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\5 \~ SEPTIC TANK ~VALUATION <br />ADDRESS/LOCATION OF EVALUATION <br /> <br /> -To Be Completed By L'icensed Septic pumper Only- <br /> <br />~ATE SEPTIC TANK WAS <br />SEPTIC TANK NLATERIAL(%~~, CAPACITY OF TANK <br />IS TANK IN GOOD CONDITION? ~ ~YES NO <br />ARE BAFFLES AND ELBOWS IN PLACe? ~ Y~S NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />YES ~ NO <br /> <br />-Diagram Of <br /> <br /> ~.~r~ z ~ <br /> ...... i <br /> <br />House And Location Of Tank- <br /> <br />! pumped and inspected this' septic tank and found conditions as <br />above as of this date. ' <br /> <br />noted <br /> <br /> <br />