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(Supplemental Form) <br /> <br />In,order to properly evaluate your axis~im~ ~ewage s~stem, the followin~ <br />informatio~ will be nec~ssarW: <br /> <br /> ~f gout =ewage age,em is le$___~ than five (5) gears old, ~nd we <br /> any further ectioa on gout part. <br /> <br /> If your sewage =gstem is les_~_~s than five (5) ~ears old, aa~ We <br /> do no_~__~ have a re,rd of an approVed installation of the <br /> <br /> If 90ur sewage system is mor~ than five (5) years old Q$ <br /> <br /> You must have the sep~im tank pumped. <br /> Have =he septic tank pumper ~m~let~ the form <br /> c. A field visit will be required b~ th~ Sanitarian ~ <br /> verify the lOca=i~ and condition of :he s~pt~C <br />d. If ~o~ have sr~f tha~ gout sepeic t~k has <br /> pumped wi=bin =he las~ fiv~ [5) ~ears, ~a~ioas a ~ b <br /> will no= be r~quir~d. <br /> <br />COMPANY NAME: $~a~ton Septic Service <br />PROI~ERTY OWNER: ....... D~ane Woolsey <br /> <br /> 11457 McClellan <br />ADDRESS WHER~ TANK PUMPED: <br /> Aums~ !lc, OR <br /> <br /> 550 me~a~ <br />APPROXIMAT~ SiZE OF SEPTIC TANK:~allons <br /> <br /> XX YES~ <br />~ YES; Xx NO <br /> <br />IS T~NK IN GOOD COHDI~ION <br />ARE BAFFLES OR ELBOWS IN <br />IS DRAINUZELD BACMING UP <br /> <br />off <br /> <br /> Septi= <br /> Tank <br /> 6 ' ~ <br /> <br />, · ,, ,~ZeC ,, <br /> <br />DIAGRAM OF HOUSE AND <br />EXAMPLE: <br /> <br />below Outlet, Tank has no~ ~eeu <br /> <br /> <br />