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[~mrzon,County oN-sx~ $~ao~ <br /> <br /> ~he foll~ing r~lrements apgly =o khe evalua=io~ of a~ existing on-site <br /> ~age ey~t~. Please select the appropriate section and follow the directions <br /> carefully ~ <br /> <br /> 1. 'I~ your sewage eyst~ is less than five (S) years ' old and a <br /> Certificate .of Satisfacto~ ~mp~etion has been iesu~ for .the <br /> ey.tem, t~e .:.eptic tank does not re~fre pumping at this time. <br /> ~. ~ fleld"inepect~on will be made..of the entire system and a re~rt <br /> ;:, will ~e issued. <br /> <br /> 2. If your sewage system l. more fha, five (5) years old and the <br /> septt~ 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 h~. been ~m~d withi, the last five (5) years, sections <br /> · ~ and (b) .will'not be r~/red. ' <br /> a. TheT/sep.tic tank must be pureed by a D.E.Q.' licensed septic <br /> tank .purr. <br /> b. Thb:septic.tank ~r ~st complete the ~o~ bel~. . <br />k, c. A field ~ns~ction will be re~ired by ou~ on-site staff to <br />~. v~rify the location and condition of the septic system. <br /> <br /> · for se~lc ~r use only* <br /> <br /> APPROXIMATE SIZE O~ TANK: gallons <br /> SEPTIC TANK MATERIAL: Concrete % Steel ; Other <br />i.(~i IS TANK IN GOOD CONDITION? ............. Yes ~; No. <br /> If "No", explain: <br /> <br /> AR~ INLET & OUTLET FITTINGS IN PLACE? ·, Yes ~-- ; <br /> <br /> i'S DISPOSAL FIELD BACKINO iNTO ~TANK? .... Yes ; - No <br /> <br />~.~%;-,....: ;;.~ If "Yes" <br /> <br /> D'IAGRAM OF HOUSE AND.SEPTIC TANK: <br /> <br /> ? <br /> N <br /> <br />(show detail with measurements) <br /> <br />~C15-S19 <br /> <br />'Senalor Bu~'~n& 2nd Floor <br /> <br /> <br />