Title 5 Owner's Sign Off
Owner's Name
*
Address Line 1 of Property Being Inspected
*
Address Line 2 of Property Being Inspected
City of Property Being Inspected
*
Zip code of Property Being Inspected
*
Email Address
*
example@gmail.com
Preferred Phone Number
*
Please enter a preferred phone number in case I need to call.
Format: (000) 000-0000.
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How did you hear about us?
Do you have a realtor?
Realtor Name
Realtor Email Address
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Questions:
Type of Inspection
*
Official Inspection
Unofficial Inspection
Number of Bedrooms?
*
A bedroom is defined as a room with a ceiling height of at least 7', must contain a windows, heat, electricity and the expectation of privacy (as in a door).
Total number of rooms in the house not including bathrooms and closets?
*
Is the house currently occupied?
*
Yes
No
How many people live here?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
Last date occupied?
*
Is this building used for seasonal dwelling
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Yes
No
Is there a garbage grinder in the kitchen sink?
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Yes
No
Is there a water filtration system in the house that backwashes water like a water softener?
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Yes
No
Where does the backwash go?
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Type of building sewer (pipe going through the cellar wall to the septic system)?
*
Plastic (schedule 40)
Cast Iron
Unknown
Other
Are all fixtures (including laundry) connected to the building sewer?
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Yes
No
Where do other fixtures exit the building?
*
Was the tank pumped in the last two weeks?
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Yes
No
When was the tank pumped last?
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What company pumped the tank last?
*
Do you have a well on the property?
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Yes
No
Is the well used for drinking water?
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Yes
No
Is there a sump pump in the cellar
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Yes
No
Have you had a problem with water in the basement
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Yes
No
Have you had a problem with septic backup, septic ponding in the yard or septic smells?
*
Yes
No
Please explain
*
Do you have any irrigation system for the lawn?
*
Yes
No
Additional comments
Question End
*
By signing below, I agree that all the information provided is accurate and I agree to pay the invoice when provided. The process of inspecting your septic system involves digging in your yard and damage to above and underground items may occur. Repairs will be at the owner's expense. A 24-hour notice for cancellation or reschedule is required. Notice made 24 hours or less before an appointment will be subject to half the service rate. Notice made after arrival will be subject to the full charge.
Signature
*
Name of Person Signing
*
First Name
Last Name
Date
-
Month
-
Day
Year
Date
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