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AUTHORIZATION NOTIC~/~EISTING SYSTEM EVALUATION <br /> PUMPER <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />If your sewage system l~ less than five ($; years old, and w~ do <br />not have a record Of an approved installation of the sy~tem~ <br /> <br />or; <br /> <br />If your sewage system is more than five ($) years old or ha~ not <br />been Dumped within the last five years~ <br /> <br />a. You mu~t Nave the septic tank pumped. <br />b. Have ~he septi~ tank pumper c0mple~e the form below. <br />c. A field visit will be required by the Sanitarian to verify <br /> <br /> Stayton/MilfO~gp~icSi~a~cot~n ~ Use Only <br />COMPANY NAME: ~Dt~C ~TVi~ ~. DEQ L~CENS~ NO, 349~6 <br />PROPERTY O~ER: ~S S. ~d <br /> <br /> A~vill~, ~n <br />APPROXI~T~ ~ OF SZPTIC TANK: 1000 <br /> <br />IS TAN~ IN ~000 CONDITION? <br /> <br />ARE EAPFL~$ OR ELBOWS IN PLAC=? <br /> <br />IS DRAIHFI~LD ~A~KING UP INTO TANK? <br /> <br />S~PTIC TANK MATERIAL: Co~crete X <br /> <br />*****NOTE: Tank leaks at seams -- Water level in tank too low. <br /> DIAGRAM O~ NOUSE AND <br /> LOCATION OF TANK~ <br /> <br />U ×,amp 1 e: <br /> <br />Rev 7/89 pb <br /> <br />N <br /> <br />DATE OF PUMPING: July 21, 1992 <br /> <br /> <br />