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Residential Service Work Order Form - Eagle River Engineering

Please fill out and submit the following form to provide the information needed to schedule your test or service. We will contact you by email with a confirmed date and price quote. 
There is no obligation until the work is started.

WE ARE STILL TRYING
TO GET THIS FORM OPERATIONAL. PLEASE CONTACT US BY EMAIL AT

inquiry@eres-ak.com

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Please provide the following contact information:

Client Name
Title
Organization
Worksite Address 
Legal Description lot/block
Billing Address
Address (cont.)
City
Zip Code
Work Phone
Home Phone
Cell Phone
FAX
E-mail
Realtor or agent
Number of bedrooms 
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Select any of the following services desired:

Survey
Well test
Leachfield test
Water Samples (included in well test)
Test hole and Percolation test
Lot evaluation or Feasibility
New Leachfield Design

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Need job completed by:

-- mo./day

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When was the septic tank last pumped? (required for septic test only)

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Do you have a copy of your most current asbuilt survey?    yes   no

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Any special instructions, enter below.

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Revised: September 17, 2003