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ADDRESS/LOCATION OF EVALUATION <br /> <br />SEPTIC TANK <br /> <br /> -To Be Comply%ed By Licensed Sep%ic Pumper Only- <br /> <br />IS TANK IN GOOD CONDITION? ~YES NO <br />ARE BAFFLES AND ELBOWS IN PLACE? ~ YES NO <br /> <br />GALS. <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />YES MO <br /> <br />-Diagram Of House And Location Of Tank- <br /> <br />I pumped and inspected thi.s 'sePtic tank and found conditions as noted <br />above as of this date, <br /> <br /> SIGNATURE OF SEPTIC TANK PUMPER , <br /> <br /> <br />