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~ ~ ~/ ~ AUTHORIZATION NOTICE <br /> (Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the foZlow~ng <br />information will be necessary: <br /> <br />rf your sewage system is less than five {$) years old, and wo <br />have an approved recor~ of =he $gstem, we can proceed w~thout <br />any further action on gout <br /> <br />If your sewage sW$tem is l~ss than five (5) years eld, and w~ <br />do not have a record of an a---~proved installation of the system: <br /> or; <br />If yo~r Sewage SUp=em is ~r~ tham five (5) y~ars old or has no~ <br />b~en pumped wi=bin =he lest five ~oa=S: <br /> <br />a. You taus= have ~he s~pt~c ~ank pumped. <br />b. Ha~ the septic tanR pumper ~mplete zho form below. <br /> A field vial= will bo required bg =he $unltar~an =o <br /> verify the location and Condition of the Septic s~S~em. <br /> If you have pr~f ~ha~ ~our septic tank ha~ been <br /> pu~ped within the las= f~ve (5) g~ars, seO=ions a & b <br /> will no= be required. <br /> <br /> -For Sep=ic Ta~ Pum~r 'Us~ O~lyU~ <br /> <br />IS TANK IN GOOD CONDITION2 <br /> <br />_____YES; ~0 <br /> <br />ARg BAFF~S OR ELBOWS IN <br /> <br />IS DRAINFIBLD BACKING UP INTO <br /> <br /> If ~es, explain; <br /> <br />NO <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />EXA,qpLE; <br /> <br />Septic Tmnk <br /> <br />:v. 2/86 <br /> <br /> <br />