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ADDRESS/LOCATION OF EVALU~%TION <br /> <br />SEPTIC TANK EVALUATION <br /> <br /> -Fo Be Compl~tea By Licensed septic Pumper Only- <br /> <br />COMPANY N~ ~L~. ~ · <br /> <br />DEQ LICENSE NUMBER~.~,:~7~ <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES AND ELBOWS IN' PLACE? <br /> <br />CAPACITy OF TANK ,/~7.)~-cT GALS. <br /> F YES NO <br /> ~S NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />, .,YES_ ? NO <br /> <br />-Diagram Of HOUSe A~d Location Of Tank~ <br /> <br />.9 <br /> <br />! Pumped and inspected this' septic tank and ¢oun~ conditions as <br />above a~ of thi~ date. ' ' - , <br /> <br /> S IGNATUR~ <br /> OF <br /> <br />noted <br /> <br /> <br />