Aquzar Inquiry & Stage 1 Project Accessment Form

Aquzar Inquiry & Stage 1 Project Accessment Form

Please fill out the following form to help us evaluate your project requirements:(Fill out where relevant. Mark N/A where not relevant, mark 'TBA' if details not yet known)
1. Client*

First NameLast Name
2. Email Address*
example@example.com
3. Phone Number*
Please enter a valid phone number.
4. Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
5. Have You Been Referred Via

Internet Search/Social MediaPrevious or Current ClientAvanza Team MemberReferral Team Member
6. Name Of Referrer (if not internet based)
7. Brief Description and Address of Business, Industry or Project For Aquzar. Please include County and State*
8. Project(s) Type Source of Wastewater? :

Residential housing, ApartmentsHotelBar RestaurantMixed CommercialRV Park, Resort, GlampingVillage, Town, CityWork Site, Work CampCommercial Cooking Taking Place, Restaurant, Canteen ETC
9. Est Number of Structures or Units to be serviced by Aquzar
10. Est Number of Persons to be serviced by Aquzar
11. Has project Received:

Site and Architectural PlansPlanning SummisionsBuilding EntitlementsBuilding PermitsWastewater Permits
12. Timeline For Waste Water Installation at Project Site:

6 - 12 Months1- 2 years2 Years +
13. Type of Installation Required

New TemporaryNew PermanentUpgrade or Replacement of Existing EquipmentAbove groundPartially BuriedBuried to Lid LevelHoused Independently
14. If An Existing Facility Do You Know Daily Flow ?

YesNoN/A
15. If yes Above : Daily Flow Numbers US Gallons
14. If an Existing Facility Is Flow Feed Via :

GravityPumpedN/A
15. Where will plant discharge to:

SoakawayWatercourseNot Decided
17. Will Installation be a

Combined Sewage & Surface WaterSewage Only
18. Do you Know Temperature Range or Weather Related Factors?
19. Any Further Relevant Site or Project Details or Comments at This TIme?