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(Su~plementaI Form} <br /> <br />In order to prop~rlw evaluate Wo~r existing sewege system, :he following <br />informati~ will De necessary: <br /> <br />2/86 <br /> <br />rf your sewage system is less ~han five {~) years old, and we ~ <br />have an approved recold of t~e system, we can proceed wit~t~ <br /> <br /> If your sewage system &s less than fin (5) years old, aha we ~'.' ~ I,;~ <br /> do not have a record Of~ approved installation of the system: <br /> or; ~gtON COUNI~ <br /> <br />be~n pumped within ~he last five y~ars~ <br /> <br /> Fou must have ~he septlc tank Bum~d. <br />b. Have =h~ septic tank pum~r complete the form bulow. <br />c. A field visit will be reguir~d by the Sani:ari~ to <br /> verify the loca=i~u ~d condition of ~he ~e~tic system, <br />d. Zf ~ou have pr~f that gout $eptic t~k ha~ b~en <br /> <br /> will not be required. <br /> <br />-For Septic T~k PUmper Use Only- <br /> <br />IS T~K SN GOOD C~DITION~ ~ YES; NO <br /> <br />ARE BAFF~S OR <br />IS DRAINFIELD BACKING UP INTO T~K? ~ YES; ~. NO <br /> <br /> DIAGR~ OF HOUS~ ~D <br /> ~CATI~ OF TANK: <br /> <br />EX~P~ <br /> <br /> <br />