inspection request form

Main Phone: 613-692-3571 x 1129 Inspection Request Form Complete and fax to: 613-692-1507 or e-mail: [email protected] Section A. Property and General Information Date Submitted Septic File Number: Civic Address Former Township ☐ Osgoode ☐ Cumberland ☐ Goulbourn ☐ Torbolton ☐ Nepean ☐ Huntley ☐ Rideau ☐ Gloucester ☐ Fitzroy ☐ Kanata ☐ Ottawa Property Owner Section B. Requestor Information Name of Requestor Phone Number: E-mail Fax Number: I am the (check one) ☐ Installer ☐ Engineer ☐ Property Owner Section C. I am Requesting the following: ☐ 1 st – Subgrade (If required - check one): ☐ 2 nd – Installation Inspection (Check all that apply) ☐ 3 rd – Final Grade Inspection ☐ Scarification Refer to attached: Note: Topsoil must be applied unless winter conditions exist at Director’s discretion All deficiencies must be addressed from installation report ☐ Clay Seal ☐ As-Built Components Page ☐ Subgrade ☐ As-Built Drawing ☐ Engineers Letter ☐ Filter Media Bills ☐ Grain Size Analysis ☐ Maintenance Agreement ☐ ESA Permit Number:____________ Notes/Comments Section D. Re-inspection ☐ Re-inspection - 1 st call ☐ Re-inspection Request – 2 nd call Note: Re-inspection fee applies on requests for same deficiency – Please provide payment information below Card Type: ☐ Mastercard ☐ Visa Card Number: Expiry: Cardholder Name: Notes/Comments Please Note: 3-5 business day turn around for inspections OSSO file will be given to inspector upon receipt of this request form PRIORITY will be given to requests that have septic file/permit numbers

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Main Phone: 613-692-3571 x 1129

Inspection Request Form Complete and fax to: 613-692-1507 or e-mail: [email protected]

Section A. Property and General Information Date Submitted Septic File Number: Civic Address

Former Township

Osgoode Cumberland Goulbourn Torbolton Nepean Huntley Rideau Gloucester Fitzroy Kanata Ottawa

Property Owner Section B. Requestor Information Name of Requestor Phone Number: E-mail Fax Number: I am the (check one) Installer Engineer Property Owner Section C. I am Requesting the following: 1st Subgrade (If required - check one):

2nd Installation Inspection (Check all that apply)

3rd Final Grade Inspection

Scarification Refer to attached: Note: Topsoil must be applied unless winter conditions exist at Directors discretion All deficiencies must be addressed from installation report

Clay Seal As-Built Components Page Subgrade As-Built Drawing Engineers Letter

Filter Media Bills Grain Size Analysis Maintenance Agreement ESA Permit Number:____________

Notes/Comments

Section D. Re-inspection Re-inspection - 1st call

Re-inspection Request 2nd call

Note: Re-inspection fee applies on requests for same deficiency Please provide payment information below Card Type: Mastercard Visa Card Number: Expiry: Cardholder Name:

Notes/Comments Please Note:

3-5 business day turn around for inspections OSSO file will be given to inspector upon receipt of this request form PRIORITY will be given to requests that have septic file/permit numbers

Date Submitted: Septic File Number: Civic Address: undefined: undefined_2: undefined_3: undefined_4: undefined_5: Huntley: Rideau: Gloucester: Fitzroy: Kanata: Ottawa: Huntley Rideau Gloucester Fitzroy Kanata OttawaProperty Owner: Name of Requestor: Phone Number: Email: Fax Number: undefined_6: undefined_7: undefined_8: 1st Subgrade If: 2nd Installation Inspection: undefined_9: undefined_10: undefined_11: AsBuilt Components Page: Subgrade: undefined_12: undefined_13: undefined_14: undefined_15: Maintenance Agreement: undefined_16: ESA Permit Number: NotesComments: Reinspection 1st: undefined_17: Mastercard: Visa: Mastercard VisaCard Number: Expiry: Cardholder Name: NotesComments_2: Submit: Reset: Print: