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The following requirements apply to the evaluation of an exiStiNg on-site <br />sewage system. Please select the aDpropriate section and follow the directions <br />carefully. <br /> <br />If your sewage system is less than five (5) years old and a <br />Certifi~ate of Satisfactory Completion has be~n issued for the <br />system, the sep=ic :ank does ~st require pumping at thin time, A <br />field inspection will be made of the entire system and a report <br />will be issued, <br /> <br />If your sewage system is more than five (5) years old and the <br />septic tank has not been pumped within the last five (5) years, <br />follow the directions below. If you have proof that the septic <br />tank ha~ been pumped within tbs las% five {5) yea~s, sections <br />and (b) will not be <br />a. The septic tank must De pumped by a D.E.Q. licensed septi~ <br /> tank pumper. <br />b. The septic tank pumper must complete the f~rm below. <br />c. A field ins~ec~io~ will be required by out on-site staff tO <br /> verify the Location and condition of the s~p%io system. <br /> <br />*for ael~tic pumper use only* <br /> <br />(please print) <br /> <br />S~PT~C ~NK MATERIAL.~ Concrete ~ - steel <br /> <br /> gallons <br /> ; other <br /> <br /> ~$ TANK IN GOOD CONDITION? ............. <br /> No <br /> <br />AR~ INLET ~ OUTLET FITTINGS IN PLACe? .. <br /> <br />IS DISPOSAL FIELD BACKIRG INTO TANK? ... <br /> <br />DIAGRAM OF MOUSE kND SEPTIC ~ANK; (show ,,detail with meaSurement~ -~~ <br /> <br /> N <br /> SEP 1 2 1995 <br /> <br /> <br />