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AUTHORIZATION NOq~CE/EK~$TING SYSTEM EVALUATION <br /> <br />PUMPER FORM <br /> <br />mm <br /> <br />If your sewage ~ystem is le~ than five (~) years old, and we have <br />an approved record of the system, we ean proceed without any <br /> <br />not have a record of an approved installation ¢£ the system: <br /> <br />or; <br /> <br />If your ~ew~ge system is more than five (5) years old or ha~ not <br />beep p~mp~d within the last five year~: <br /> <br />a. You must have the ~pt:~¢ tank p~mped. <br /> Rave the septic ~a~k ~u~er ~lete the form below. <br />c. A field vi~i~ Wi~l ~.e .~eq~ired by the Sanitarian to verify <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />I~ TANK IN GOOD CONDITION? <br /> <br />ARE ~AFFL~S OR ~LBOWS ~N PLACE? <br /> <br />~ DRAINFIELD P~CKING OP INTO TANK? <br /> <br /> ~f yes, explain; <br /> <br />SEPTIC TANK ~ATER~AL: <br /> <br />L~-- YE~: NO <br />YES; ~.- NO <br /> <br />DIAGRAJ4OF NOU~E AND <br />LOCATION OF TANK: <br /> <br />example: <br /> <br />E <br /> <br />Rev 7/89 <br /> <br />SIGNATURE OF PUMPER: <br />DATE OF PUMPING: <br /> <br /> <br />