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.(sopplemen~al Form) <br /> <br />~n' order to properly evaluate your existing sewage <br />info~matiOn will be necessary: <br /> <br /> action on your part. <br /> <br />system, the following <br /> <br />years old, and w~ hava <br /> any furaher <br /> <br />If your sewage system is less than five (5) years old, and we do not <br />have a record of an approved installation of the system: <br /> or; <br />If your sewage ~y~tem is more than five (5} years old or ha~ not been <br />pumper within th~ last five years= <br /> <br />You mus~ have the septic tank pumped, <br />Bare the septic tank pumper complete the form below. <br />A field visit will be required by the Sanitaralan to verify the <br />location and condition of the septic system. <br />If you have proof ~hat your $epti= tank has been pumped within the <br />last five (~) years, ~actions a & b will not be required, <br /> <br /> ~t~.vton/Mill City & Silverton <br />COMPANY NA~E= Silver.tO?' Se~t~.C S~.~ViC~ . <br /> <br /> PROPERTY OWNER: Adrian & ~ane~ A~erV .. <br /> <br />ADDRESs WHERE TANK PUHPED~ 1 ~0...T.,aPm~ ~rive <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />A~E BAFFLE~ OR ELBOWS IN PLACZ? <br /> <br />IS DRA/NFIELD BACKING UP INTO <br /> <br /> If yes, <br /> <br />LICENSE NO: 34Q16 <br /> <br /> gallons <br /> <br /> X YES; .... NO <br /> <br />~YE$; ;.f NO <br /> <br />LOCATION OF TA~K: <br /> <br /> ~ S~pCi¢ Tank <br /> 6'! <br /> <br />............. ~e <br /> <br />/82 Rev 10/87 <br /> <br />W <br /> <br /> <br />