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"IsTY.Y:.: - • "ImIPITIT•" 77-"—-- Y; . <br /> • <br /> ,- <br /> ! . <br /> .• <br /> VALLEY SEPTIC SERVICE <br /> P.O.BOX 5241 • <br /> SALEM,OREGON. 97304 <br /> 503 588-1115 FAX 503.370-9822 • . • . <br /> . . <br /> . .•.: .• . . <br /> . . . <br /> . . <br /> SEPTIC TANK EVALUATION <br /> • 1 • <br /> . I I <br /> L <br /> PROPERTY OWNER 3-CC,I WI -€ ill. 1• i ex -621-0 <br /> PROPERTY ADDRESS l'i ::;. C7 54( Niria wl :14."'") Y . CITY es eireS - . <br /> , ,,,T-. <br /> TANK LOCATION ON PROPERTY go r.-1 M .i 0,.f 0 F P r 6 Pet'/71/. <br /> . . <br /> EVALUATED BY lb tli „r Pe ;73-If 0 0 leg VALLEY SEPTIC SERVICE <br /> 17,..E:Q.LICEltISB*3 6786 C.C.B.#7116-r. . . <br /> TYPE OF TANK: CONCRETE STEEL V... FIBERGLASS. OTHER <br /> SIZE IN GALLONS t 0 00 CONDITION: GOOD FAIR . POOR REPLACEj/ <br /> ARE THE SOLIDS AT A NORMAL LEVEL re-5. . EXCESSIVE . <br /> - . .. • <br /> .,...... .. . <br /> j ..• . <br /> . INLET F.TrTING IN-PLACE''..5(.(0.5 CONDITiON 4 0 0'er <br /> OUTLET FITTING IN PLACEKe5 •CONDMON: 4 00 Of <br /> . ' <br /> , . <br /> . .INNER WALL CONDITION; Pa d <br /> . <br /> PUMP SYSTEM: YES g9 PUMP TANK SIZE ..CONDITION <br /> . IS A*CLEAN OUT ON INLET LINE YES NO 'LOCATION <br /> k o 1.....e.., <br /> .44GGESTED REPAIRS -1?9. Pl-a-G -e _5€ell.C.- riX Ni K. <br /> RECOMMENDED PUMPING FREQUENCY DIAGRAM OF HOUSE&TANK LOCATION <br /> , <br /> COMMENTS: <br /> 2 ,t.i 1 , .50 <br /> . .. 0 r .;Iv A f.to 1 La c• K 2'f t ij<24 10 i <br /> ,iv PA Tr€ .9 u...i <br /> ick ,z. • <br /> pkgr?htJ9 : • • <br /> .. .. ._. ... ... . <br /> .. '\''t..°1 1,14."-13 • <br /> ..... . <br /> . . <br /> . <br /> . .. <br /> . <br /> • ._....._Ro.ve <br /> . .... <br /> • . THE DRAINFLELD IS NOT INCLUDED IN THIS EVALUATION.IT IS RECOMMENDED THAT THE COUNTY SANITATION DEPARTMENT VERIFIT THE LOCATION <br /> -AND CONDITION OF THE DRAINFIELD AND ANY OTHER PART OF THE SYSTEM,IF A TOTAL SYSTEM EVALUATION IS REQUIRED.ay AccErrixo AND • <br /> USING THIS EVALUATION FORM YOU ARE ACKNOWLEDGING THAT THE DRAINFIELD.HAS NOT ZEEN EVALUATED: <br /> . 1 CERTIFYTHAT ID DIE BEST OF MY KNOWLEDGE,ALL OF THE WESTIONS ANSWERED ON THIS FORM ARE TRUE Al4D ACCURATE. <br /> ' ... DATE 6"---CI(--9-7 <br /> SIGNA OF LIC ER. <br /> . . <br /> . .. .. <br />