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SEPTIC ~rK P~PII~ AN'D INSPECTION <br /> <br />The foll~ing retirements apply tO the evaluation of . an. existisg on-site <br />sewage system. Please select the appropriate section and follow the directions <br />carefully. <br /> <br />1. ~f you~ sewage sy~ i~ less than f~ve {~) vear~ old and a Certifioate <br /> of Satisfactory Comple~ion has been issued for the System, the s~ptic <br /> <br /> a. Authorization Notices do.. ~ot re~ire a field inspection of <br /> <br /> b. Existing System Evaluations d~ r~ire a field ins~ctio~ of the <br /> <br />COMPANY NAKE: <br /> <br />If your Sewage system is ~ore %has fiv~ ~5) years old and the ~epfic <br />tank has not been pumped within the last five (5) years, ~ollow the <br />directions below. If you have proof that the septic tank has been pumped <br />within th8 last five (5) year~, section {a) will Dot b~ required. <br />a. The septic tank must b~ pumped by a D.E.Q. licensed septic tank <br /> ~umger. <br />b. The septic tank pumper must complete the form below. <br /> Authorization Notices and Existing Syste~ ~valuations require a <br /> field inspection to verify the location and condition of the <br /> septic system. <br /> <br /> *for septic pumper use only~ <br /> <br />PROPERTY OWNER: <br /> <br />{$031 <br /> <br />APPROXIMATE SIZE OF TANK~ gallons <br />SEPTIC TANK MATERIAL~ Concrete ,; Steel, ; Other__ <br /> <br />Is TANK IN GOOD CONDITION? ............. Ye~ ; No <br /> <br />ARE INLET & OUTLET FITTINGS IN PLACe? .. Yes .,~ NO <br /> <br /> If "Yes", explain: . <br /> <br />DIAGRA~ OF ROUSE AND ~EPTIc TANK: (show detail with measurements) <br /> <br /> N <br /> <br />220 Eil~h St. NE * SaJem, (DR 97301-~70 <br /> <br />~ATE OF ~UMPING <br /> <br />StGNATUP~Z OF PUMPER <br /> <br />~C15-S19 <br />REV 1/93 <br /> <br /> <br />