Engineering Services Request

Engineering Service Request Form
Contact/Client Name*

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

Street Address

Street Address Line 2

CityState / Province

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

YesNo
Project Address*

Street Address

Street Address Line 2

CityState / Province

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

ResidentialCommercialCombination
New Construction or Replacement/Repair*

NewRepair/Replacement
Type of Water Service*

Public WaterWell
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*

YesNo
Number of Future Bedrooms*
Description of Commercial Activity*
Have you obtained a soils evaluation report for this site?*

YesNo
Would you like us to obtain a soils evaluation report for you for an additional fee?*

YesNoUnsure
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
Should be Empty:

Engineering Service Request Form