Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Photo of House

People on Site

  • Buyer

  • Home Inspector

  • Real Estate Agent

  • Seller

  • No One On Site

House Occupied

  • Yes

  • No

Plan On Site

  • Yes

  • No

Septic Tank Location

Septic Tank Type

  • Metal

  • Concrete

  • Plastic

  • Add media

Approx. Septic Tank Size

  • 500 gal

  • 1000 gal

  • 1250 gal

  • 1500 gal

Septic Tank Condition

  • Poor

  • Good

  • Add media

Septic Tank Due For Pump Out

  • Yes

  • No

Inlet Baffle Type

  • Plastic

  • Concrete

  • Missing

Inlet Baffle Condition

  • Poor

  • Good

  • Add media

Outlet Baffle Type

  • Plastic

  • Concrete

  • Missing

Outlet Baffle Condition

  • Poor

  • Good

  • Add media

Pump Station

  • Yes

  • No

  • Add media

Leach System Location

Leach System Type

  • Drywell

  • Pipe and Stone

  • Concrete Chambers

  • Plastic Chambers

  • Elgin

  • Enviro-Septic or Geo Flow

  • Add media

Leach System Condition

  • in Failure

  • Poor

  • Fair

  • Good

  • Add media

Additional Notes

  • Add signature

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