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—r , , <br /> EXISTING SEPTIC SYSTEM DESCRIPTION <br /> Please answer the following questions as completely as._possffile,and to the best of your.knowledge.. <br /> • 1. Your existing septic, -011 consists of(check all that apply): <br /> Septic Tank E:V isposal Trenches C1 Capping Fill ❑SanijECdfilter <br /> O Seepage Bed . 0 Cesspool or Pit U Unknown <br /> o Other (Descnbe): ., : ' ‘,:.,,, <br /> 2 When was your septic system installed?, . <br /> tv � <br /> 3. Tank material,.El Concrete Steel Q Plastic or.Fber,1 cs Q Mika,nkaaw.n ^ <br /> 4. Septic tank volume(in gallons) _7 <br /> C''',,::,,,,,'''''r(i'':::.'' nk" Attach receipt if available. <br /> 5_ When was the se�,fac to lastpumped?. I��� �P <br /> r <br /> _: 6. Number of disposal trenches <br /> '-` 7. Total lengthof disposal osal trenches(m feet) .1 "' <br /> P <br /> 8. Do you propose to use the existing septic system? Yes 0 No$j <br /> 9. Is your septic system currently m use7 Yes❑ No4 If no date of last use <br /> 10 If the septic system,cuffeutly serves a dwelling • <br /> �Howmanypeople occupythe'dwellin ? <br /> How many bedrooms are m the dwelling?° g <br /> ;, 11. How madybedrooms Will he;in the proposed dwelling`t" How many occupants? <br /> •" z: 3 <br /> '"12. If the septic system serves a business <br /> How many total`"employees-are t3iere? . " <br /> ' Type of business <br /> 13. Is'there a proposed change-of use of your stncture.(home or business)? Yes"❑O. No❑ <br /> If yes,please,asp laiu <br /> 14 Provide-a plot plate.(sketch)on the reverse side of this form showing the.best estimated or actual <br /> measurements that locate,the existing septic tank and disposal trenches,property lines,easements, <br /> . <br /> existing structures,driveways,and water supply Indicate the.direction'of north.If you are proposing to. <br /> replace the septic system,•indicate the test hole location, <br /> that>the above info n ation and the'plot plan on the.reverse side of this form are <br /> , By my signatute,I certify <br /> accurate-and true to the;best of my knowledge. <br /> `' ' ' ii/ig L3 <br /> tare ofPropertyOwner ctnd <br /> `office use oul Rs�rd cf co isttng'sytc+,,-Yes 0 No❑ Attached ❑ Date Sssned <br /> " peffiitNumbe tear$cateofSatisfacthycQmpletioaIssaed Yes .NOD nk; <br /> • ter; <br /> Other fife mf4n 1abon. <br />