Laserfiche WebLink
O {99R <br /> <br />AUTHORIZATION NOT~CE/~XlSTING SYSTSM EVALUATION <br /> <br /> PUMPER FORM <br /> <br /> the roll.win9 <br /> RION COUNI <br /> <br />an approved record of the system, we can proceed without a <br />further action on your part. <br /> <br />If your ~ewage system is less than five (5) years old, and we do <br />not b&ve a ~ecord of an approved ipst~llation of the system: <br /> <br /> If your sewage system is more than five (S) years old or has not <br /> <br /> You must have the septic tank pumped. <br /> b. Eave the septic tank pumper complete the form below. <br /> A fielO visit will be required by the Sanitarian to verify <br /> the location and condition of the septic system. <br /> If you have proof that your septic tank ha~ been p~mped <br /> within the last five (5] ye&rs, ~ection$ a & b will not be <br /> required. <br /> <br />Stayton/Mill City & Silver'on <br />COMPANY NAMe: . Septic SErvices DZQ LICSNSE NO. 3491~ <br /> <br /> PROPZRT¥ 0~m~a: Richard & Margaret Fa~an <br />ADDRESS W~ER= TANK ~UMPED: 7591 Bish~,.p RDad,~ SE ,. <br /> <br />A~msville. Oreoon 97325 <br /> <br />APPROXIMAT~ SIZE OF SEPTZC TAN~: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />· .RE BAFFLES OR ELBOWS IN PLACE? <br /> <br />~S DRAIN~IELD BACKING ~P INTO TANK? <br /> <br /> If yes, explain; <br /> <br />S~PTIC TANK MATERIAL: Concrete X <br /> <br />1000 <br /> <br />X YES; NO <br /> <br />X YES; NO <br /> .YES; X NO <br /> <br />Steel Other <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />example <br /> <br />Rev 7/89 pb <br /> <br />DATE OF PUMPING: 10/29/92 <br /> <br /> <br />