Septic Survey - GLRA Name(s)_________________ Phone __________Lake Lake Address_____________ _____________Home

email address_______________

Septic System Year Septic Tank installed _________ Septic Tank Size: 250 gal ___500gal ___ 750gal OR ____ gals Cabin Size: No. Bedrooms ___ or approx ______Square feet Septic tank flow to field: Gravity _____ OR Pump_____ Distance: field to lake ______feet approx. Vertical elevation difference Field to Lakeshore ______feet approx. Ground condition below field: Rocky___ Sand/gravel___ loam__ silt/clay__ lava ash___ Slope of land on/below field: Level___ <15% slope___ >15% slope____ >30%____ Last time (year) septic tank pumped out?_____ OR Never/not known____ Distance of water intake line from centre line of septic field flow at lake: ___Ft aprox Water Intake location: Distance from shore___ft Depth below water surface ___ Ft Distance to property lines: Upstream ___Ft Downstream ____Ft Water treatment, if any? Y__ N__ Boil___; UV ____;Reverse Osmosis____; Other_____ Any problems with septic tank, pump or field?__________________________________ ie: Back up, leaks, smell from field or lines??Describe____________________________ Drainage: Any Roof drainage gutters?____; Foundation drainage___ Typical summer occupancy ____no. of people Peak occupancy, Nos. _____ Peak occupancy period___________________________ Do you store chemicals or fertilizer on property?______ Are you willing to have a dye test done (No Charge) to try to determine retention time in septic system? Yes___ No_____ DATE_______________ Contact: name/number__________ Fax to: 604261-1511