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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the ?ollowing <br />~information will be necessary: " <br /> <br />rf gout sewage system is less than five (5) years old, and we <br />have an approved record of ~he system, we can proceed without <br />a~y further action on your part. <br /> <br />If your sewage system is less than five ($) years old, and we <br />do not have a record of an approved installation of the system~ <br /> or; <br />I~ your sewage swstem is more than five (5) gears old or bas not <br />been pumped within the last five years: <br /> <br />a. You must have the septic tank pumped. <br />b. Have the septic tank pumper complete the form below. <br />c. A field visit will be required bg the Sanitarian to <br /> verify the location and condition of the septic system. <br />d. If 9ou have proof that your septic tank has been <br /> pumped within the las= five (5) wears, sections a & b <br /> will not be required. <br /> <br /> -For Septic Tank Pumper Use Onlg- <br /> <br />PROPE~Y OWNER; <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />__~allons <br />__~ES; NO <br />~w~Y~E$; NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? YES; NO <br /> <br />DIAGRAm! OF HOUSE AND <br />LOCATI~¥ OF TANK: <br /> <br />EXA~;PLE ~ <br /> <br /> 6' ~ Septic Tank <br />I22'- <br /> <br />SIGNATURe' OF PUMPER: <br /> DATE: <br /> <br /> <br />