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AUTHORIZATION NOTICE/EXISTING SYSTEM EVALUATION <br /> <br />PUMPER FORM <br /> <br />In order to properly evaluate your existing sewage system, the <br />following information will be necessary: <br /> <br /> 1. If your sewage system is less than five (5) years old, <br /> and we have a record of the system, we can proceed <br /> without any further action on your part. <br /> <br /> 2. If your sewage system is more than five (5) years old <br /> and/or we do not have a record of the system: <br /> <br /> a. It will be necessary to have the septic tank <br /> pumped <br /> b. Have a DEQ licensed septic tank pumper complete <br /> the form below <br /> c. A field visit will be required by the Sanitarian <br /> to verify the location a~d condition of the septic <br /> system <br /> d. If you have proof that your septic tank has been <br /> pumped within the last five (5) years, sections a <br /> and b above will not be required. Provide <br /> verification of pumping (receipt from pumper) to <br /> this office. <br /> <br /> --FOR SEPTIC TANK PUMPER USE ONLY-T <br /> <br />COMPANY NAME: Carl~s SepSTc ?~nk DEQ LICENSE NO~ 36051 <br /> <br />PROFERTY OWNER:Peter & Jacquellne RoSS <br /> <br />ADDRESS WF~ERE TANK PUMPED: 19065 Beaver Lane, <br /> <br />AuroFa, Ore,on 97002 <br /> <br />A~PROXIMATE SIZE OF SEPTIC TANK: 1250 <br /> <br />GALLONS <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />YES= NO: <br />YES: NO: <br /> <br />ARE BAFFLES OS ELBOWS IN PLACE? <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br />3/82 Rev 10/87 <br />Car <br /> <br />W <br /> <br />SlGNATUP~ OF PUMPER: <br /> DATE: <br /> <br />gEE ATTACHED FORM <br /> <br /> <br />