Specifications

Page 52
Milan Supply Company/Milan Engineered Systems
NAME PHONE
SITE ADDRESS PHONE
PHONE
MAILING ADDRESS (If Different)
DATE Sun Mon Tue Wed Thur Fri Sat TIME OF DAY
1. # OF PEOPLE LIVING IN HOME: ADULTS:
M F CHILDREN (Total inc. Teenagers)
TEENAGERS: M
F
2. LAUNDRY HABITS: MAX. LOADS / DAY CONSECUTIVE LOADS: YES / NO
TOTAL LOADS/WEEK
3. BRAND OF LAUNDRY DETERGENTS USED: WITH / WITHOUT BLEACH POWDER / LIQUID
4. BLEACH USED: YES / N0 POWDER / LIQUID USE: CUPS/LOAD LOADS/WEEK
5. HOT OR COLD WATER USED:
6. LIQUID FABRIC SOFTNER USED:
7. NUMBER OF ROLLS OF TOILET PAPER USED PER WEEK:
8. GARBAGE DISPOSAL: YES / NO USE: TIMES/DAY TIMES/WEEK
9. DISHWASHER: YES / NO USE: TIMES/DAY TIMES/WEEK
10. IS A WATER SOFTENER USED: YES / NO SALINE CHLORINATION: YES / NO
11. IS A DRAIN CLEANER USED: YES / NO BRAND FREQUENCY:
12. LIST ANY ANTIBACTERIAL PRODUCTS USED (ie: hand cleaner, soaps, cleaning products):
13. IS ANY RESIDENT USING A (LONG TERM) PRESCRIPTION DRUG OR ANTIBIOTICS: YES / NO
14. IS THIS THE FIRST HOME YOU HAVE LIVED IN THAT HAS A SEPTIC SYSTEM: YES / NO
15. HOW OLD IS THE SYSTEM: YEARS
16. HAS THE SYSTEM EVER BACKED UP: YES / NO DAY OF WEEK: Sun Mon Tue Wed Thurs Fri Sat
17. HAS EFFLUENT EVER SURFACED: YES / NO
IF YES: WINTER: YES / NO SUMMER: YES / NO DAY OF WEEK: Sun Mon Tue Wed Thurs Fri Sat
18. HAS PLUMBING EVER BACKED UP INTO HOME: YES / NO
IF YES: WINTER: YES / NO SUMMER: YES / NO DAY OF WEEK: Sun Mon Tue Wed Thurs Fri Sat
19. WATER SOURCE: (circle) PUBLIC PRIVATE WELL COMMUNITY WELL OTHER
RESIDENTIAL ONSITE WASTEWATER SYSTEM REVIEW
EVALUATION CHECKLIST
USE PRIOR TO REPAIRING ONSITE SYSTEM