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(Supplemental Fo¢'m) <br /> <br />In order to properly evaluate your existing sewage system, the follol/ing <br />information Hill be necessary'- <br /> <br />rf your sewage system is less than five (5) gears old, and we <br />have an approved record of the System, we can proceed without <br />any further action on your part. <br /> <br />If your sewage system is less than five (5) years old, and <br />do not have a record of an approved installation of the system: <br /> or; <br />If your se~ge system is more than five (5) gears e~d or has not <br />b~ou pu~ped ~ithin the lest five ycars.~ <br /> <br />a. ~ou must have the septic tank pumped. <br />b. Hav.:~ the septic ~ank pumper oemp3et~ the fo~m belo~. <br />c- A field visit will be required by the Sanitarian to <br /> verify the location and condition of the septic system· <br />d. .If you have proof that your septic rank has been <br /> pumped within the last five (5) years, sections a & b <br /> will eo~ be required. <br /> <br />-For Septic Tank Pumper Use Only- <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS lANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PIECE? <br /> <br />IS DRAINFIELD BACKING UP INTO ~ANK? <br /> <br /> If yes, explain; <br /> <br />__ gallons <br /> <br /> ~YES; <br /> ! <br /> ~YES; <br /> ¢ <br /> <br />YES; <br /> <br /> NO <br /> NO <br /> <br />~ NO <br />! <br /> <br />PIAGRAM OF HOUSE AND <br />[.OC~TI'O~¥ OF Tz~=¥K~ <br /> <br />E.%L~MPLE : <br /> <br />.6~2,.Septic Tank <br /> 6' <br /> <br /> St ro_e.t <br /> <br /> <br />