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AUTHORIZATION NOTICE/EXISTING SYSTEM EVALUATION <br /> <br /> PUMPER FORM <br /> <br />In order to properly evaluate your existing Sewage system, the following <br />information will be necessary: <br /> <br /> 1. If your sewage EyE=em is less thud five (5) years old, and we have <br /> an approved record of the system, we can proceed without any <br /> <br /> If your ~ewage system is less than five (5) years old, and we ho <br /> not have a record of an approved lns~alla%iOn of the ~y~tem: <br /> <br />If your sewage system is more than five (5) years old Or ham not <br />been pumped within the last five years: <br /> <br /> You must Dave the septic tank pumped. <br /> b. Nave the septic ~snk pumper complete the form below. <br /> c. A field visit will be required by the Sanitarian to verify <br /> the location and con~ition of the septic system. <br /> d. If you have proof that your ~eptic tank has been pumped <br /> ~i.t,hk~__tbP~A$~ <br /> required. <br /> <br />CO.ANY NAME; Septic Sgrvices DEQ L~ENSE NO. 34916 <br /> <br />~ROmEETX OWNER: Boyd ~.orkq~ist ..... <br /> <br />ADDRESS ~ER~ TANK PUMP~D; 370 Detroit Road <br /> Detroit, Oregon <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: 500 <br />IS TANK IN GOOD CONDITION? ~X <br />AR~ BAFFLES OR EL~0W$ IN PLACE? IX <br />iS D~AINFIELD SACKING UP INTO TANK? <br />If yes, explain; ............ <br />SEPTIC TANK MATERIAL: CoDCrete <br />**NOTE: Has bad lid. <br />DIA~ O~ ~0~== AND <br />L~ATION OF TANK: <br /> <br />example: <br /> <br />Rev 7/89 pb <br /> <br />W <br /> <br />..... gallons <br />YES; NO <br />YES; NO <br />YES; XX NO <br /> <br />Steel ~Df Other <br /> <br /> ! Penny Wilson, Owner <br />DATE OF PUMPING: <br /> <br /> <br />