Carter County

Application for an On-Site Wastewater Treatment System Permit

Fee of $25.00

NO CONSTRUCTION OF DWELLINGS OR SEPTIC SYSTEMS SHALL TAKE PLACE UNTIL A PERMIT HAS BEEN ISSUED AND ALL REQUIRED FEES PAID

1. Property Owner_________________________________Phone:Work________________Home___________________

2. Address_____________________________________________________________________________________________

3. Property Address___________________________________________________________County__________________

4.Legal Description___________________________6A. Lot of Parcel Size______________________________

5. Installer_______________________________________________________Phone________________________________

6. Treatment system to serve:          Residential_______Commercial___________Other_______________________

7. Number of bedrooms________ 8. Type of water supply_____________________ if a well, give depth_________

9. Is lot in an existing subdivision?_______ Year subdivision recorded____________

    If so, name or tract number of subdivision & lot number

10. Type of sewer system to be installed?________________________Soil type________________%Slope_________

11.Will this sewer system replace and existing system?_____________

12. Will sewer system be installed within 100 feet of the 100 year floodplain. Yes____ No____

13. Depth of groundwater_________________Depth of bedrock___________Depth Limiting Layer_________

                How were these depths determined?

14. Size septic tank.______Gallons     Septic tank will be concrete_____or________

15.Will any portion of this sewer system be installed within 10 feet of the property line?

        a. Has the property line been verified?

16. Directions for finding property. (Highway marker, road, street, map, etc.)

        The following information shall be provided on the plans:

A. Provide a scale drawing or label distance. (Examples would be to indicate 100 feet from the well to septic tank, 20 feet from house to septic tank, 10 feet from septic tank to drainfields, 100 feet long drainfield lines, 10 feet between drainfield line, etc.)

B. Provide location of septic tank, drainfield, and 100 % replacement area

C. Location of cleanouts

D. Location of proposed and existing well and water lines in the area of the proposed system and land adjacent to it.

E. Show lot boundaries (when the drainfield or replacement drainfields will be installed within 20 feet of lot boundaries)

F. Location of watercourses, irrigation ditches, lakes, and impoundments including the 100 Year floodplain in the immediate area

G. Percent slope of ground surface and direction of slope

H. Location of soil profile holes and percolation test holes

I. Indicate north on map

The information submitter on this application is true. I agree to install this sewer system according to the Carter County Health Regulations, which I have read and understand. I understand that if any of the information is found to be untrue or if the sewer system varies from the application of Carter County regulations without approval, the permit issued will be void.

Signature of Applicant __________________________________________________Date_________________

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