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In order to properly evaluate your existing sewage system, <br /> <br />the following <br /> <br />information will be necessary: <br /> <br />If your sewage system is less than five (5) years old, and we have <br />an approved record of the SyStem, we can proceed without any <br />further acSion on your part. <br /> <br />2. If your sewage sysSem is less than five (5) years old, and we do <br /> not have a record of ~n approved installation of ~he system: <br /> <br />****NOTE: <br /> <br /> If your sewage system is more %hah five (5) years old or has not <br /> been pumped within the last five yearm: <br /> <br /> a. ¥o'u must have the septic tank pumped. <br /> b. Have the septic %~nk pumper complete the form below. <br /> c. A field visit will be required by the Sanitarian to verify <br /> the location and CoRdition of the ~eptic system. <br /> d. If you have proof that your septic tank has been pumped <br /> within the last five (5) years, ~ections a & b will not be <br /> required. <br /> <br /> Stayton/Mill clEy ~ ozzvernon <br />COMi~ANY NA/dE: Septic Services D~Q LICENSE NO. 349]6 <br /> <br />PROPERTY OWNER; Roger & Patti Roth <br />AD~R~S W11ERE TANK PUMPED: <br /> <br /> Detroit ~ Ore,on <br /> <br />APPROXIMATE $I~ OF $~PTIC TANK: 1000' <br />IS TANK IN GOOS CONDITION? X <br />ARE BAFFleS OS ~SOWS IN PLACE? X <br /> <br /> _gallons <br />YES; NO <br />YES; NO <br />y~$; X NO <br /> <br />IS D~AINFIgLD SACKING UP INTO TANK? <br />If yes, explain; <br />SEPTIC TANK MATERIAL: Concrete Steel X Other <br /> <br /> Evidence that water level in tank has been high in past. <br /> <br /> Water level in tank OK at t~me of pumping. <br /> DIAGtQkM OF MOUSE AND <br /> LOCATION OF TANK: <br /> <br />example: <br /> <br />wall <br /> <br />Rev 7/89 pb <br /> <br /> <br />