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(Supplemental Form) <br /> <br />In crder to properly evaluate your existing sqwage ~yste~, the following <br />information will be necessary: <br /> <br />rf your sewage system is less than five (5) pears old, and we <br />have an approved recor'd of the system, we can proceed witho~t <br />any further action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we <br />do not have a record of an approved installation of the system: <br /> er; <br />If your sewage system is more than five (5) years old or has ~?ot <br />been pdmpe~ within thc last five years: <br /> <br />a_ 2~u must have the septic tank pumped- <br />b. Hmve the septic tank p[~mper complete the form beiow_ <br />c. A field visit will be required by the Sanitarian to <br /> verify the location and condition of the septic system. <br />d. If you have proof that your septic tank has been <br /> p~lmpe~? within the last five (5) pears, sections a & b <br /> will not be required. <br /> <br />CO~PANY NA~IE: <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WH~RE TANK PUMPED: <br /> <br /> -For Septic Tank Pumper use Only-. <br /> <br />Stayton Septic 'Service <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS T~JK TN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />IS DRAINEIELD BACKING UP INTO TANK? <br /> <br /> If yes, explain; <br /> <br />~£~or~& s Moral/ <br /> <br />150 S~n-t ism Ave. <br /> <br />DEQ LICENSE <br /> <br />Detroit ~ <br /> 4OO <br /> <br />Or ~ ~,~! <br /> metal <br /> gallons <br /> <br /> ~ YES; NO <br /> ~ YES; NO <br /> YES; ~ NO <br /> <br />D~AGR£~] OF HOUSE ~tND <br />LOCATION OF TANK: <br /> <br /> 6 ' ~ Septic, Tank <br />~22'- <br /> <br /> St feet <br /> <br /> <br />