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AUTHORIZATION NOTICE <br />(Supplemenual Form) <br /> <br />I~ order to properly evaluate your exhs¢ing sewage system, the follouing <br />information will be necessary: <br /> <br />rf your sewage system is less Than five (5) years old, and <br />have an spproved record of the system, we can proceed withou~ <br />any further action on your parT. <br /> <br />If your sewage system is less than five (5) years old, and we <br />do hOC have a record of an approved installation of the system= <br /> <br />If your sewage sys¢em is more Than five ($) years old or has not <br />been pumped within the last five years: <br /> <br />a. You must have the septic tank pumped. <br />b. Have The septic Tank pumper complete the form be!ow. <br />c. A field visit will be reguired by the SaniTarian to <br /> verify the location ~nd condition of The s~ptio system. <br />d. If you have proof Thac ~our septic tank has been <br /> pumped within The last five (5) years, secthon$ a & b <br /> will not be required. <br /> <br /> -For SepTic Tar~k Pumper Use Only- <br /> <br />~PROXIZATE SIZE OF SEPTIC TANK:. /~ ~ ~ gallons <br /> ~YES; <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />A~,E BAFFLES OR HI~OWS IN £~-ACE? <br /> <br />IS DP~INFIELD BAC~ZNG UP~ INTO TANK? <br /> <br />YES~ <br /> <br />DEO :ICE=XE ? <br /> <br />NO <br /> <br />NO <br /> <br />If ~es, explain; <br /> <br />DIAgRam! OF HOUSE AND <br />LOCATION OF <br /> <br />E,¥AM~LE: <br /> <br /> Septic <br /> Tank <br /> <br />6 ' | <br /> <br /> <br />