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. • - • — wrrQva,e,aw,rm,' - <br /> EXISTING SEPTIC SYSTEM DESCRIPTION <br /> OfttCO'la 3 <br /> Please answer the following questions as completely as possible,and to The best of your knowledge. <br /> 1. Your existing septiosystem consists of(chPck all that apply): <br /> bit Septic Tank 0 Disposal.Trenches 0 Capping Fill 9 SPnefilter <br /> 13 Seepage Bed 0 Cesspool or Pit 0 Unknown <br /> 0 Other (Describe) <br /> 2. When was your septic system installed? IAA- <br /> 3. Tank material: fa—Concrete 0 Steel 0 Plastic or Fiberglass 0 Unknown <br /> 4 Septic tank volume(in gallons) 2-5D <br /> 5. When was the septic tank last pumped? V\-A Attach receipt if avilale. <br /> _6. Number of di.sposal trenches .1 <br /> _ <br /> 7. Total.length of disposal trenches cm feet) 2-0 <br /> 8. Do yonpropose to usethe existing septic system? Yes 0 Na121 <br /> 9. Is your septic system currently in use? Yes 0 No lino,date of last use <br /> 10.. If the septic system currently serve a dwelling <br /> How many bedrooms are in the g? How many people occupy the dwellins? <br /> 11. How many bedrooms will be in the o dwelling? How many occupant? <br /> 12. If the septic system serves a business; <br /> How many total employees are there <br /> Type of business <br /> 13. Is there a proposed APTige of useof your stmetute(home or business)? Yes 0. No 0 <br /> If yes,please explain <br /> 14. Provide a plot plan(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,easement, <br /> existing structures,driveways,and ater supply.Indicate the direction of north.If you are proposing to <br /> replace the septic systena,indicate the test hole location. <br /> By my signature,I certify that the above imformation,and the plot plan on the reverse side of this form are <br /> accurate and true to the best of my knowledge. Air <br /> -? ./it) amer ceLzsidirAzu=atteriz-zeuauve---- <br /> Alr <br /> Office use only:Record of=icon" sysucc Yo El No,IE Acce:tred DDatelesced <br /> PsmitNi=bc Cerdficate of Satienawr C=Pletion Issued: YesEi 2'100 <br /> Otha file inframatica: <br />