Parcel Number:

Name:

Site Address:

Your Phone Number:

Your Email:

Were repairs made to the septic system (tanks, drainfield, etc.)?: Yes N/A No

Have the septic system deficiencies been corrected?: Yes N/A No

Date septic system repairs were made:

Who performed the work?:

Comments or details:

Would you like information on the following septic system financial resources?

• Craft3 Clean Water Loans for septic system repairs.
• Washington State Department of Health septic rebate program for pumping, maintenance, and/or retrofitting tanks.

Yes No

Please click the check box: