Well & Septic Inspection Order Form

When ordering an inspection please fill out the entire form to the best of your knowledge.
Inspections are scheduled Monday - Thursday.
Results take at least 24 hour from Inspection Date.
If additional work or chlorination is needed, results may take up to an additional week.
All inspections must be paid at the time of services, unless otherwise approved by Prairie State Water Systems.
Septic Inspections do NOT include pumping, unless otherwise arranged with Prairie State Water Systems. *see further details.
Prairie State Water Systems does NOT have access to Sentry Locks. Lock Box code will need to be provided or the person responsible for the property will have to be present at the time of inspection.

Property Address for Inspection

Inspection Location County(Required)

Address(Required)

Street Address City State ZIP Code

Lock Box Code

Phone Number of Responsible Party(Required)

Property Owner Contact Information

Property Owner Current Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Attorney Contact Info

Attorney Name

First Last

Firm Name

Firm Address

Street Address Address Line 2 City State ZIP Code

Realtor Information

Realty Company

Realtor Name

First Last

Realty Company Address

Street Address Address Line 2 City State ZIP Code

Office Phone

Cell Phone

Inspections Needed

Inspection Needed For(Required)

Is Property Currently Vacant?(Required)

If YES, how long?

Well Information

Type of Well

Is there currently water to residence?

NOTE: If well is winterized at time of inspection, Prairie State Water Systems will re-activate well in order to test, but is not responsible for re-winterizing well after inspection is complete.

Septic Information

How old is the current septic system?

Number of people currently living at property?

After sale of home?

Number of bedrooms?

Has there ever been a backup in the house?

Any repairs made to the system?

Is there a service contract for the system components?

Has the system recently been inspected by others?

Did it pass or fail?

When was the last time the septic system was pumped?

*We recommend having the septic pumped, this will include a more detailed physical septic inspection, However, if the lower cost visual septic inspection is chosen, this will NOT include checking baffles or opening of the tank. This will be a visual check that effluent is not surfacing in the field.

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Well Inspection Form

Property Address for Inspection

Property Owner Contact Information

Attorney Contact Info

Realtor Information

Inspections Needed

Well Information

Septic Information

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