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(Sopplemental Form) <br /> <br />I~'~rde½ to properly evaluate your existing sewage system, tt~e follo~ng <br />~nform~t~..~on ~l.~i be: r~oessarg= <br /> <br />7f you£ sewage sus6em is less than five (5) years old, and we <br />have an appz'oved t'ocord of the system, we can proceed ~iEl:out <br />anU further action o~ your parT. <br /> <br /> If uour sewage system is less than five (5) years old, and we <br /> do no8 have a record of a~ approved i~stallation of the s~stem~' <br /> or; <br /> r_f ,_?eI!~ se~.,~ge sysCe~ is m~re than fi~ve (5) y~a~s o~d or has no~ <br /> <br />d. rf you have proof that your septic t~k has be~n <br /> ,uo.-n~oo~ w. iSh~.n th~ last five (5) ye.urs, sections a & b <br /> <br />-For Septic Tank Pumpe~ Use Only- <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />gallons <br /> <br />IS =ANY IN COOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS JN PLACE? <br /> <br />YES: <br />YES~ <br /> <br />NO <br /> <br />NO <br /> <br />IS OPAINFIELD BACKING UP INTO TANI<? <br /> <br />YES~ ~ NO <br /> <br />yes, expialn; <br /> <br />DIAGRA~1 OF HO,IJSE AND <br />LOCATION OF ~ ' <br /> <br />EA=~3.?LE : <br /> <br /> C~ ' ~ Septic Tank <br />F22 ' <br /> <br /> '~'t' ~,et~ <br /> <br /> <br />