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SEPTIC TANK EVALUATION <br /> <br />PROPERTY OWNER <br /> <br />ADDRESS/LOCATION OF EVALUATION <br /> <br /> -To Be Completed By Licensed Septic Pumper Only- <br />SEPTIC TANK MATERIAL t'(:h/~n_$~'~ CAPACITY OF TANK <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES AND ELBOWS IN PLACE? <br /> <br />~YES NO <br />~"'YES NO <br /> YES_ ~ NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />I pumped and inspected <br />above as of this date. <br /> <br />this septic <br /> <br />SIGNATURE OF SEPTIC TANK PUMPER <br /> <br />%%%%%%% <br /> <br />tank,and~/],~,~/,~~ ~q/~_f°u~c) conzlitions as <br /> <br />noted <br /> <br /> <br />