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(Supplemental Form} <br /> <br />In order to properly evaluate ~our existing s~Wage $~s~e~, the following <br />informatio~ will be ~e~e$$ary: <br /> <br />have an approved ~eco~d of thc swstem, we can pro~ed without <br /> <br /> If your sewage svscem is le$.__~ ~han fi,= (5) ~ears old, and wc <br /> do no~ have ~ record of an ~$proved installation of th~ s~stem: <br /> <br /> If ~our s~a~ system i~ ~r~ t~n f~ve (5) ~ars old or has not <br /> <br /> a_ You mumt have the septic t~k <br />b. Bmv~ th~ meptic ~ank p~r ~m~l~t~ the form below_ <br /> <br /> verif~ ~h~ loca~i~ ~nW ~ondi~lon of th~ septic sws~em. <br /> p~m~ wi=bin the l~t five (5) ~r=, $~ctlons ~ & b <br /> <br />CO~ANY NA~= Stayton Segtic 'Service <br /> <br />PROPERTF OWNER: <br /> <br />ADDRESS WHERE TANK PUMPED~ <br /> <br />Thg,mas Moran <br />150 Santism Ave. <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />Detroit, OreF~D <br /> <br /> 400 metal <br /> gallons <br /> <br />TANK ZN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />NO <br /> <br />IS DRAINFIELD ~ACKI~G UP INTO TANK? <br /> <br />Y~$; ,EX ~o <br /> <br />If Fes, explain; <br /> <br />3/~6 <br /> <br /> Septic <br /> Tank <br /> <br />6 ' | <br /> <br />SICNATUP~ OF PUMPER: <br /> <br /> <br />