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The following requirements apply' go~': the evalbation of' an existing on-site <br />sewage system. Please select the appropriate section and follow the dimections <br /> <br /> 1. If your sewage syste~is less thin 'five ,(5)~'eare oi~ a~d a <br /> Certificate of. Satisfactory Completion has been issued for the <br /> system, the septic tack does not require pumping at this time. A <br /> ~.field inspection wil~be made of t/%e entire sys. t~m aqd ~eport <br /> will be issued. <br /> <br /> 2. If your sewage system is more than five (5) years old and the <br /> septic tank has not'~een pumped within the las~ ,five (5) years, <br /> follow the directions below. If you have proof that the septic <br /> tank has be~n pumped within the last five (5) years, sections (a) <br /> and (b) will not be required. <br /> a. The septic tank must be pumped by a D.E.Q., licensed septic <br /> tank pumper. <br /> b. The septic tank pumper must complete the form below. <br /> c. A f. ield inspection will be required by our on-site staff to <br /> verify the location and condition Of the septic system. <br /> <br /> *for septiS"'pumper use only* <br /> (plea.se print) <br /> <br />SEPTIC T~K ~TERI~: Concrete.~.; Steel <br /> <br />IS TANK IN GOOD CONDITION? ............. Yes <br /> <br /> qall0ns <br />Other <br /> <br /> No <br /> <br /> If "No", explain: ~ <br />ARE INLET ~ OUTLET FITTINGS IN PLACE? .. Yes ~ ; <br /> <br />IS DISPOSAL FIELD BACKING INTO TANK~ ..... Yes <br /> <br /> If "Yes", explain: <br /> <br />DIAGRAM OF HOUSE AND SEPTIC TANK: <br /> <br /> ' I / <br /> <br />No <br /> <br />(show detail with measurements) <br /> <br />MClS-S19 <br /> <br />(5031 588-~147 ~..~t.o.r,Su. ilc~i~, .2n? <br /> <br />DATE OF PUMPING <br /> <br /> <br />