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(Susplemental Form) <br /> <br />In o~der' to ~ro~e~i~ ~valuate your exlsti~ s~wa~e S~Stem, the following <br />information will be n~cessarg: <br /> <br />.rf gout sewage system is les__~s ~h~ five (5) gears old, and we <br />hav~ an approved ~ecofd ~f the $~stem, we ~an px~ceed without <br />~ furDher action on ~Our ~rt. <br /> <br />do ~o~ hav~ a re~rd, of an ~ppro~ installation of the <br /> <br />~ ~our sewage s~s~m ~s ~re th~n f~V~ (5) ~ears old or h~s not <br />been p~ed wi=h~n th~ las% f~ve gears: <br />a. You must have the sep=t~ tank <br />b. Have the septic ~k pum~r oom~le:~ :he fo~ below. <br />c. A field visit will be r~quir~d bg ~h~ S~itarl~ ~o <br /> verif9 the location and ~dit~ of =he Septic s~s~em. <br /> <br />PROPERTY <br /> <br />ADDRESS WHERE T~¥K PUMPED= <br /> <br /> Stayten Septic Service <br /> Troy Lu~z <br /> <br /> 6898 Sherman Rd. <br /> Aum$~ille, OR <br /> <br />?h~PROX~MATE $~ZE OF SEPTIC TANK: ~ 000 <br />IS T;J~K IH GOOD CONDITION? <br /> <br />.gallons concrete <br /> <br /> XX ~'~S; Ho <br /> <br />ARE ~AFFLE$ OR ELBOWS IN pLACE? <br /> <br />IS DRAINFIE~D BACKING UP INTO TANK? <br /> <br />XX,,,,~Es; _ NO <br />__YES; XX, ,NO <br /> <br />If yes, <br /> <br />DIAGRA~ OF HOUSE AND <br />LOCATZ~¥ OF T~¥K: <br /> <br />SI(;NA~UR~ OF PUMPER ~ , <br /> <br /> <br />