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AUTHORIZATION NOTIC~ <br />{supplemental Form) <br /> <br />In order to properlw evaluate your existing sewage system, tbs follo~¢ing <br />fnfo~mti~ will be necessar~ <br /> <br />rf your s~wsge system is les___~s than five (5) ~ea=s old, and we <br />have an approved record of the $gS=em, we can pz~eeed without <br />~ further a~io~ O~ your part. <br /> <br /> If your s~wage system is les__s~ha~ five (5) gears old, and we <br /> do not have ~ reo~;rd of ~ ap~o~d lnstallati~ of the s~stem; <br /> <br /> ~ your s~a~ system i~ ~r~ than fiv~ (5) ~ea~s old or has not <br /> bee~ p~d w~thin the last five <br /> <br /> a. You ~st ha~ Ohs ~eptic t~k <br /> b. Ha~ the septic t~ p~r comple=e the fu~ below. <br /> c. A field visit will ~ require~ b~ the S~itari~ <br /> <br /> d. If ~ou have p~f tha~ Uour septi~ :~k has been <br /> pumped within th~ l~t fi~ (5) gear~, sections a & b <br /> will not be <br /> <br />PROPER~ ~ER~ PUnY ~L ESTATE SRO~ ~.U.S. <br /> <br />WHERE 2ANK PUMPgD: 8991 F-~ol.,,iff Ct. $,]~, Aumsville~ Ore. <br /> <br />A~PROX~ATE SIZE OF SEPTIC TANK: <br /> <br />~S TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ~L~OWS ZN PLACe? <br /> <br />~S DRAINFIELD BACKING UP INTO T~K? <br /> <br /> If yes, explains_. . <br /> <br />YES; <br /> <br />... YES; <br /> <br />NO <br /> <br />DIACRA~ OR ~OUSE AND <br />AOCATTON OF TANK: <br /> <br />Sapti <br /> e <br /> <br />Rev. 2/86 <br /> <br /> <br />