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(Supplemental FOrm) <br /> <br />Ip~rde~ ~o properly evatua~e your <br /> <br />rf your ~ewage s~stem is less than five (5) years o1~, and we <br />hav~ an approved rocord Of the syste~, we can proceed without <br />~nU further aO=iOn on your pa~t. <br /> <br /> 2. If gout sewag~ tugs,em is less than fiv~ (~) years old, and ~e <br /> do not have ~ record of a~ approved i~stallation of :he sgstem: <br /> or; <br /> r~' your s~ge sys~m is mere than five (5) yea~s old or 1}~ no~ <br /> <br /> leu mus= h~v~ the sep=~ tank pumped. <br /> b. ~%...~ =:-o septic Tank pum~r co~ple~o =he form be~o~. <br /> <br /> verify the 3ocation and condition of the septic sgsteR~. <br /> d- If you have proof =hat your ~eptic t~k has been <br /> ~d.~f~e~' wi=bin the last five (5) uears, s~c=ions a .~ D <br /> <br />........ Pum~r ........ <br /> .... -For Septic Ta~ Us~ Onlg- <br /> <br />APPROXIMATB SIZE OF SEPTIC TAWK: /~) . gallons <br /> <br />Is T;~VK .tN COOD CONDITION? <br /> <br />ARE BAfFLeS OR ELBOWS IN PLACE? <br /> <br />_~_~YES; __NO <br /> <br />_~__YES; __NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> If yes, explain; ..... <br /> <br />YES; _~NO <br /> <br />PZAGRZ=U OF HOUSE AN~ <br />fJ)C~TI~¥ OF <br /> <br />Tank <br /> <br /> <br />