Existing Wastewater and/or Well Inspection

Existing Wastewater and/or Well Inspection
Requested By
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Inspections Requested*

EXISTING Wastewater System InspectionExisting Water Well InspectionBOTH existing Wastewater System AND Water Well Inspection
Reason for Inspection*

Financial InstitutionBuilding PermitDivision of PropertySystem FailureOther
Is the report to be sent to another agency?*

YesNo
Agency Information

Enter the information for the agency that will be receiving a copy of the report
Entity Name
Entity Phone
Please enter a valid phone number.
Entity Email
example@example.com
Entity Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Information
Name of CURRENT Property Owner*

First NameLast Name
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Directions to site*
Draw a map to the location and upload it here*

Cancelof
Property Serial #*
Year Home Was Built*
Original Property Owner

First NameLast Name
Individual or Contractor who Installed the System
Date of Installation

MonthDayYear
Date
Dates and Descriptions of any inspections, repairs, replacements, or upgrades
NOTE: Signed and dated "Quality of Verification of Septic Systems by Scavenger Services" form may be required.

There is NO guarantee that TriCounty Health Department will find information on this research request.

You MUST submit payment with this application. This application CANNOT be submitted without payment.
DISCLAIMER: For Water Well Inspections IN ADDITION to the payment submitted today you will be required to pay the lab fees associated with the inspection.
Cost Calculation

Inspection Fees

USDInspection for Wastewater and/or water well

Payment Methods

Credit Card

Apple Pay

Should be Empty:

Existing Wastewater and/or Well Inspection

Requested By

Agency Information

Property Information

Payment Methods