Septic System Assessment Form

Please fill in this online form about your property so we can detemine the appropriate septic system for your needs. Note: for all work other than septic systems, please fill in our standard Work Request Form.

Name:
Date:
Email:
Mobile:
Home ph:
Work ph:
Address/es
Street - Emergency 911
Mailing:
Legal
Select quarter:   NE   NW   SE   SW
 
Section    Township     Range    Meridian 
Requirements

Description of work to be performed
Building information (for new and existing septic systems only)
House Size
  Select units:   Sq. Ft.   Sq. M.

Plan Upload:

Are any future additions planned?

Future addition Size:
  Select units:   Sq. Ft.   Sq. M.
Occupants:

Current # of occupants

Occupant notes:
(e.g. does # of occupants expand greatly during parts of the year?)
Bedrooms:

# of bedrooms required

Additional Bedrooms (future development)
Please indicate how many additional bedrooms are planned for future development
Bathrooms:

# of bathroom required. Please specify 2 piece, 4 piece...

Additional Bathrooms (future development)
Please indicate how many additional bathrooms are planned (2 piece, 4 piece...) for future developement
Products:
Water softener?   Yes   No   Required in future     Iron filter?   Yes   No   Required in future
Reverse osmosis?   Yes   No   Required in future     Garburator?   Yes   No   Required in future  


Additional high water use fixtures?
i.e. jet tub, hot tube, pool, steam shower, multi-head showers. Please indicate whether these are required now or an allowance made for a future requirement.

If yes, please indicate...

Tub/s
Size of tub

Steam shower / Multi head shower
# of standard heads    # of body sprays    # of rain cans
Water Source:
Select source:   Well   Cistern   Municipal    

Location of neighbouring wells
Restrictions:
Any covenants or easements?

ie. water, sewer, power, cable, fiber optic, gas, phone, underground tanks, other pipeliens, rights of ways
Hobbies:

i.e. Beer or wine making, canning etc.
Lifestyle:

i.e. entertaining, catering, gourmet cooking ( excess oil and grease) , maid service (use of high strengh cleaners), other?
Buildings:
Are there other buildings on site?
Business:
Do you have/will have a home based business?

i.e. Hairdresser, dog grooming, catering, bed & breakfast, daycare...

Business timeframe: Required now   Required in future
Comments or Questions:
Terms
Yes, I agree
By ticking the box above, you acknowle that the information supplied on this form is correct to the best of your knowledge. You further acknowlede and understand that your system design will be based on this information supplied.
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