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AUTHGRIZATION NOTICE <br />(Supplemental Form) <br /> <br />In okder to properlU evaluate ~our ~xisting sewage system, the following <br />i~formation will be necessary: <br /> <br />rf Four 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 Four 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 sFstem: <br /> or; <br />I~f Four sewage system is mere than five (5) Fears 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 below. <br />c. A field visit will be required by the Sanitari~ to <br /> verify the location and condition of the septic spst~m. <br />d. If you have proof that pour 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 />COMPANY NAME: ~/,/~5~ ~~ ~6~ ~/C ~ <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: ,..,~ <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARB BAFFLES OR ELBOWS IN P~CE? <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />gallons <br /> <br />DEQ LICENSE NO: <br /> <br />YES; <br /> <br />NO <br /> <br />If yeS, explain; <br /> <br />DIAGRA~I OF BOUSE AND <br /> <br />LOCATION OF TANK: <br /> <br /> ~ septic Tan~ <br /> <br /> <br />