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Water Testing & Well Inspection
Realtor Well & Water Form
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* Indicates required question
Requester: Name, Phone, & Email
*
Your answer
Seller's Name
*
Your answer
Seller's Contact Information
Your answer
Seller's Agent
*
Your answer
Buyer's Name
*
Your answer
Buyer's Contact Information
Your answer
Buyer's Agent
*
Your answer
Tests Needed
*
Water Test: Bacteria, Nitrates, Arsenic
Well Inspection
Septic Inspection
Required
Who should we contact to schedule the inspection/tests?
*
Seller
Seller's Agent
Buyer
Buyer's Agent
Closing Date:
*
MM
/
DD
/
YYYY
Deadline for results:
MM
/
DD
/
YYYY
Property Address
*
Your answer
Lock Box # - Entry Instructions
Your answer
If the property is vacant, the water will need to run for at least 8 hours prior to testing & inspection.
(If the owner is unable to run the water, contact Complete Water to schedule an extra trip to run the water.)
*
Occupied
Vacant
We need to schedule an extra trip to run the water.
Required
Is it a shared well?
*
Yes
No
If it's shared, where is the equipment?
Your answer
Who should be billed?
*
Your answer
Will the invoice be paid at closing?
*
Yes, at closing
No, outside of closing
If the invoice will be paid outside of closing, please explain.
Your answer
If a septic inspection is needed, then please answer the following.
How many occupants?
Your answer
How many bedrooms?
Your answer
Are manhole covers above or below ground?
Above
Below
Clear selection
Is there a working hose bib? Where is it in proximity to the septic?
Your answer
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