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(Supplemental Form) <br /> <br /> order to properly evaluat~ your existing sewage system, the followieg <br />hnformation will be necessary: <br /> <br />rf your sewage sys=em is less than five (5) years old~ and we <br />have an approved record of the sgscem, 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 hava a record Of an approved installation of the system: <br /> <br /> or; <br />If your sewage system is more than five {5) years old or has not <br />been p=~ped within the last five years: <br /> <br /> You must have the septic tank pumped. <br />b. Have the septic tank pumper complete the form below. <br /> A field visit will be required bH the Sanitarian ~o <br /> verifg the location and condition of the septic system. <br /> If you have proof =ha~ your septic t~k has been <br /> pumped wichin the last five {5) years, sections a & b <br /> will DoC be required. <br /> <br /> Stay=on, <br />COMPANY N~E: <br /> <br /> -For Septic Tank Pumper Use Only- <br />Mill City & Silverton Septic Services <br /> DEQ LICENSE NO: <br /> <br />PROPERTY OWNER: <br /> <br />Howard Relocation Group <br /> <br />ADDRESS WHERE TANK PUMPED: <br /> <br />1~%~5 Patton <br />D~it, OR <br /> <br />34916 <br /> <br />APPROKZMATE SIZE OF SEPTIC TANK: 500 <br /> <br />gallons metal <br /> <br />IS T~¥K IN GOOD CONDITION? <br /> <br />XX YES; NO <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />XX YES; NO <br /> <br />IS DR~INFI~LD BACKING UP INTO TAN~? <br /> <br />YES; .. X~ NO <br /> <br />If yes, explain; <br /> <br />DIAORA~%! OF HOUSE AND <br />LOCATION OP TA.VK: <br /> <br />Septic <br /> Tank <br /> <br />v· <br /> <br /> <br />