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Please take a moment to fill out this question form so that we may better diagnose and help you with your Septic System.

Homeowner Questionnaire for Failing Septic Systems



Your Name: *required
Phone Number: *required
E-Mail:


1. Who was the installer of septic system:


2. Septic system installation date:


3. Has your septic system been pumped out recently? Yes No
If yes, when was it pumped last?


4. Number of people who live in your home:
How many Adults:
How many Children:


5. What would you estimate is your average daily water usage (in gallons)?


6. Do you have a garbage disposal? Yes No


7. Do you have a dishwashing machine? Yes No


8.a Do you have a clothes washing machine? Yes No


8.b If yes, is your clothes washing machine connected to your septic system? Yes No


9. Do you have a water softener or water treatment system? Yes No
If yes, where does it drain?


10. Do you use an "in tank" toilet bowl sanitizer? Yes No


11. Is any family member using long-term prescription
drugs, antibiotics or chemotherapy? Yes No
If yes, what kinds?


12. Are you using any anti-bacterial products, powder
detergents, or any other chemicals? Yes No
If yes, what kinds?


13.a Have you checked inside your home for plumbing leaks? Yes No


13.b Do any of your sinks drip continuously or does your toilet
run continuously? Yes No


14 Do you have an underground lawn-watering system? Yes No


15. Has any site work been done to the house since you
moved in, such as underground roof gutter drains,
basement or foundation drains, landscaping, etc.? Yes No
If yes, what kinds?


16. Please check off any underground utilities are on your lot:
Power
Phone
Cable
Gas
Water



17. Describe what happens when you have a problem with your septic tank system.



18. Does the problem seem to be linked to a specific event (washing clothes, heavy rains, friends coming over, etc.)?



19. When did you first notice the problem?





Ph: (360) 794-5506   |    (360) 568-8531   |    1-800-851-5180     Fx: (360) 794-6349      P.O. Box 262 Monroe, WA 98272