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SEPTIC TANK EVALUATION <br /> <br />PROPERTY OWNER ..... , ~ <br />ADDRESS/LOCATION OF EV~UAT~ON <br /> <br /> -To Be Compl~2e~ By ~fcens~d s~p~ic pumper Only- <br /> <br />SEPTIC ~K <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES AND ELBOWS IN PLACE? <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />~E$ NO <br />YES NO <br /> <br />-Diagram Of House And Location Of Tank- <br /> <br />I pumped and inspected this septic tank and .foun~.condltion$ <br />above as of this date ~----~/~4 ~~_.[/~ <br />SIGNATURE OF ~E~IC ~ANK PUMPER q <br /> <br />as noted <br /> <br /> <br />