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(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the folle~.ving <br />lnfo~mation will be necessary: <br /> <br />rf your sewage system is less than five (5) years old, and we <br />have an approved record of the system, we can proceed without <br />any further action on your part. <br /> <br />2'f your sewage system is less than five (5) years old, and <br />do not have a record of an approved installation of the system~ <br /> or/ <br />If' your se~¢age system is more than five (5) years o~d or has not <br />been pu~pe~ ;~i¢hin the last five years: <br /> <br />a. ~ou must have ¢he septic tank pumped. <br />b. Haw? ¢~e septic tank pumper complete ¢he for~ below. <br />c. A field visxt will be required by the Sanatarian to <br /> verify the location and condition of the septic system. <br />d. If you have proof tha~ your septic t~k has been <br /> pI~mped ~ithin the last five {5) yeers~ sections a & b <br /> wi2! eot be require,~. <br /> <br />-For Septic Tan~ Pumper Use Only- <br /> <br />ADDRESS W~IERE I'ANK PUMPED: <br /> <br />APPROXIMATE SI~E OF SEPTIC TANK:_. /6~... --gallons <br /> <br />IS TANK IN GOOD CONDITION2 <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />~ES; NO <br />YES; NO <br /> <br />iS DRAINFIELD ~ACKING UP INTO <br /> <br /> If gas, expt~in; <br /> <br />YES; .. ~ NO <br /> <br />O[ACR>XM OF HOUSE AND <br />IOCz~TION OF TANK: <br /> <br />SIjNATURE OF PUMPER: ~ <br /> ................... <br /> <br /> <br />