Homeowner Declaration Form

Homeowner Declaration Form For Septic System Design

Client Name

Home Phone

Cell Phone Number

Mailing Address

Legal Land Description & Subdivision Info

Municipal Address of Project

What County Is The Project Located In

Type of Septic System

Property Size

Water Source

Type of Building

Type Of Building Foundation

Building Size

# of Bedrooms

# of People Living in Home

# of Full Bathrooms

# of Half Bathrooms

Public Washroom

# of Kichen Sinks

# of Laundry Washing Machines

# of Laundry Sinks

# of Floor Drains

Sink, Floor Drain or Bathroom in Garage?

High Flow, Multiple Heads or Steam Showers?

Weeping Tile or Sump Drains Into Septic System?

Jacuzzi Large Volume Jet Tub?

Garbage Grinder?

Water Treatment Equipment?

Any Extra Fixtures That Use a Plumbing Drain

Water Saving Appliances?

Furnace/Boiler Condensate Drain Into Septic System?

Allowances For Future Expansion?

Do You Home School Kids?

Hobbies* (That affect septic system loading)

Commerial Use?

Other Buildings on Property Connecting to Septic System?

Outhouse on Property?

Additional Info

Soil Info (If Known)

Excess Soil From Excavation

Overhead Lines Conflicting In Work Area?

Underground Utilities Conflicting In Excavation Area?

Trees Conflicting In Work Area?

Other Obstacles Conflicing In Work Area?

Any Additional Work To Be Completed?

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Complete this form accurately and honestly. Improper or incomplete information could result in inaccurate estimates, major job delays, added costs and/or change in scope of work.

This form is used for estimating, design and permit purposes.

Other info to be provided by homeowner for Spetic System Design:

Plans & Specifications of building & landscaping plans
Plot plan or lot survey
Signed contract to authorize designer to begin work ( sent upon approval of estimate)
Reference plans, terms & copies of any covenants or easements
Location of all existing services
Water well reports/drillers reports/chemical analysis
Locations of all neighboring wells

Homeowner Declaration Form

Homeowner Declaration Form For Septic System Design

Other info to be provided by homeowner for Spetic System Design:

On Track Contracting Ltd.