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Form) <br /> <br />In order to properly evaluat~ ~Our existing sewage system, abe <br />Information will b~ <br /> <br />have an approved record of the sgs~em, we c~n Rroceed w~thout <br />any further action on ~our part. <br /> <br /> 2. if your sewage system is les~s than five (5) Hears old~ and we <br /> do not have a record of a~ approved installation of the s~wtem: <br /> <br /> If you~ sewage st~stem is mor~ than fiv~ [5) geaz's old ~r <br /> ~eun pumped within the la~ five years: <br /> <br /> verif~ the loca=io~ and ao~di=ion of the septic <br /> If ~ou h~ve proof =ha= wour s~pt~c t~k has been <br /> <br />........ ~' -For Septic Tank Pum~r Use Onl~- ~ <br /> <br />IS TANX IN SOOD CONDITION? <br /> <br />ARE ~AFFLBS OR ELBOWS IN P~J4CE? <br /> <br />_gallons <br /> <br />~$ DRAINFIELD BACKZNG UP INTO TANK? <br /> <br /> If yes, ~xplain;~ _ .. <br /> <br />. YES; ,,, /~ NO <br /> <br />QrACRAM OF HOUS£ AND <br />LOC~zI~V OF <br /> <br />Tank <br /> <br />SIJNATURE OF PUMPER; <br /> <br /> <br />