /> a. You must have th~ $eptlc tank pumped. <br /> b. Have ~he septic tank pumpe~ complet~ the form be2ow. <br /> A field visit will be r~quired by the Sanitarian zo <br /> verifg the locaCton and condO=ion of =h~ septic sgs=~m. <br /> d. If you have proof =ha= ~our septic =~k has b~en <br /> pumped w~thin th~ 2asC five (5] years, s~c~ton~ a & b <br /> will no~ be required. <br /> <br /> -For Septic Tank Pum~r Use Only- <br /> <br />COMPANY NAME: <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WHERE TANK PUMPED: <br /> <br />ptayton Septic S~rvi~ <br /> <br /> Duane Lindley <br /> <br />APPROXIMATE SIZE OF S~PTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN P~ACE? <br /> <br />DEQ LICENSE NO: <br /> <br />34916 <br /> <br />5912 Villag~ View <br /> <br />Aumsville, OR <br /> <br />1000 <br /> <br />gallons concrete <br /> <br /> ~XYHS; NO <br /> <br />XXyEs; NO <br /> <br />IS DRAINFIELD BACKING UR INTO TANK? <br /> <br />YES; ~ NO <br /> <br />DIAGE~'! OF HOUSE AND <br />LOCATI~¥ OF T~¥K: <br /> <br /> 6'~ S~ptic Tank <br /> <br /> <br />