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SEPTIC TANK EVALUATION <br /> <br /> -To Be Comple.~ted By Licensed Septic Pumper Only- <br />COMPANY NA~4E <br /> <br />DEQ LICENSR NUMBER <br /> <br />SEPTIC TANK MATERIAL (/_.;~/~,C,/t,'~,~'~,i_ CAPACITY OF TANK ,,,/(~ ~<_ "~; GALS. <br /> <br /> YES <br /> <br /> · "'~" YES <br /> <br />~S TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES AND ELBOWS IN PLACE? <br /> <br />~S DRAINFIELD BACKING UP INTO TANK? <br /> <br />NO <br /> <br /> NO <br />YES __~I NO <br /> <br />-Diagram Of House And Location Of Tank- <br /> <br /> j-~,~, ~, ~_, <br /> <br /> ---~ ~-~ ~ <br /> <br />pumped and <br /> <br />SIGNATURE OF <br /> <br />inspected this septic tank as noted above.· <br />qEP, TIC TANK PUMPER _?~ <br /> <br /> <br />