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'In order to propeuly e~aZu.ete your e,~is~ing seitage sgstem~ the foZiow~ng <br />inform,~t~on '~;i~ be neoes~ry: <br /> <br />rf your se~uge system is le:s than five (5) years old, and we <br />have an appro~ed reco~d of the system~ w~~_ can proceed w~thout <br /> <br />been pumped within the last five years: <br /> <br />o. A field visit will be required by the Sanitarian to <br /> verify the location and ~o~di=ion of the septic system. <br /> <br /> pumped within the last five (5) years, sections a & b <br /> will not be required. <br /> <br /> -For Sei3tic Tank Pumper Use Only-' <br /> <br />PRQP6RTY OWNER: .,., {; I' ~ t,:, - ,-7~,~ .... 0s / ~ <br />ADDRESS WHERE TANK PUMPED: <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK:7~~-/6~3 <br />IS TANK IN GOOD CONDITION? <br /> <br />YES; <br /> <br />NO <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br />rs DRAINFIELD BACKING UP INTO TANK? <br /> <br />YES; NO <br />~ES; ~ NO <br /> <br />If yes, explain; <br /> <br />DIAGR~=%! OF BOUSE AND <br />LOCATION OF <br /> <br />] Septfc Tank <br /> <br />SII~NATURE OF PUblPER/~ <br /> <br /> <br />