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Septic Design Questionnaire
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* Indicates required question
Name
*
Your answer
Parcel Number
Your answer
Address
Your answer
Phone Number
*
Your answer
Email
Your answer
Preference for Receiving Invoice & Design Information
*
Mail
Email
Both
Reason for Design
*
New Construction
Replace Existing System
Expansion
Other:
Type of Use
*
Residential dwelling
Other:
Type of System Desired
*
Full Septic System (septic tank and drainfield)
Holding Tank (tank only, no drainfield)
Other:
Number of Bedrooms
(include future bedrooms in unfinished basement)
*
Your answer
Is there an in-home business (ie: daycare, hair salon, taxidermy)? If yes, please describe.
*
No
Other:
Describe any current or future uses beyond those described above
Your answer
Water-Using Devices (mark all that apply)
* = clear water source - should not be plumbed into the septic system
*
Garbage Disposal
Sewage / Grinder Pump in basement
Clothes Washing Machine
Dishwasher
Large Bathtub (>40 gallons)
Water Softener *
Iron Filter *
Hight Efficiency Furnace
Hot Tub *
Sump Pump *
Self-Cleaning Humidifier *
Other:
Required
If you have a preferred septic installer, please list them below.
Your answer
By submitting this form, I attest the information is complete & accurate. I agree to have Cubed B LLC complete a septic design using the information provided. I also agree to pay for the service provided.
(Fees are listed here)
*
Yes
No
Submit
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