On-site Wastewater Pre-inspection Contract

Agent's Name*
First
Agent's Phone*
Client's Name*
First
Client's Address*
Street Address City State ZIP Code
Client's Phone*
Client's Email*
Property Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is Home Vacant?*
Client is*
Describe
Certified Inspector Name: Brian Woodlief
Company Name: David Brantley & Sons
Company Address: 37 Pine Ridge Rd Zebulon, NC 27597

Inspector Certification Number: 4607I

Inspector Phone: 919-868-9003

The on-site wastewater system inspection, hereinafter referred to as Inspection, shall be performed in accordance with 21 NCAC 39 .1004, 21 NCAC 39 .1005 and 21 NCAC 39 .1006. General Statutes, Rules and Minimum Inspection Requirements, can be viewed at www.ncowcicb.info
Services provided shall include:*
Describe
****Inspection with a copy of the septic permit $300
****Inspection without a copy of the septic permit $350
****Well water sampling if done at the time of the inspection:*
****If done at another time there will be an additional charge of $125 for the service call.
****Invoice(s) MUST be paid before the report can be released****
****MUST GIVE 24 HOUR NOTICE FOR CANCELLATIONS OR THERE COULD BE A SERVICE CHARGE OF
$125****
Do you have septic permit?*
****Please upload your septic permit (File type: PDF/JPG/PNG)*
Accepted file types: pdf, jpg, png.

Inspector is not required to report on:	1) Life expectancy of any component or system 2) The causes of the need for a repair 3) The methods, materials and costs of corrections 4) The suitability of the property for any specialized use 5) The market value of the property or its marketability 6) The advisability or inadvisability of purchase of the property 7) Normal wear and tear to the system
Inspector is not required to:	1) Identify property lines 2) Offer warranties or guarantees of any kind 3) Calculate the strength, adequacy, or efficiency of any system or component 4) Operate any system or component that does not respond to normal operating controls 5) Move excessive vegetation, structures, personal items, panels, furniture, equipment, snow, ice, or debris that obstruct access to or visibility of the system and any related components 6) Determine the presence or absence of any suspected adverse environmental condition or hazardous substance, including toxins, carcinogens, noise, and contaminants in the building or in soil, water, and air 7) Determine the effectiveness of any system installed to control or remove suspected hazardous substances 8) Predict future condition, including failure of components 9) Project operating costs of components 10) Evaluate acoustical characteristics of any system or component 11) Inspect equipment or accessories that are not listed as components to be inspected 12) Conduct dosing volume calculations 13) Evaluate soil conditions beyond saturation or ponding 14) Evaluate for the presence or condition of buried fuel storage tanks 15) Evaluate the system for proper sizing, design, or use of proper materials 16) Perform a hydraulic load test on the system
Inspector is required to:	1) Uncover tank lids and distribution devices so as to gain access unless blocked as described om 21 MCAC 39 .1004(b)(5). The distribution box may remain covered if the Inspector has an alternate method of observing its condition. 2) Probe system components where deterioration is suspected 3) Report the methods used to inspect the on-site wastewater system 4) Open readily accessible and readily openable components 5) Report signs of abnormal or harmful water entry into or out of the system or components

As required by 21 NCAC 39 .1002 (1) this contract must be provided by Inspector and signed by client or client’s representative prior to Inspection being performed.

Signature below acknowledges receipt of copy of this contract and acceptance of Inspection as stated above:
Signature of Client or Client’s Representative*
Date*
Date Format: MM slash DD slash YYYY
Note: 21 NCAC 39 .1002 (2) Requires written permission from owner or owner’s representative to perform the inspection must be acquired prior to the inspection.
Name
This field is for validation purposes and should be left unchanged.

Feel free to contact us if you haven’t gotten a response by the end of the day? Call us: 919-868-9003

Address	45 Green House Dr Zebulon, NC 27597
Mailing Address	37 Pine Ridge Rd. Zebulon, NC 27597
Phone	(252) 478-3721 (888) 817-1904
Fax:	(919) 573-0443
E-mail:	brantley.reception@gmail.com
E-mail:	brantleyar@gmail.com