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Property Address
*
Number of Bedrooms
*
Township
*
Expected Closing Date
Tax ID
OWNER/BUYER INFO
Name
*
Cell/Mobile Phone
Home Phone
Owner/Buyer Address
REALTOR INFO
Name
Company
Email
*
Mobile/Cell
Alt Phone Number
Fax
Mailing Address
Contact for service needs/arrangements
Owner
Realtor
Broker
Other
If other, who?
Send report via
Email
Postal Mail
Fax
PROPERTY INFO
Is there electric power?
Yes
No
Is the property vacant?
Yes
No
If yes, how long?
Services Requested - NOTE THERE IS A $100.00 MAX RETURN FEE if we have to return to property to re-inspect septic or well due to inaccessibility or incomplete inspection first visit, could not get in, resample water well, check isolations, no power or water available first visit, etc. No hidden fees, includes travel and transaction fees
Septic Only (Includes: "Locate And Expose Septic System") - $334.00
Well Only - (Includes: Bacterial/Nitrate samples) - $284.00
Septic and Well (Includes: "Locate And Expose Septic System" and Bacterial/Nitrate Samples) - $394.00
Dewinterize/Rewinterize - $109.00 per well
Locate, Expose and Diagram Septic System - $184.00/hr., 1 hour min.
Lead Water Analysis (7-10 Day Turnaround by STATE of MI Lab) - $159.00
Arsenic Water Analysis (7-10 Day Turnaround by STATE of MI Lab) - $159.00
Nitrites (if requested, there is an additional 30.00 lab fee, check with underwriter/loan officer) - $30.00
Septic RX - General check of septic system for homeowners - should do annually - $209.00
Well RX - General check of well system for homeowners - should do annually - $209.00 w samples $259.00
Sewer Line Scope - check line from house to private septic or public sewer - $209.00
Sample Well or City Water - includes bacteria/nitrate sample - $109.00
Payment ADD ALL CHARGES BEFORE PROCESSING CREDIT CARD or TOTAL FOR CHECK/CASH
*
Credit Card (immediate payment online with CC info)
Completion of Service
Has the home been winterized?
Yes
No
House dewinterized and ready to sample?
Yes
No
Keybox/Combination Code
Date of Submission
Additional Information
