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- l/ ar on Counts o -sz= <br /> <br /> The following $i~dirsmenta apply to [,~e evaluation of an cx~stlng on-s~re <br /> sewaqe systs~. ~leMse select the apprDpr~ate s~ion and follow the d~rec~c~ls <br /> carefully, <br /> <br /> 1, ~ f your sewage' system is less than five 15) yea~ alt anO a <br /> Certificate of Satimfactory. Completion haz bee5 issu~d for the <br /> system, the septic tank do~s sot recruits pumping at this time. A <br /> field inspection will be ~ade of the entire ~ystem ant a report <br /> <br />[f your sewa§e system ~s mo~e than ~ive /5I years old and the <br />~sptie tank has not been pumped within the Lass five {5) years, <br />~oilow the directions below. If you have proof that the septkc <br />tank has been pumped within the last five (5) years, sections <br />and (b) will not be required. <br />a, The septic tank mus~ De pumped by a D.E.Q. licensed septic <br /> ~ank pumper, <br /> The septic tank pumper must complete the form <br /> A 'field inspection will be required by our on-site staff to <br /> verify tb~ location and condition of the septic system. <br /> <br /> *for septic pumper use only* <br /> (please print) <br />COMP/~Y NAME1 ~f~,, C d~ /~mMOf D.E.Q, LICE~;SE #: <br /> <br />AP~ROXIMATC SI~E OF TANK: ~ gallon~ <br /> <br />SEPTIC T~K ~TERI~: Concrete. ; Steel ~ ~ Other... <br /> <br />IS T~K IN G~D CONDITION7 ............. Yes <br /> <br /> If "No", ex,lain: <br /> <br />~ INLET & OUTLET FITTINGS IN P~CE? .. Yes <br /> <br />IS DISPOBkL FIELD BACKING INTO T~K? ... Yes <br /> <br /> If "Y~.", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPT'Ic TA~K: <br /> <br />(show detail with meas~rementm) <br /> <br />DATE. OF'. ~UMPING <br /> <br />SIGNATURE O~ PUM <br /> <br /> <br />