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AUTHORIZATION NOTICE/~XISTING SYSTEM EVALUATION <br /> <br /> PUMPER FOR/4 <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information wil~ be necessary: <br /> <br />If your sewage system is ~e$$ than five (5) years old, and we havc <br />an 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 />b. <br /> <br />(5) years Old or has not <br /> <br />You must have the eeptic tank pumped. <br />Have the septic tank pumper complete the form below. <br />A field visit will be required by the Sanitarian to verify <br /> <br />required. <br /> <br />YES; NO <br />YES; ~ NO <br /> <br />A~ BA?FLES OR ELBOWS IN PLACE? <br /> <br />IS DRAINFIELD BACKING bP ~NTO TANK? <br /> <br /> I~ yes, explain; <br /> <br />DIAGR~4OF HOUSE AND <br />LOCATION OF TANK= <br /> <br />example: <br /> <br />-22 - X <br /> <br />Rev 7/89 pb <br /> <br />N <br /> <br />SIGNATURE OF PUMPER:,, <br />DATE OF PUMPING: <br /> <br /> <br />