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In or~L~r to p~o~.~.-rly evalnate your <Y~ting r,::~w :,je sys[~ m, %he fo~o'~ing <br /> <br />If your ccwa~3e 'system is lc:ss tbJ~n five (five) <br />a~ approved record of the system, ~e can proc~%~-~ ~ithout .any f~lrth~3r <br />action on your part. <br /> <br />If your sewage system is less than five {5) ~&rs 6¢d,¢han8 we ,fo not <br />have a record of an approved installation of the <br /> or, '' <br />:f yo~r se~'age system is more th3n fiv~ (5) ye~'s <br />pu;:r:per within the last five year~: ~/'~¢A~, "'. <br /> <br />c. i f:cld visit will be re~i:'ed by the Sanitaraz~to verify tke <br /> location and condition of the So~>t ic S~'~,t~'a. <br /> ~f ~:'Ot% h;~Ve proof that your septic tank has hr,~n ~>~; i~0d within t. Le <br /> last five (5) years, sections a & b will not bc required. <br /> <br /> Vet Septic Tank Pu::per U:~e Only <br />(.O,,z. ..... .~,~Y ~ A~E-Stayton, Mill City & Silverton Septic SVc.DEQ LIC?::{SE NO: 34916 <br /> <br />t>ROi~ERTY OKNER: Fred & ~ra ~lin <br />ADI3RE~$ %;HI:RE tANK PUI~t>I:D: 1~937 ~usey ~ <br /> A~sville, OR <br /> <br />API>.ROXI~Q',TE SIZE OF SEPI'IC r;.NK:._ 1000 ~3alJons <br /> <br />iS l,,,[ K IN GOOD CON )I'['IE N? <br /> <br />ARE )3A~'FLES OR ELt30%~S IN PLACF.? <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? ......... YES; <br />If yes, explain; .................. <br />~CI>FIC lANK ~'Lr~k'ERIAY,: Conei:cte <br /> <br />_>_ ._] _-_ ....... <br /> <br /> St <br /> <br />3/232 ,' v <br /> <br />NO <br /> <br />NO <br /> <br /> Steel ~D{ Other <br /> N <br /> <br /> <br />