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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />.,~ order ~o properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />rf your sewage system is less than five (5) years old, and we <br />have an approved reoo~d of the system, we can proceed without <br />any further action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we <br />do not have a record of an approved installation of the system: <br /> or; <br />I~ your sewage system is more than five (5) years old or has not <br />been pumped within the last five years: <br /> <br /> You must have the septlc tank pumped. <br />b. Have the septic tank pumper complete the form below. <br />c. A field visit will be required by the Sanitarian to <br /> verify the location and condition of the septic system. <br />d. If you have proof that your septic tank has been <br /> pumped within the last five (5) years, sections a & b <br /> will not be required. <br /> <br /> -For Septic Tank Pumper Use Only- <br /> <br />PROPERTY OWNER: <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />IS DRAINFIELD BACKING ~ INTO TANK? <br /> <br />gallons <br />~ YES; <br /> <br /> ~YES; <br /> <br />YBS; <br /> <br />NO <br />NO <br /> <br />NO <br /> <br />If yes, explain; <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />EXAMPLE; <br /> <br />6'~ Septic Tank <br /> <br /> <br />