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AUTHORIZATION NOTICE/EXISTING SYSTEM EVALUATION ~~ ~ <br /> PUMPER FORM <br /> .In order to proper~y evaluateinformation will be Dece$~ary: your existin~ sewage system, the foll~ ~ ~.~ ~ ~ ~ <br /> <br /> 1. If your sewage ~ystem i~ le~$ than five (5) years o1~, and w~e <br /> <br /> been pumpe~ within the last five years: <br /> <br /> a. You must have the sepKic ~ank pumped. <br /> b. Have the seDtic tank pumper complete the form below. <br /> c. A fiel~ vi~i~ will be requi~ed by the Sanitarian to verify <br /> the location and condition of %he seDtic system. <br /> d. If you have prOOf that yurt ~eptic tank has been pumped <br /> wi=hin the last five (5) years, sections a & b will not be <br /> required. <br /> <br /> For septic Tank ~er Use ~ly <br />Sta~on, ~11 City & Silv~ton <br /> CO,ANy N~: SeDti~ices DEQ LICENSE NO. 34916 <br /> <br /> PROPERTY OWNER: James E. Duncan <br /> <br /> ADDRESS ~R~ TANK PUMPED: 9033 West Stayton Road <br /> <br />Aumsville, Oregon 97325 <br /> <br />APPROXIMATE $IZ= OF S=PTIC TANK; <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />A~E ~AFFLES OR SL~OWS IN PLACE? <br /> <br />IS DRAINFIELD ~ACKING UP INTO TANK? <br /> <br /> If yes, explain; Bad drainage <br /> <br />SEPTIC TANK Fa~TERIAL: Concre=e X <br /> <br />1200 <br /> <br /> ~allons <br />YES; NO <br />YEE; NO <br />YES; NO <br /> <br />-or- Bad drainfiel~ <br /> <br />Steel Other <br /> <br />DIAGRAM OF HOUSE AND <br />~OCATiON OF TANE: <br /> <br />example <br /> <br />Rev 7/89 pb <br /> <br />DAT~ O~ PUMPING: January 5, 1993 <br /> <br /> <br />