Engineering Services Request

Engineering Service Request Form
Contact/Client Name *

First Name Last Name
*Business Name
*If Applicable
Phone Number *
Email *
example@example.com
Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Is the Project Address the Same as the Billing Address?

Yes No
Project Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Service Needed *
Residential or Commercial Site *

Residential Commercial Combination
New Construction or Replacement/Repair *

New Repair/Replacement
Type of Water Service *

Public Water Well
Structures To Be Serviced by Septic System (OWTS) *
*List all structures that will be connected to the system.
Total Number of Bedrooms *
*Include all bedrooms in any structure that will be connected to the system.
Potential for Future Bedrooms *

Yes No
Number of Future Bedrooms *
Description of Commercial Activity *
Have you obtained a soils evaluation report for this site? *

Yes No
Would you like us to obtain a soils evaluation report for you for an additional fee? *

Yes No Unsure
Structure(s) to Be Evaluated *
Structural Issue(s) to Be Evaluated *
Please Note:

In order to complete your septic (onsite wastewater treatment) system design we also request that you provide the following information:
- A soil evaluation report, unless we are obtaining that for you
- A plot plan showing the property lines and all structures on the site: This includes existing, and proposed structures such as residences, detached garages, shops, pools, gazebos, etc.
- Any other information or documents that may help us in completing this project
This information can be emailed to: drurypropertyservices@gmail.com
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Engineering Service Request Form