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AUTEORIZATION NOTICE/EXIST~N~ SYST~M EV~LUATION <br /> <br />PUMPER FORM <br /> <br />following information will be necessary: <br /> <br /> 1. If your sewage system is less than five (5) 'years old, <br /> and we have a record of the system, we can procee~ <br /> <br /> 2. If your sewage system is ~ore than five ($) ~ears old <br /> <br /> It will be necessary to have the septic tank <br /> puraped <br /> b. Save a DEQ licensed septic tank pumper complete <br /> the form below <br /> c. A field visit will be required by the Sanitarian <br /> to verify the location and condition of the septic <br /> system <br /> d. If you have proof that your septic tank has been <br /> pumped within the last five ($) years, sections a <br /> and b above will not be required. Pro=ide <br /> verification of pumping (receipt from pumper) to <br /> this office. <br /> <br /> ---FOR SEFTIC T/kNK POMi~ER USE O~IL~-~ <br /> <br />COMPA/~Y NA~; <br /> <br />DEQ LICENSE NO: <br /> <br />PROPERT~ OWNER: <br /> <br />AJDDRESS WI~ERE TANK PUMi°=D~ <br /> <br />A~PROXIMATE SIZE OF SEPTIC TANK: <br /> <br />G/tLLONS <br /> <br />IS TANK IN G~D CONDITION? <br /> <br />NO: <br /> <br /> ARE BAFFLES OR ELBOWS IN PLACE? <br /> SEPTIC TA~ ~TERIAL: <br /> <br />DIAGRA!tOF ~OUSEA_ND <br /> LOCATION OF TANK: <br /> <br />W <br /> <br /> YES: NO: <br />Concrete Steel Other <br /> <br />N <br /> <br />SIGNATURE OF PUP~PER: <br /> DATE OF PUMPING: <br /> <br />"11/88 97 <br /> <br /> <br />