Septic Re-inspection Program Questionnaire

Septic Re-inspection Program - Mandatory Questionnaire

Inspection Property Address

Property Owner Name(s)

Owner's Email Address

Telephone Number:

Inspection Property Tax Roll Number

Name of Person Completing Questionnaire if not the Property Owner

Occupancy Data (Complete all that apply)

A) Complete this section for Residential Properties Only

Type of Occupancy

Seasonal

Permanent

Finished Floor Area

Numbers of Bedrooms

Number of Bathrooms

B) Complete this section for Commercial Properties Only

Type of Commercial Occupancy

Office

Restaurant

Store

Service Station

Other

If Other was selected in type of commercial occupancy, please enter the type of commercial use.

Please complete all that applies to the Commercial Property

Finished Floor Area

Number of Employees

Number of Fuel Nozzles

Number of Water Closets

C) Complete this section for Institutional Properities Only

Type of Institutional Occupancy

Church

School / Daycare

Hall

Other

If you selected Other, please enter type of institutional use.

Water Supply

Type of water supply (check all that apply)

Drilled Well

Surface Water (Lake or River)

Bottle

Municipal

Dug / Bored Well

Sand Point

Cistern

Sewage System Data

What type of Septic System(s) do you have? Check all that apply

Class 1 Outhouse, Composting / Incinerating Toilet

Class 2 Greywater Pit

Class 3 Cesspool

Class 4 Septic Tank / Treatment Unit & Leaching Bed

Class 5 Holding Tank

If known, please identify the size of your tank:

Septic Tank Size

Holding Tank Size

Volume

If known, please identify other sysyem components (if present).

Balancing / Pump Tank

Distribution Box

Advanced Treatment Unit

System Component Type / Supplier (if present)

Servicing Company

System Age

Septic Permit # (if known)

Date of last pump out

Age of system

Please provide a general sketch of the property include the location and approximate distances between septic system components (tank, bed, greywater pit from structures (House, Shed, Garage, Decks, etc.), surface water features and onsite/ neighbouring wells. If installation report (use permit or septic final) is submitted, the sketch is not required.

General Sketch of the Property if required

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