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AUTHORIZATION NOTICE/EXISTING SYSTEM =VALUATION <br /> <br /> PUMPER FOR34 <br /> <br />In order to properly evaluate your existing ~ewage system, <br />information will be necessary: <br /> <br /> 1. <br /> <br />the following <br /> <br />If your ~ewage system is les~ than five (5) years old, and we have <br />an approved record of the system, we can proceed without any <br />further action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we dc <br />not have a record of an approved installation of the system: <br /> <br /> or; <br /> <br /> If your 5swage ~ystem is more than five {~) years old or has not <br /> been pumped within the last five years= <br /> <br /> a. You must have the septic tank pumped. <br /> b. Nave the septic tank pumper complete the form below. <br /> c. A field visit will be required by the Sanitarian to verify <br /> the location and condition of the septic system. <br /> · d. If you have proof that your septic tank has been pumped <br /> within the last five (5) years, sections a & b will not be <br /> required. <br /> <br /> For Septic Ta~k X~r Use Only <br /> <br />Sta ty i Silverton.. Septic SeI~zic~Q LICENSE NO. 34916 <br /> PROPERTY O%~NER~ Brian E. & Beverly. Waters 4 <br /> <br /> ADDRESS hq4ERE TANK PUMPED: 8633 Shaw Square Road <br /> <br />ARRROXIPiAT~ SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE SAPFL=S OR ELBOWS IN PLACE? <br /> <br />IS DEAINFIELD BACKING UP INTO TANK? <br /> <br />Aumsville, OR 97325 <br />1000 ..... gallons <br /> <br /> X YES; NO <br /> YES; X NO <br /> <br /> If yes, explain; ,,, <br /> <br />SEPTIC TANK ~4AT~RIAL: Concrete X Steel~Other <br />Water level in tank OK at time of pumping, however there are signs that it <br /> <br /> has been too high in the past. <br />DIAGRAM OF ~O~S= AND <br />LOCATION OF TANK: <br /> <br />example: <br /> <br />Lid of tank is 13.5 feet <br /> north of vent pipe and <br /> 9 feet north from SE <br /> corner of the shop. <br /> <br />se~c tank <br /> <br />W <br /> <br />ye,ur p,'ee ~(5" <br /> <br />SIGNATURE dP PUMPER: <br /> <br />Stayton, Mill City and <br />Silverton Septic Service <br /> <br />E <br /> <br />Rev 7/89 pb DATE OF PUMPING: 3/20/91 <br /> <br /> <br />