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(Susplemental Form) <br /> ,, <br /> <br /> order to sroperly evaluate your existing sewage sys=e~, the following <br />information will be necessary: <br /> <br />h~ve an approved record of the sOs=eH, we can proce~ without <br /> fur=her action o~ ~ourlpart. <br /> <br />If your s~eage system is les.__~than five (5) years old, and i~e <br />d~ no___._~thave a record of a~ approved i~s=allat~en of ~he system: <br /> or; <br />If yo~;r s~age system is more ~han five ($) years old or has no= <br />bee~ p==ped wi~hi~ th~ last five years: <br /> <br />a. You must have =he sept~ tank pumped. <br />b. Have the septic =ank pamper c~mplet~ the form b~low. <br /> A field ViSl= will be reqU~ed bg ~he S~tarian ~o <br /> verify =he location and ~ndit~ of ~he s~pt~c system. <br /> <br /> pampe~ within the las= five {5) years, s~c~ions ~ & b <br /> will nec be required. <br /> <br /> -For Se$~i~ Ta~ Pum~r Use ~1~- <br /> <br /> Stayton, Mill City & Silverton Septic Services 34916 <br />COMPANY NA~Z~: DEQ LrCENS~ <br /> <br />PROPERT~ OWNER: <br /> <br />ADDRESS WHERE TAN~ PUMPED: <br /> <br />Howard Relocation Group <br />%~5 Patton <br /> <br />DetrOit, OR <br /> <br />APPROXIMATE SIZE OF SEPTIC TANIf: 500 <br /> <br />gallons metal <br /> <br />IS T;~¥K IN GOOD CONDITION? <br /> <br />ARE ~AFFLES OR ELBOWS IN PLACE? <br /> <br />XX YES; NO <br /> <br />IS DRAINFIELD BACKING UP. INTO TANK? <br /> <br />~ NO <br /> <br />If yes, <br /> <br />DIAOR~ OF HK~iSE AND <br />LOCATI61~ OF <br /> <br />21~6 <br /> <br /> <br />