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AUTHORIZATION NOTICE/EXISTING ~YSTF~ ~VALUATION <br /> <br />FORM <br /> <br />In order to properly evaluate your existing sewage <br />following information will be necessary: <br /> <br />system, ths <br /> <br /> 1. If yOUr sewage system is less than five (5) years <br /> a~d we have a record of t~ system~ we can proceed <br /> without any further action oB your part. <br /> <br />2. If your sewage system is more than five (5) years old <br /> and/or we ~,not have a reC~6~of the system: <br /> <br /> a. It will be necessary to have the septic tank <br /> pumped <br /> b. Have a DEQ licensed septic tank pumper complete <br /> the form below <br /> c. A field visit '~i!l be required by the Sanitarian <br /> to verify the location and condition of the septic <br /> ~ystem <br /> d. I~ you have proof that your septic tank has been <br /> ~mped within the last five (5) years, SectiOns a <br /> and b above will not be reg~ired. Provide <br /> verifi=ation of pumping (=eceipt from pumper) to <br /> this office. <br /> <br /> --FOR ~F~TIC TANI~ PUMA~ER U~ O~LY-T <br /> <br />APPROXIMAT~ SIZ~ OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />~ ~/~"PLEs OR EL~OW~ IN PLACE? <br /> <br />,.GALLONS <br /> <br />NO: <br /> <br />NO: <br /> <br />DIAGRAM OF HOUSEAND <br />LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br /> ..... .--- -, <br />'m .... <br /> ~ CiL] L _~-T~ <br /> <br />3/82 Rev 10/87 <br />car <br /> <br />N <br /> <br /> <br />