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In' order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br /> 1. If your sewage system is less than five (five) years old, and we have <br /> an approved record of the system, we can proceed without any furaher <br /> action on your part. <br /> <br /> 2. If you~ sewage system is less than five (5) years old, and we do not <br /> have a record of an approved installation of the system: <br /> or; <br /> If your sewage system is more than five (5) years old or has not been <br /> pumper within the last five years: <br /> <br />You must have the septic tank pumped, <br />Have the septic tank pumper complete the form below. <br />A field visit will be required by the Sanitaraian to verify the <br />location and condition of the septic ~ystem. <br />If you have proof that your septic tank has been pumped within the <br />last five (5) years, sections a & b will not be required. <br /> <br />For Septic Tank Pumper Use Only <br /> <br /> S~oyton/Nill City & Silverton <br />COMPANY NAME: SzlvertonSeptic ?~rvices <br /> <br />PROPERTY OWNER: Adrian & Janet Emerv <br />ADDRESS WHERE TANK PUMPED: l qr~ <br /> <br /> ~)etroit, <br />A~PROXIMATE SIZE OF SEPTIC TANK: <br /> <br />©re-on <br /> <br />100o <br /> <br />.DEQ LICENSE NO: 34916 <br /> <br />gallons <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />YES; NO <br />YES; NO <br /> <br />IS DRA/NFIELD BACKING UP INTO TANK? <br />If yes, explain; <br /> <br />YES; ~ NO <br /> <br />SEPTIC TANK MATERIAL: Concrete <br /> <br />Steel ~' <br /> ~.~: Other <br /> <br />DI~GRAH OF HOUSE AND <br />LOCATION OF TA~K: <br /> <br />EXAMPLE <br /> <br /> Septic Tank <br /> <br />t2z~- ~ell <br /> Stre~ , <br /> <br />/8~ Rev 10/87 <br /> <br /> $ <br /> <br />SXGNATURE OF PUNPER; . _ ] ~, ~ ..... I ,.c~ i'c',57v ic '?~; <br /> <br /> DATE: ' ..... ~. i'~ '~ ~ ~'1 <br /> <br /> <br />