Appointment Request Form

Person Submitting Form*

Sellers AgentBuyers AgentHomeowner/SellerBuyer of Home

Seller Name*

First NameLast Name

Buyer Name (put N/A if not applicable)*

First NameLast Name

Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Sellers Agent Information (put N/A if not applicable)*

First NameLast Name

Sellers Agent Phone Number*

Please enter a valid phone number.

Sellers Agent Email*

example@example.com

Buyers Agent Name (put N/A if not applicable)*

First NameLast Name

Buyers Agent Phone Number*

Please enter a valid phone number.

Buyers Agent Email*

example@example.com

Title Company (put N/A if not applicable)*

Escrow Officer*

First NameLast Name

Title Co. Email*

example@example.com

Title Company Phone #*

Please enter a valid phone number.

Will the septic tank lids be uncovered with no digging required? (Most septic tanks have 2 concrete or plastic lids roughly 20-30" in diameter and 5'-7.5' apart)*

YesNo

Is home vacant? (Please run water in home for 30 minutes 1 day prior to our arrival if vacant)*

YesNo

Will water be turned on? (Must have outside water access for inspection)*

YesNo

Would client like us to check the condition of the main line between home and septic tank with a camera? (Optional addition to our standard inspection - rates listed on next page)*

YesNo

Pre-Listing Inspection? (Must Provide Contact Info Below)*

YesNo

Homeowner/Seller Phone # (Required on Pre-Listing Inspections)

Please enter a valid phone number.

Homeowner/Seller Email (Required on Pre-Listing Inspections Only)

example@example.com

Seller Payment Responsibility*

Locating/Labor (Digging)Septic Pumping FeeInspection FeeN/A - Buyer Paying All Fees

Buyer Payment Responsibility*

Locating/Labor (Digging)Septic Pumping FeeInspection FeeN/A - Seller Paying All Fees

I hereby certify that the information contained on this form is accurate and complete to the best of my knowledge and authorize Waters Vacuum Truck Service to perform a septic pumping and inspection at the address listed on this form. I further agree that I am either the buyer, seller, or other duly authorized party (i.e. realtor) with approval to agree to work on behalf of my client(s). By signing below I certify that I have reviewed the pricing and limitiations listed on this form in detail and shared this with all financially responsiblity parties prior to commencement of service. I also agree to the following payment terms:

1. Active Sale Inspections: Escrow billing available at no charge, but client can pay directly via cash, check or credit/debit card if preferred.

2. Pre-Listing Inspections: COD only. Payment is due at time of service via cash, check or credit/debit card.

If payment is not received within 90 days of service account may be turned over to a collections agency. Client will be given advance warning.

Name of Person Signing Form *

First NameLast Name

Authorized Signature (Buyer/Seller or Authorized Agent)*

Special Instructions/Notes (Optional):

SERVICE PRICING FOR SEPTIC INSPECTIONS

INSPECTION RATES (requires pumping of tank as well):

Inspection without camera of main line = $170.00

Inspection w/ camera of main line = $295.00*

SEPTIC PUMPING RATES (starting price – will vary depending on tank size):

NV Region 1 (0-20 miles of Reno-Tahoe Airport): $495.00*

NV Region 2 (21-40 miles of Reno-Tahoe Airport): $565.00*

NV Region 3 (41-60 miles of Reno-Tahoe Airport): $655.00*

NV Region 4 (61-80 miles of Reno-Tahoe Airport): $735.00*

NV Region 5: (81-100 miles of Reno-Tahoe Airport): $815.00*

CA Region 1 (within 40 miles of Reno-Tahoe Airport): $655.00*

CA Region 2 (41-60 miles of Reno-Tahoe Airport): $735.00*

CA Region 3 (61-80 miles of Reno-Tahoe Airport): $815.00*

*Pumping prices listed are for a 500-1000 gallon septic tank. If septic tank is larger, any additional gallons collected are billed at the rate of $0.26 per gallon. If tank has not been properly maintained a charge of $200 may apply for excessive solids. Engineered systems with lift/pump stations are an additional $250. Driver must be able to get truck within 200’ of tank or a $95 fee for extra hose may apply. A chain-up fee of $180 may apply for work requested during inclement weather. Camera of the main line must be done through a main line cleanout and be performed at the same time as the pumping (video footage not included).

LABOR RATES (applicable only if we must locate or dig up lids to tank):

Hand Digging w/ shovel and digging bar (up to 30” max. depth): $95.00 per hour*

Mini Excavator w/ operator (if lids are 30”+ deep): $195.00 per hour*

Electronic Locator Fee: $220.00

*All hourly rates billed port to port from the Reno-Tahoe International Airport. A 2 hour minimum charge applies on all jobs requiring a Mini Excavator. A minimum service call charge of $180 per hour applies for our travel time/visit if we are given inaccurate information (i.e. we arrive and the lids to the tank are not exposed, the water is turned off, roads are not clear due to snow/ice, etc.).

FOR PRICING ON ALL OTHER AREAS PLEASE CONTACT OUR OFFICE AT 775-825-1595.

LIMITATIONS, TERMS & CONDITIONS

1. Inspection does not include any testing or evaluation of material or workmanship used in the original installation or subsequent repairs or modifications to the septic tank system, leach lines or leach field.

2. Inspection of the tank lids and covers is limited to a visual inspection of condition and placement at the time of inspection and does not include any testing or analysis of composition, strength or quality.

3. Inspection of the septic tank is limited to a visual inspection of components that are visible from the access ports available or provided by the customer. Inspection does not include any testing or analysis of the tank’s composition, strength or quality. Only one tank will be pumped and inspected unless a design or plot map indicates that more than one tank makes up the component parts of the system. No materials test, x-rays, or other means are used to determine the quality of the materials, age, or condition of the tank.

4. Inspection in Washoe County does include the induction of water into the leach field pipe to verify that the field is accepting water at the time of service. Other counties are taken on a case by case basis. Factors such as age, vacancy or minimal use can affect the ability of a leach field to absorb effluent. The fact that the line or lines are accepting water at the date of inspection is no assurance that they will continue to function in the future, that the leach field has not exhausted its useful life or that the absorption capacity in the future will be adequate to meet new demands.

5. Inspection of the septic system does not include a site inspection of the ground surface. It is recommended that the owner or prospective owner examine the ground surface in the vicinity of the tank and leach field to determine whether there is any evidence of percolation.

6. Inspection of the leach field, when a design or plot map is provided, shall be limited to a surface inspection of the exposed ground surface for percolation of effluent in the area where the map shows the leach field to be located, but does not include an inspection below the ground surface or beneath any building, pavement or other natural or man made obstruction.

7. Inspection does not include testing to determine whether any toxic, corrosive or hazardous materials have been disposed of through the septic system or whether the leach field has been contaminated by such discharge.

8. Inspection is limited to a visual examination of those parts of the system which can be visually examined and does not include soil tests, saturation tests, review of design criteria, or any other test or calculation to determine whether the system meets the design criteria, building codes, ordinances or other local, county or state requirements and is limited to a report of the condition of the septic system, leach lines, or leach field as can be determined from visual inspection at the date of inspection. If requested, we can use a camera to inspect condition of the main line provided there is cleanout pipe for access. This camera inspection is limited to a maximum distance of 100’.

9. This report of inspection is intended for the use of the person or persons requesting the inspection and paying for the service rendered and is non-transferrable to any persons not listed on our real estate work order form.

10. This report reflects visually observable conditions of the inspected septic system on the date of inspection only and is not a warranty of the sufficiency of the system to function or meet the demands to which it may be subjected in the future nor a guarantee as to the design, construction, installation or usable life of the system expressed or implied.

Septic Inspection Request Form