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AUTHORIZATION NOTICE/EXISTiNG SYSTEM £VALUATICN <br /> <br /> PUMPER FORM <br /> <br />In order to properly evaluate your existing sewage system, the following <br /> <br /> 1. If your sewage system is less than five (5) years old~ and we have <br /> further action on your part. <br /> <br /> 2. If your sewage sys%em ~$ less than five (5) yeers old, and we do <br /> <br />If your ~ewage system is more than five (5) years old or has no% <br />been pumped within the last five years: <br /> <br />a. You must have the septic tank pumped. <br />b. ~ave the septic tank pumper complet~ the form below. <br />c. A field visit will be required by the Sanitarian to verify <br /> the location and condition of the ssDt~¢ system+ <br /> I~ you have proof ~hat your eeptic tank has been pumped <br /> within the last ~iv~ (5} year~, sections a & b ~ill not be <br /> require~. <br /> <br /> For Septic Tank ~lm%oer Use Only <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />;iRE BAFFLES O~ EL~0WS IN PLACe? <br /> <br />IS DRAINTIELD BACKING UP INTO TANK? <br /> <br /> If ye~, expleln; <br /> <br />SEPTIC TANK ~AT~AL: Concrete. ~ <br /> <br />~< NO <br /> <br />DIAGP~ OF ~0USE AND <br />LOCATION OF TANK= <br /> <br />example <br /> <br /> 22 ~ we/1 <br /> <br />W <br /> <br />SIGNATURE OF PUMPER:~6/~t~z- <br /> <br />Rev 7/89 pb ,, <br /> <br /> <br />