Phase III Property Questionnaire

First name

Last name

Phone

Email

Resident's Name(s) (If Different than above)

Parcel Tax ID Number

(ex. 0200 900.00 08.00 025.001)

Property Address

Property Owner's Mailing Address (If Different)

1. Where does your sewer lateral exit your house? (Answer as if you are standing in the street looking at the front of your house.)

2. What is the size of your existing sewer line?

4"

6"

Don't Know

Other

3. Do you have natural gas service?

Yes

No

4. What type of water service do you have for your house?

Public

Well

5. What side of your house is your water line? (Answer as if you are standing in the street looking at the front of your house.)

6. What side of your house is your electric service meter? (Answer as if you are standing in the street looking at the front of your house.)

7. Is the electrical service to your house delivered via overhead lines or through underground lines?

Overhead

Underground

8. Do you have a water sprinkler/irrigation system?

Yes

No

10. Where is your septic tank(s) located? (Answer as if you are standing in the street looking at the front of your house.)

12. Where is your cesspool(s) located? (Answer as if you are standing in the street looking at the front of your house.)

13. Current Septic Hauler Company Name

16. Does your home have a basement?

Yes

No

17. Does your home have a crawlspace?

Yes

No

18. Does your home have a bathroom in the basement?

Yes

No

19. Does your home have a clothes washer located in the basement?

Yes

No

20. Do you grant the field technician permission to access the outside of your property (front, back and side yard) to perform field investigation work if you are not home?

Yes

No

In the space below, please provide any additional information or comments that you feel are relevant to your specific property.

File upload

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Phase III Property Investigation Questionnaire