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AUTMORIZATION NOTICE/EXISTING SYSTEM EVALUATION <br /> <br /> PUMPER FORM <br /> <br /> In order to properly evaluate your existing sewage system, the following <br /> information will be necessary: <br /> <br /> 1. If your sewage system is less than five (5) years old, and we have <br /> aD approved record of the system, we can proceed without any <br /> further action on your part. <br /> <br /> If your sewage system is less than five (5) years old, and we do <br /> not have a record of an approved installation of the System: <br /> <br /> or; <br /> <br /> ~f your sewage system is more than five (~) years old or has not <br /> been pumped within the last five years: <br /> <br /> a+ You must have the septic tank pumped. <br /> b. Nave the seDtic tank pumper complete the form below. <br /> A field visit will be required by the Sanitarian to verify <br /> the location and condition of the septic system. <br /> d. If you have proof that your septic tank has been pumped <br /> within the last five (5) years, sections a s b will not be <br /> required. <br /> <br /> FOr Septic Tank ~m~er ~se Only <br /> <br /> ~ ..... <br />APPROXXMATE SIZE OF SEPTIC <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ~LBOWS IN PLACe? <br /> <br />IS DRAINPI~LD BACKING UP INTO TANK? <br /> <br /> yes, explain; ~/~ ...... <br /> If <br /> <br />SEPTIC TANK MATERIAL: Concrete ~ Steel <br /> <br />YES; NO <br /> <br /> __NO <br /> ~ NO <br /> <br />Other <br /> <br />DIAGRAM OF NOU$~ AND <br />LOCATION OP TANK; <br /> <br />example <br /> <br />-22 L- X <br /> <br />W <br /> <br />SIGNATURE OF PUMPER: ~'-'~- <br /> <br />Rev 7/89 pb <br /> <br /> <br />