Laserfiche WebLink
AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />In order to properly evaiuate your existing sewage system, the following <br />information will be necessary: <br /> <br />1. <br /> <br />T? your sewage system is less than five (5) years old, and ~e <br />have an approved reco~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 /> <br /> or; <br />If your sewage system is mo~e than five (5) years old or has not <br />been pumped ~ithin the last f~ve years: <br /> <br /> You must have ~he septic tank pumped. <br /> Have the septic tank pumper complete the form below. <br />c. A field visit will be requi~e~ by l:he 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 />F,~:.u_ 2/86 <br />pmb <br /> <br /> -For Septic Tank Pumper Use Only- <br /> <br />APPROXIMA~ SIZE OF SEPTIC TANK: ~~ ~ <br />fS TANK IN GOOD CONDITION? NO <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? NO <br />IS DRAINFIELD mACK.rNG UP INTO TANK? __YBS; ~ <br /> <br />If yes, explain; <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF' TT~VK: <br /> <br />EXA~3p f,E : <br /> <br /> Septic <br /> Tank <br />6 ' [ <br /> <br />SIGNATURE OF PUMPE ......... <br /> <br /> <br />