Septic Inspection Form
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Client Signature
Time
Hour Minutes
AM
PM
AM/PM Option
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Picture of the home
Age of home
Approx age of system
Last service date
Weather at time of inspection
Occupied
Please Select
yes
no
If vacant how long
Number of current occupants
Number of Potential occupants
Location of septic tank
Location of EDA / Leachfield
Septic Tank Information
Tank Size approx:
Please Select
500 gallons
750 gallons
1000 gallons
1250 gallons
1500 gallons
1750 gallons
2000 gallons
2250 gallons
2500 gallons
2500+ gallons
Type of tank construction
Please Select
Metal
Concrete
Plastic
None
Tank Depth
Tank condition
Please Select
Option 1
Option 2
Option 3
Does tank need to be serviced
Take Photo
Condition of septic tank covers
Tank Depth
Risers
Inlet baffle condition
Please Select
good
fair
poor
replace
none
Outlet baffle condition
Please Select
Good
Fair
Poor
Replace
None
Outlet filter
Please Select
yes
no
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Septic tank pictures
Inlet baffle
Outlet baffle
General
General
Septic tank notes
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Leach-field / EDA Information
Type of leach field
Please Select
Stone and pipe
Eljen
Concrete chambers - stone
Concrete chambers - sand
Plastic chambers - stone
Unknown, requires more investigation
Plastic chambers - sand
Enviro - septic
Dry-well
Cesspool
Community leach field
Geo flow
Enviro fin
GST
Condition of leach field
Please Select
Good
Good- Fair
Fair
Fair - poor
Poor
In a state of failure
Failed
Leach-field notes
Distribution box condition
Please Select
good
fair
poor
replace
unknown
Distribution box type
Depth of leach-field
Pump up system?
Please Select
yes
no
unknown
Pump working?
Alarm?
Pump chamber notes
General
Salt water softener
large tub / jacuzzi
Garbage disposal
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Leach-field / EDA Pictures
Picture 1
Picture 2
Picture 3
Picture 4
Recommendations
Submit
Submit
Should be Empty: