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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br /> 1. If your sewage system is less than five (five) years old, and we have <br /> an approved record of the system, we can proceed without any further <br /> action on your part. <br /> <br />If your sewage system is less than five (5) years eld, and we do not <br />have a record of an approved installation of the system: <br /> or; <br />If your sewage system is more than five (5) years old or has not been <br />pumper within the last five years: <br /> <br />You must have the septic tank pmmped, <br />Have the septic tank pumper complete the form below. <br />A field visit will be required by the Sanitaraian to verify the <br />location and condition of the septic system. <br />If you have proof that your septic tank has be~n pumped within the <br />last five (5) years, sections a & b will not be required. <br /> <br />For Sep/ic Tank Pumper Use Only <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 UP INTO TANK? <br /> <br />gallons <br />~YES; NO <br />_ C~ YES; NO <br />YES; ~ NO <br /> <br /> If yes, explain; <br /> <br />SEPTIC TANK MATERIAL: Concrete ~/Steel <br /> <br />Other <br /> <br />DIAGRAM OF MOUSEAi~ <br />LOCATION OF TAI~K: <br /> <br />EXAMPLE: <br /> <br />.,,6'~ Septic Tank <br /> well <br /> <br />3/82 Rev 10/87 <br /> <br /> <br />