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7525 WINDSOR ISLAND RD. NORTH SALEM, OREGON 97303 <br /> (503) 393-1311 <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS OF TANK PUMPED: <br /> <br />LOCATION OF LID <br /> <br />APPROXIMATE SIZE OF TANK: (~oo GALLONS <br />TANK CONDITION? GOOD__~i~ ~ _ FAIR CONCRETE ujv ') OTHER <br />ARE BAFFLES OR ELBOWS IN PLACE? YES_~¢~ NO <br />EFFLUENT PUMP AJ~ PUMP TANK .'~) DOSING SYSTEM <br />DRAINFIELD WORKING__L~ ~.t_ ._SURFACING _/17 SLUGGISH -4)0 <br />SOLIDS: NORMAL___LI~~_ EXCESSIVE ........ OVER OUTLET <br />REPAIR NEEDS: INLET_J~. _ OUTLET [~__ MAINLINE_~)~. ...... LID__~_~- D. BOX '-- <br />TI~E LINE '~- LOT SlZE_/ J NO. BRa_ ....... HOUSE: VACANT._~ z~ OCCUPIED <br /> <br />NUMBER OF PEOPLE IN HOME: PRES'ENT <br />NUMBER OF YEARS SINCE LAST PUMPING <br />RECOMMENDED PUMPING INTERVAL: ~ ~) fc~0-.e~ <br /> <br /> ~RION C <br /> BUILDING O~N~ <br /> INSPEC~/ON <br /> <br />SIGNATURE OF PUMPER: <br /> DE.Q LICENSE <br /> <br />NO B.B NO. 85813 <br /> <br /> <br />