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SEPTIC TANK EVALUATION <br /> <br />ADDRESS/LOCATIoN OF EVAI~UATION <br /> <br /> -To Be Compie~d By Licensed Septic <br /> <br />SEPTIC TANK MATERIAD ~>~C~J%_~.L~51-_CAPACITY OF T~K <br />IS T~K IN GOOD CONDITION? ~ES <br />ARE BAFFLES ~D ELBOWS IN PLACE? /~S <br /> <br />Pumper only- <br /> <br />/~'-~d~, GALS. <br /> <br /> NO <br /> <br /> NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />YES L/ NO <br /> <br />-Diagram Of HoUse And Location Of Tank- <br /> <br />I pumped and Inspected this septic tank and <br />above as of this date, ' <br /> <br /> SIGNATURE OF SEPTIC TANK PU~4PER <br /> <br />foUnd <br /> conditions ~s <br /> <br />noted <br /> <br /> <br />