Septic System Intake Form

Septic System Intake Form For Septic System Estimating & Design

All fields must be filled out or the form may not submit. If a question doesn’t apply, please enter N/A.

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

# 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? (List Units)

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?

Commerial Use?

Other Buildings on Property Connecting to Septic System?

Additional Info

Soil Type (If Known)

Excess Soil From Excavation (pile, spread, haul away?)

Overhead Lines Conflicting In Work Area?

Underground Utilities Conflicting In Excavation Area?

Trees Conflicting In Work Area?

Other Obstacles Conflicing In Work Area?

Additional info or any additional work to be completed?

6640

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
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

Septic System Intake Form

Septic System Intake Form For Septic System Estimating & Design

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

On Track Contracting Ltd.