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AUTHORIZATION NOTIC~/EXISTING SYSTEM EVALUATION <br /> <br /> PUMPER FORM <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be Decessary: <br /> <br />If your sewage system is less than five (S) years old, and we have <br />an approved record of the system, we c~n proceed without any <br />further action on your part. <br /> <br />If your sewage my~tem is less than five ($) years old, and we do <br />not have a record of ~n approved installation of the system: <br /> <br />or; <br /> <br />If your sewage system is more than five (5) years old or has not <br />been pumped within the last five years: <br /> <br />a. You mu~t have the septic tank pumpe~. <br />b. Nave the septic tank pumper complete the form below. <br />c. A field visit will be required by the Sanitarian to verify <br /> the location and condition of the septic ~y~tem. <br /> If you have proof that your septic tank has been pumped <br /> within the last five (5) year~, ~ections a & b will not be <br /> required. <br /> <br /> S- -- , ~ For ~eptic ~ank <br /> Lay~on/Mi±l Cisy & Silver+on <br /> COF~PAN¥ NAME: S~Dt~ c ~l~ices % DEQ LICENSE NO. <br /> <br /> PROPERT¥ O~rNER: ThcH~as A. Schmid <br /> <br /> ADDRESS ~HERE TANK PUMPED: 7490 Sherman Road, SE <br /> <br /> At~nsviller Oregon <br /> <br /> APPROXIMAT~ SIZE OF SEPTXC TANK: 1000 <br /> <br /> IS TANK IN GOOD CONDITION? YES; <br /> ;%RE BAFFLES OR ELBOWS IN PLACE? X YES; <br /> <br /> IS DRAINFI~L~ SACKING UP INTO TANK? <br /> If yes, explain; <br /> <br /> SEPTIC TANK MATERIAL: Co~crete X Steel Other <br /> <br />****~7gOTE: Tank leaks at seams -- Water level in tank too low. <br /> <br /> ~IAGR3~4 OF ~OUSE AND <br /> LOCATION OF TANK: <br /> <br />ex.ample <br /> <br /> 6'~ septic tank <br />· 22 ~- X <br /> North <br /> <br />Rev 7/89 pb <br /> <br />. . <br /> <br />DATE OF PUMPING: July 21, 1992 <br /> <br />349~6 <br /> <br />N <br /> <br /> <br />