Septic Tank Remediation Program - Application Qualification Form
If you have a failing septic system, we hope to be able to assist you with repairing or replacing that system. Please complete the form below to let us know that you are interested in learning more about the program and help us determine if you are eligible to participate.  We will review and contact you to discuss.  

Questions? Email the Program Manager at contact@irwp.org.
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Homeowner Name(s): *
Property Address (Where the Septic System is Located): *
Phone Number: *
Email address: *
Preferred Method of Contact?
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How did you learn about our program?
Describe the septic problem: *
When was the tank last pumped? *
The property is located in which watershed? If unsure, please use the "Find My Watershed" tool at <https://watersheds.cast.uark.edu/find_your_watershed.html> - Your watershed will be listed under the "8-Digit HUC" on the right side. *
Has the system been evaluated by a septic professional and noted as failing or designated as failing by the Arkansas Department of Health county health unit?
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