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AUTHORIZATION NOTICE/EXISTING sYSTF-24 Ev~%LUATION <br />PUMPER FORM <br /> <br />In order to properly evaluate your existing sewage system~ the <br />following information will be necessary; <br /> <br /> 1. If your sewage system is less than five (5) years old, <br /> and we have a record of the system, we can proceed <br /> without any further action on your part. <br /> <br /> 2. If your sewage system is more than five (5) years old <br /> and/or we do not have a record of the system: <br /> <br /> a. It will be necessary to have the septic tank <br /> pumped <br /> b. Have a DEQ licensed septic tank pumper complete <br /> the form below <br /> c. A field visit will be required by the Sanitarian <br /> to verify the location and condition of the septic <br /> system <br /> d. If you have proof that your septic tank has been <br /> pumped within the last five (5) years, sections a <br /> and b above will not be required. Provide <br /> verification of pumping (receipt from pumper) to <br /> this office. <br /> <br /> --FOR SEPTIC TANK PUMPER USE ONLY-- <br /> <br />kPPROXIMATE SIZE OF SEPTIC TANK: <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BA~LES OR ELBOWS IN PLACE? <br /> <br />GALLONS <br /> <br />NO: <br /> <br />NO= <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br /> .... <br /> <br />3/82 Rev 10/87 <br /> <br />N <br /> <br />SIGNATURE OF <br /> <br />DATE: <br /> <br /> <br />