Septic Permit Application

FORM – English

When filling out this form please DO NOT use the autofill suggestions. Doing so could result in your form not being received by BRHD.

Required Contact Information




SEPTIC SYSTEM PERMIT APPLICATION






***The following questions are not applicable if only applying for a renewable operating permit***

What is the anticipated depth of the lowest floor below natural grade:

Will the building have:
Basement
Crawlspace
Slab on grade

If residential, how many bedrooms will the home have (unfinished basement = 1 additional bedroom):

If commercial, what is the anticipated maximum daily wastewater flow (gallons per day):

If a public water system is to be used, has a connection been approved for the proposed building:

If a private well/spring is to be used, what is the water right number or date right was applied for:

*Please attach a PDF building site plan that is drawn to scale and a minimum of 11” x 17”. The
following information is required to be on the plan:

  1. Complete address, Parcel identification number, Owner, and Date plans were drawn
  2. North Arrow
  3. Property line boundaries
  4. Access to property from point of connection with publicly maintained road(s)
  5. Ground surface contours (topographical) or slope direction/percent arrows
  6. Location and explanation of type of dwelling or structure to be served by the septic system
  7. Location of utility lines or service points of connection (water, electrical, gas, propane tanks)
  8. Location of all intermittent or year-round streams, ditches, watercourses, ponds, subsurface
    drains, etc.
  9. Location of all existing and proposed water supply sources. Also include the location of existing
    and proposed water supply sources on neighboring properties within 200 feet of the proposed
    septic system area
  10. A general location of the proposed/preferred septic system area and 100% replacement area
  11. If public drinking water source protection zone two area(s) are located on the parcel, show the
    area(s)
  12. If the property is located within a sewer service boundary, show the location and distance to
    nearest sewer
  13. Show any existing easements
  14. Show existing structures

Application Signature

I certify that the information given is true and correct to the best of my knowledge

Septic Fees

Site feasibility - $100

Residential septic permit - $150

The permit fee total does not include fees for alternative technology septic permits and/or non-residential uses. Payments can be made over-the-phone by calling: 435-792-6570

Click the SEND button only once. It will take just a moment to process your information. You will receive a confirmation email if your submission was successful.