DRAFT - Wastewater Construction Permit

Wastewater Construction Permit - Drainfield Only
THE WASTEWATER DRAINFIELD AREA NEEDS TO BE DETERMINED BEFORE ANY OTHER PLANS ARE MADE.

The following items must be completed before a construction permit application can be reviewed:
1. Site Assessment must be completed by TriCounty Health Department.
2. All issues stated on Site Assessment must be addressed.
3. Drinking water source must be approved by TriCounty Health Department. ***Well water will need to be tested prior to health department approval, approx. 4-6 week time frame
4. Site Plan/Plot Plan submitted. This is a plot of the lot showing property lines with dimensions, house/structure location, driveway/parking area, location of onsite wastewater system, location of drinking water source, and protection buffer for source. This must be signed by the property owner.
5. A certified individual must design the wastewater drainfield. (see list of certified individuals)
6. TriCounty Health Department requires that a registered or “In process” installer install the onsite wastewater system. A homeowner may install their own onsite wastewater system if trained by TriCounty Health Department. A training fee of $100.00 will apply. This training does not qualify a homeowner as an installer; it only allows you to install your own system. Please note that a $100.00 fee will be assessed for each additional inspection due to incorrect installation.
7. Fill out the application completely.
Full List of Waste Water Contractors and Installers

Detailed System Design Instructions

Plans must be prepared and signed by a state-certified individual and include their certification number. Plans must be prepared in such a manner that the installer can read and follow them in order to install the system properly. Construction shall not commence until the plans have been approved. Faxed designs must be legible.

Materials
- Schedule, material, and size of pipe to be used
- Septic tank manufacturer, size of tank, and maximum burial depth of tank
- Type of gravel to be used (¾” minimum to 2½” maximum)
- Type of separation material to be used (straw or fabric)
- Type of chambers to be used: manufacturer, model, and size
Details
- Plans shall be drawn to scale (not to exceed 1 in = 30 ft), and indicate the scale used
- Must include risers, clean-outs, and sampling ports as required by rule
- Location and distance from water supply lines
- Location of private water source, including 200’ protection zone
- Location of 200’ protection zone must be indicated on a County Plat showing property line, water source location, and 200’ in all directions with no source of contamination.
- Locations and distances of any watercourse, lake, pond, or reservoir within 200 ft
- Location and distance from curtain drains
- Location and distance of property lines
- Location of roadways, driveways, and parking areas
- Location of easements or right-of-ways affecting property
- Location and distance from the down slope, cut bank, or top of embankment
- Location of soil exploration and perc. test holes
- Location and size of replacement area
- Distance from any building foundation
- Distance between septic tank and trenches
- Distance between trenches and length of distribution lines
- Slope of building sewer (must not be less than ¼” per foot). Includes pipe from building to tank, and tank to drainfield.
- Slope of distribution laterals (should be level)
- If required, on-site assessment form and relative elevations must be provided. Indicate the original grade and trench bottom for both ends of each distribution lateral.
Cross Section of Trench
- Depth and width of excavation
- Depth of pipe or chamber inlet
- Depth of filter material
- Separation material
- Depth of backfill
- Maximum dig depth of trenches
Installation Instructions
- Please provide detailed installation instructions to enable the owner or a third-party contractor to install the system. Examples: how to enter/exit chamber end caps, orientation of perforated pipe, etc.

Application - Drainfield Only
Date*

MonthDayYear
Date
Property Serial #*
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant Information
Are you the current property owner?
Applicant Name*

First NameLast Name
Applicant Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Phone Number*
Please enter a valid phone number.
Applicant Email*
example@example.com
Other Information:

Is the System Designer the same as the applicant?
System Designer Name*

First NameLast Name
System Designer Phone Number*
Please enter a valid phone number.
System Designer Email*
example@example.com
System Designer Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is the System Installer the same as the applicant?
The System Installer is a:

Registered InstallerIn-Process to be a Registered InstallerHomeowner (Training class required: $100)
System Installer Name*
System Installer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
System Installer Phone Number*
Please enter a valid phone number.
System Installer Email*
example@example.com

Drinking Water
Drinking Water Source:

Well/Spring (need to provide proof of water rights)Public Water Connection (need to provide a will serve letter stating availability)Other
Number of water connections:

Submit the following:
Proof of Drinking Water Source

(e.g. will serve letter, well permit, spring rights)
Cancelof
Shared Well/Spring Agreement

(Required if there is more than one water connection.)
Cancelof
Detailed System Design

(Refer to page 2 for specific design requirements)
Cancelof
Site Plot Plan

(Ensure that the plot shows property lines with dimensions, house/structure location, driveway/parking area, location of onsite wastewater system, location of drinking water source, and protection buffer for source.) THIS MUST BE SIGNED BY PROPERTY OWNER AND LEGIBLE.
Cancelof
Official Floor Plans

(Submit floor plans for each level of the building)
Cancelof
Current Tax Identification Form

(Only required if your information has changed since the Site Assessment)
Cancelof

Fees

Conventional System

$150.00 Quantity

Deep Trench or Absorption Bed System

$250.00 Quantity

Homeowner Class

$100.00 Quantity

Total

$0.00

Credit Card

The property owner has ultimate responsibility for the design, installation, operation, and maintenance of the onsite wastewater system.
Property Owner Signature

Clear
Should be Empty:

Wastewater Construction Permit - Drainfield Only

Application - Drainfield Only

Applicant Information

Drinking Water

Submit the following:

Proof of Drinking Water Source

Shared Well/Spring Agreement

Detailed System Design

Site Plot Plan

Official Floor Plans

Current Tax Identification Form

Credit Card