Name
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First Name
Last Name
State / Time Zone
Email
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Phone
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Best day & time to call
How did you hear about us?
NextDoor
Google
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Email/ Newsletter
Referred by someone (please tell us who)
Other (please describe)
What symptoms of septic failure are you experiencing?
Select all that apply!
When do these symptoms occur?
How long have these symptoms been happening?
Less than a month
Less than 6 months
Less than 1 year
Over 1 year
Over 2 years
How old is the house?
*
How long have you been in the home?
Has the house been continuously occupied?
Yes
No
Not Sure
If the house was vacant, for how long?
How many adults, teens, children in household?
Type of septic system?
Single chamber septic tank with disposal field
Two chamber septic tank with disposal field
ATU (Advanced or Aerobic Treatment Unit)
Cesspool or seepage pit
Mound (septic tank with pump to sand or soil mound)
Sand filter (septic tank with pump to a hole filled with sand)
PD (pressure distribution)
Don't know
Type of Disposal System or Drain Field?
Leach Lines
Leach beds
Seepage pit or dry well
Chambers
Mound (sand or soil)
PD (Pressure distribution)
Don't know
Has the drain field ever been replaced?
Yes, within past 5 years.
Yes, within past 7 years.
Yes, within past 10 years.
Yes, within past 20 years.
Yes, but not sure when.
Don't know.
Never.
Is there a Pump Tank and Distribution Pump?
*
Yes
No
Don't know
Septic Tank Capacity
500 gallons or less
1000 gallons or less
1250 gallons
1500 gallons
2000 gallons
2500 gallons
3000 gallons
over 3000 gallons
Don't know
If your septic tank has been pumped, how many gallons were removed?
IMPORTANT - How deep is the water in septic tank?
IMPORTANT - How wide is the opening to septic tank?
Is there a riser or ground level access to tank?
Trees or bushes on or very near disposal field?
Water softener backwashing into tank?
Additional information here:
Terms & Conditions
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