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lemental Form) <br /> <br /> ~v~lua:e ~our exi~tin'~'sewage $~$tem, ~he follo~¢ing <br /> <br /> U~ s~a~e s~st~ is less th~ five (5) ~s 01~, and we <br /> app~ved ~fd of th~ sWse~, we ~an ~eed <br /> <br />~f ~our s~age s~stem is less than five (~ g~ars o1~, ~d w~ <br />do not ba~ a ~ of au apsro~d installa~oa of the ~stem: <br /> <br />~ ~our ~a~ s~stem is ~re t~ five (5) wears old or has not <br /> <br />b. Ha~ the septic t~ ~r ~mplete the fo~ below. <br />C. A field visit will ~ r~uired bg the S~itari~ ~o <br /> verifw the l~ati~ ~d ~ditfon Of the kept~c system. <br /> <br /> will not be ~ufred. <br /> <br />COMPANY NAM=: <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WHEPJ~ TANK PUMPED: <br /> <br />Stayton Septic Service DmO rJcmNs~ NO: 5.4916 ........ <br /> Delmer Lamb~ech~ <br /> <br />5536 Anderson Rd. <br />Aumsville, Oregon <br /> <br />APPROXIMATE $ZZg OF SEPTIC TANK: <br />IS TANK IN GOOD CONDITION? <br /> <br />~000 .... ~allons concrete <br /> <br /> IX Y~$; NO <br /> <br />ARE ~AFFI~ES OR ELBOWS IN Pf~ACE? <br /> <br />X ~ , ,YF~ ; NO <br /> <br />BACKING ~ i~;~0 TANK? <br /> <br />If Wes, <br /> <br /> <br />