Potential Debris Pit Reporting Form
Reporting Date _______________
1. Homeowner's name __________________________________________________
2. Address ___________________________________________________________
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Phone #s Home__________________ Work______________ Cell ________________
3. Are you the original owner Yes_____ No_____
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4. Does anyone remember debris being buried: Yes____ No_____
5. Year home built _________
6. Problem areas:
Subsidence: Size ___________Inches/Feet X ____________Inches/Feet depth____________Inches/Feet
Sink Holes: Size ___________Inches/Feet X ____________Inches/Feet depth____________Inches/Feet
Distressed Vegetation: Grass: Yes____ No____ Shrubs/Trees: Yes____ No_____
7. Locked Gate: Yes____ No____ Pets: Yes____ No____
Notes: _______________________________________________________________
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____________Inches/Feet
___________Inches/Feet