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AUTHORIZATION NOTIC~/E×ISTING SYSTEM ~VALUATION <br /> <br /> pUmPER FORM <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br /> 1. If your sewage system is less than five (5) years old, and we have <br /> an ag~roved record of the system, we can proceed without any <br /> further action on your parS. <br /> <br /> 2. If your sewage system is le~ than five (5) years old, and we do <br /> not have a record of an approved installation of she system: <br /> <br />If your sewage ~y~tem is more than five <br />b. <br /> <br />(5) years old or has not <br /> <br /> You mu~t have the septic tank pumped. <br /> Have the septic tank pumper complete the form below. <br /> A field visit will be required by the Sanitarian to verify <br /> the location and condition of the septic system. <br /> d. If you have proof that your septic tank has been pumped <br /> within the last five (5) years, sections a & b will no% be <br /> required. <br /> <br /> For Septic Tank Pumper Use Only <br /> <br /> :/ <br /> <br /> TANK IN ~OO~ CONDITION? ~S; <br /> NO <br /> <br />~ ~AFF~ OR ~L~OWS IN PLACe? ~S; NO <br /> <br />ZS DRAINFI~LD ~ACKING UP INTO TANK? <br /> <br />If yeS, explain; <br /> <br />Other <br /> <br />DIAGRAm4 OF ~OUSE AND <br />LOCATION OF TANK: <br /> <br />example <br /> <br />Rev 7/89 pb <br /> <br />SIGNATURE OF PUMPER: <br /> DATE OP PUMPINGu <br /> <br /> <br />