Cost Estimate

1. Please provide us with the following information:
Name:
Physical and Mailing address:
Home Phone:
Fax:
E-mail:

2. Type of service requested (please check all that apply):
Commercial Residential Permit Acquisition Soil Studies Septic System Design
Septic System Installation Septic System Repair Septic System Maintenance

3. Do you have a permit to install or repair your septic system?



4. If you have obtained a permit please provide the following information in the space provided below:

Health Dept. #:
Tax Map#:
County:
State:
# of Bedrooms:
AOSE or Design Engineer Ph. #:

5. If no permit has been obtained please check all that apply:

I am having issues with my septic system please contact me
I would like to know if my property is suitable for a septic system
I have soil studies but no permit or design
I have a certification letter
I have a septic system design but I would like to discuss redesigning my septic system for a less expensive, less intrusive system which requires less maintenance (Clearstream Wastewater NC3T)

6. I would like Farmer's Septic System, Inc. to contact me and provide a cost estimate for the following service or services (check all that apply):
Soil Studies
Septic System Installation
Septic System Repair
Septic System Maintenance
Septic Tank Pumping
Other (Please let us know below)

7. I would like to make an appointment to meet on site with a representative from your company:



8. If you checked yes please provide the following information:

1. Please provide a physical address and driving directions to your site. If you are using Google, MapQuest, Bing, or other maps please set your starting point at
Farmer's Septic Service, Inc.
125 Blue Crab Drive, Moon Va. 23119.

2. For new construction sites, building lots, or large tracks of land there may not be a physical addresses or 911 #. In such cases please provide route #s and intersecting route #s as we have to contact Miss Utility Virginia before digging (soil studies, septic system repair, septic system installation, etc.).

3. In most cases a plat of your property or building lot will be required for us to provide soil studies, septic system design, or permit acquisition.

Privacy Statement:

The protection of your privacy is important to us at Farmer's Septic Service Inc. Rest assured that the personal information that you provide us with will not be sold. We are the sole owners of the information collected on this site. We only have access to collect information that you voluntary give us via e-mail or other direct contact from you. The information you provide will only be used for the purpose of bringing you the best service possible. We will not share your information with any third party outside of our organization other than those necessary to fulfill your request for services or products we may offer. We may be contacting you via e-mail or phone using only the information you have provided to us over this website or other direct contact from you. You may contact us by phone at (804)-725-9645 or by e-mail at farmersseptic@gmail.com with any concerns or problems you may have with the information you have provided to us over this web site. You may opt out of future contact from us at any time.