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(Suppl'emental Form) <br /> <br /> ~f~er to properly evaluate you~ existing sewage system, ~he following <br />~nformation will be necessary: <br /> <br /> 1. rf gout sewage system is less than five (5) years old, and we <br /> have ~u~ approved recold Of the system, we can proceed wi=hour <br /> any further action on you~ part. <br /> <br /> 2. If your s~¢age system is less than five (5) years old, and we <br /> do not have a record of a3] approved installation of =he system: <br /> or; <br /> If your sewag~ system is more than five (5) years old or has not <br /> been p=~ped wi=his the iasc five <br /> <br /> a. You must have the septic =ask pumped. <br /> b. Have ~k~ septic tank pumper complete the form below. <br /> A field vi$i~ will be required by <br /> verify the location and condition of the septic system. <br /> d. If you have proof tha~ wour ~eptic tank has been <br /> pu.~ued within the last five (5) years, sections a $ b <br /> will ncc be required. <br /> <br />C~IPANY <br /> <br />PROPER~¥ OWNER: <br /> <br /> -For Septic Tank Pumper use Only- <br />Stayton Septic Service <br /> <br />Bobby & Betty Shepard <br /> <br />DEQ LICENSE NO: <br /> <br />ADDRESS WNERE TANK PUMPED: <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS T~¥K ~N GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN P~CE? <br /> <br />IS DRAINFIELD BACKING UP INTO T~¥K? <br /> <br /> Zf yos, explain; <br /> <br />91 61 Smith Rd. SE <br /> <br />Aumsville, OR <br /> <br />1000 <br /> <br />gallons Concrete <br />XX Y~S; NO <br />XX YES; NO <br /> <br /> YES; XX NO <br /> <br />34916 <br /> <br />DIAOP.;~! OF HOUSE AlqD <br />LOCATI~V OF T~VK: <br /> <br />Septic Tank <br /> <br /> <br />