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2/86 <br /> <br />AUTHORIZATION NOTICE <br />($~$Sleme~al Form) <br /> <br />In erder to pro. fly ~valuate your existing sewage sws~em, the following <br />informatiOn will be necessary: <br /> <br /> If ~OUr sewage system is less than fi~ (5) ~ar$ old, and we <br /> dO no~ have m r~rd of an ap~ro~d lnstallatioo of =h~ syst~A~*O~ OOUNIY <br /> or; UiLD NG [NSPECTIO ,I <br /> ~ Four s~age sFstem is ~re bhan five (5) Fears old or ha~ no~ <br /> been pureed wi~in the last flve Fears: <br /> <br /> a. You mus~ have bhe septic ta~ pum~d, <br /> b. ~ave the septic tank pumper complete the form below. <br /> c. A field visit will be ~quired bW the S~itari~ =.0 <br /> <br />d. If you have pr~f t~t gout septic ~k h~ b~n <br /> p~d within the last fi~ (~) g~rs, se¢~ions a & b <br /> will not be r~uired. <br /> <br /> -For Se~ic Ta~ mu~F gse ~iV- <br /> <br />NO <br /> <br />IS TANK ~N ~OOD CONDITION? <br /> <br />AR~ BAFFLES OR E~O~S IN pLACE? <br /> <br />IS DRAIMFIELD BAC;~ING UP INTO <br /> <br /> ? 7 <br />gallons <br /> <br />If ~es, <br /> <br />DIAGRAm; OF HOUSE AIVD <br />LOCATION OF TANK: <br /> <br />EXAMpL~ ~ <br /> <br />~ Septic Tank <br /> <br /> <br />