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· (Supplement. al Form) <br /> <br />In order' to properly evaluate your existing sewage <br />information will be necessary~ <br /> <br />system, the following <br /> <br />If your sewage system is less than five (fiye) years o18, a~d webave <br />an approved record of the system, we can proceed without any further <br /> <br />if your sewage system ia less than five ($) years old, and ~ do not <br />have a record of an approved installation of the system= <br /> <br />If your sewage System is more than five (5) years old or has not been <br /> <br />You must hays the septic tank pumped, <br />Have the septic tank pumper complete the form below0 <br />A f~eld visit w£11 be required by the Sanitaraian to Verify the <br />location and condition of Che septic system. <br />If you have proof that your s~p=ic rank has been pumped within =he <br />las= five (5) years, ~ections a & b w~ll not be required, <br /> <br /> Stayto~./Mill City & Silverton <br />CO,ANY NAM~: Sil.v~z~on. Septic Ser~.~ce~ <br /> <br />PROPERTY OWNER: Adrian,& Jan.~t Emery <br /> <br />ADDRESS WHERE TANK PUMPED: 1R~ ~U~.r~t m~!.~t <br /> <br /> Detroit. <br /> <br />APPROXIMATE SIZE OP SEPTIC TANK: 1000 <br />IS TANK IN GOOD CONDITION? <br />ARE BA~LES OR ELBOWS IN PLACe? X <br />IS DRA/NFZELD BACKING UP INTO TARK? <br />If yes, explain; <br />SEPTIC TANK MATERIAL: Concrete .. Steel <br /> <br />For Septic Tank Pumper Use Only <br /> <br /> ..DEQ LZCENSE NO: 34916 <br /> <br />....... ~allons <br /> YES; <br /> <br /> YES; <br /> <br />other <br /> <br />G~A~0F HOUS~A~D <br />CATION OF TA~K= <br /> <br />st~ec <br /> <br />Rev 10/87 <br /> <br />X <br />WelX <br /> <br />W <br /> <br /> Stayton, Mill city and <br />$IdNA~G~E OF PUNP~R: $i.~verton Septic _Service~. <br /> DAT~: .. Auqust 9,.. 199~ <br /> <br /> <br />