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A & B SEPTIC S RVICE, INC. <br /> 7525 WINDSOR ISLAND RD, NORTH SALEM, OREGON 97303 <br /> <br /> ~ ~ ~ (503)393-1311 <br /> <br />ADDRESS OF TANK PUMPED: ~/~ ~' ~? ~W ~t <br /> <br />APPROXIMATE SIZE OF TANK:~ GALLONS <br />TANK CONDITION? GOOD~ PAIR CONCRETE ~¢ ~ OTHER <br />ARE BAFFLES OR ELBOWS IN PLACE? YES ~ NO__ <br />EFFLUENT PUMP ¢ PUMP TANK ~ DOSING SYSTEM <br />DRAINFIELD WORKING <br />sou~s: No.M,~ ~¢~ <br /> <br />REPAIR NEEDS: INLET O~ OUTLET ~" MAINLINEZ)~2 LID <br />TI'["E LINEO~ LOTSIZE~,~/~ NO. BR ~ HOUSE:VACANT__ <br />NUMBER OF PEOPLE tN HOME: PRESENT ~' PREVIOUS <br />NUMBER OF YEARS SINCE LAST PUMPING ~ <br />RECOMMENDED PUMPING INTERVAL: ~¢ <br /> ~( <br /> ItO~ <br /> <br />¢/~,,~ SURFACING ~0 SLUGGISH <br /> EXCESSIVE OVER OUTLET <br /> ~L-D. BOX <br /> <br />OCCUPIED <br /> <br />~ARION COUNTY <br />BUILDING INSPECTION <br /> <br />SIGNATURE OF PUMPER: <br /> D.E.Q. LICENSE O~'~ . <br /> <br />DATE: <br /> <br /> <br />