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Pre-Inspection Septic Home Owner Survey
The completion of this form helps us understand how the system is being used and aids tremendously in your overall inspection.
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* Indicates required question
Email
*
Your email
Inspection Address
*
Your answer
Owner Name
*
Your answer
Client Name
*
Your answer
Client Address
*
Your answer
Client Phone Number and Email
*
Your answer
Seller’s Agent & Phone
Your answer
Buyer’s Agent & Phone
Your answer
Do You have a copy of the State Approved Septic Plan on hand?
Yes
No
Maybe
Clear selection
If no do you have a Sketch of where the Septic System Components are?
Yes
No
Clear selection
Age of House
*
Your answer
House Occupied?
*
Yes
No
If Vacant, For How Long?
Your answer
If Occupied, How Long
Your answer
How many people living/moving into the house?
*
1
2
3
4
5
6+
Do you have a Water Softener
*
Yes
No
Maybe
IF you have a Water Softener, Where it does it Discharge to?
Septic Tank
Seperate Outside Container
Other:
Clear selection
Do you Have a Garbage Disposal
Yes
No
Maybe
Clear selection
Do you have a Dishwasher
Yes
No
Maybe
Clear selection
Do you have Washing Machine
Yes
No
Maybe
Clear selection
Does the Washing Machine Discharge into the Septic Tank?
Yes
No
Maybe
N/A
Clear selection
Date of Last Pumping of Tank(s)
MM
/
DD
/
YYYY
Have There Been Any Concerns, Problems or Corrections to the System?
*
Yes
No
If Problems with the system, what kinds?
Your answer
Have There Been Fixtures Added to the Plumbing System of the House Since the Original Septic System was Installed?
*
Yes
No
If Fixtures have been added, what Fixtures?
Your answer
Additional Comments or Information
Your answer
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