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AUTB©RiZAT%ON NOT%CE/EXlS?ING SYSTEM EVALUATION <br /> <br />POMPER FORM <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />If your sewage system is less than five (5) years old, and we have, <br />an approved record of tt%e 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 />or; <br /> <br />IS TANK %N GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />~S DRAINFI~LD BACKING UP INTO TANK? <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 /> a. You must have the septic tank pumped. <br /> b. Have the septic tank pumper complete the form below, <br /> A field visit will be required by the sanitarian to verify <br /> the location and condition of the septic system. <br /> d. If you have proof that your septic tank has been pumped <br /> within the last five (5) years, sections a & b will no~ be <br /> required. <br /> <br /> For Septic Tank P~mper Use Only <br />COMPANY NAME~ A A A SeptiC se~ice ~NC. .~E>LIC~N$~ NO. 3694% <br /> <br />APPROXIMAT~ SIZE OF SEPTIC TANK: /~ gallons <br /> ~S; NO <br /> YES; NO <br /> <br /> If yes, explain; <br /> <br />SEPTIC TANK MATERIAL: Concrete ~/ ~teel <br /> <br />O=her <br /> <br />DIAGRAM OF ~0USE AND <br />LOCATION OF TANK: <br /> <br />example: <br /> <br />E <br /> <br /> <br />