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~JT~OR~ZATION N~rIC~ <br /> <br />· .~ orde~ to properlW evaluate 7o~r existing sewaFe system, the follow~ng <br /> inform~tion will be necessary: <br /> <br /> your sewage system is less ~han five (5) years o~d, and we <br />hav~ an a$proved reco~d of the syste~, we can ~roceed without <br /> further ac:~on on ~our ~rt. <br /> <br />PROPERTY OWNER; <br /> <br /> If your sewage s~Stem is le~s than fiVe (5) ~ears old, and we <br /> do n~ have a reCOrd of an a~prOV~d installation of the system: <br /> <br />If your sewa~e sgs~em is m~ze tha~ five (SJ years old er has nog <br />been pumpe~ within the la~ five years: <br />a. YOU must have the ~eptic tank pumped. <br />b. ~ave the septi~ tank pumper complete the form <br /> A field visit will be requir~ by the S~nitari~ to <br /> verif~ the locati~ ~d ~ndition of the septic <br />d. If WOU have $~oof that gout septic t~k has <br /> p~d within the t~t five (5) years, sections a & b <br /> will not be required. <br /> <br /> -For SepTic Ta~ p~r USe Only- ' .......... <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK ~N GOOD CONDZTZON? <br /> <br />ARW BAFFLES OR ELBOWS IN <br /> <br />IS DRAINFIELD ~ACRING NP INTO TANK? <br /> <br /> If yes, explain; <br /> <br />Fallons <br />~YES; MO <br />, ~YES; NO <br /> <br />~ev. 2/86 <br /> <br />DIAG'RA~ OF HOUSE AND <br />LOCATION O~ TANK: <br /> <br />Septic <br /> <br />I <br /> <br /> <br />