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AUTHORIZATION NOTIC=/~XISTING SYSTEM EVALUATION <br /> <br /> ~UMFER FORM <br /> <br />~n order to properly ev&luase your existing sewage system, the following <br />information wilI be necessary: <br /> <br />If your sewage System is less than five (5) year~ old, and we have <br />aD approved record of the system, we can proceed without any <br />further action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we do <br />not have a record of an approved installation of the system: <br /> <br />If your sewage system is more than five (5) years old or has not <br />been pumped within the last five years: <br /> <br /> ~ave the s~ptic tank pumper complete the form below. <br />c. A ~ield visit will be required by the Sanitarian to verify <br /> the location and conditio~ of the seDtic system. <br />d. If you have proof tha~ your septic tank bas been pumpe~ <br /> within the last fi~e (5) years, ~ections a a b will not be <br /> required. <br /> <br />A~PROXIMATE SIZE OF ~EPTIC TANK: <br /> <br /> TANK IN GOOD <br /> <br />AR~ BAFFLES OR ~L~OWS IN PLAC=? <br /> <br /> DPJ%~NFI~L~ BACKING UP ~NTO TANK? <br /> <br />~EPTIC TANK ~{ATERIAL: Concrete <br /> <br />YES; NO <br />YE~ ~ ~NO <br /> <br />,. Steel Other__ <br /> <br />DIAGP~J4 OF ~OUSE AND <br />LOCATION OP TANK: <br /> <br />example <br /> <br />6'~ Sep~c tank <br /> <br />Rev 7/89 pb <br /> <br />SIGNATURE OF PUMP ' "( <br /> DATE OF PUMPING:...../-- ~ .... ~( .... <br /> <br /> <br />