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'- SEPTIC ~A/~K ~UI~'IN¢ AND INS~ECIION FOP,~ <br /> <br /> The ~ollewieg requirements apply to the evaluation of as existing on-site <br /> sewage system. Please select the appropriate section and follow the directions <br /> carefully. <br /> <br /> 1, I~ your sewage system is l_~ss~,th~ ~ivej,(5) year~ old and a Certificate <br /> of Satisfactory Completion ha~ been iseued for the system, the septic <br /> ta~k does net require pumping at this time. <br /> Authorization Notices do not require a field inspection of the <br /> system. A report can be issued based on a review of our files. <br /> Existing System ~valuat~ons d__qo require a field inspection of the <br /> entire system and a report will be issued. <br /> <br /> 2. If your sewage system is more than five i5) v~ars old and the septic <br /> tank bas not been pumped within the last five (5) years, follow the <br /> directions below. If you have proof that the septic tank has been pumped <br /> withln the last five (5) years, section (a) will not be required. <br /> a. Th~ septic tank must be pumped by a D.E.Q. licensed septic tank <br /> pumper. <br /> b. The septic tank pumper must complete the form b~low. <br /> c. Authorization Notices amd E×i~tin~ System Evaluations require a <br /> field inspection tO verify the looation. -~nd,..eomdJ~tion of the <br /> septic system, <br /> <br /> *fo~ septic pumper use only* <br /> <br />APP OXl T /d <br />SEPTIC TANK MATERIAL: Concrete~'~; Steel <br /> rs TANK IN GOOD CONDITION? ............. Yes~ ; <br /> ~f "No", explain: <br />ARE INLET & OUTLET F~TT~NG$ IN PLACE? .. <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK? ~,. Yes~ __; <br /> <br />If te~", explain: <br /> <br />D3AGP31~ <br /> <br />AND SEPTIC TANK: <br /> <br />L~CENSE ~: ~ <br /> <br />gallons <br />No DEC; 199 <br /> <br />(show detail with ~easurements) <br /> <br />DATE OF PUMPING <br /> <br />MC]5-SL9 <br /> <br /> <br />