Subdivision Septic Feasibility Application

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:

How many new lots proposed:

*Please attach a PDF preliminary plat map showing the proposed lot divisions. The following
information is required to be included with the preliminary plat map:

1. The location, type, and depth of all existing and proposed non-public water supply sources within
   200 feet of the proposed onsite wastewater systems, and of all existing or proposed public water
   supply sources within 1,500 feet of the proposed onsite wastewater systems

2. If any of the proposed lots are located within public drinking water source protection zone two
   area(s), these zones shall be shown on the preliminary plat

3. The location and distance to nearest sewer, owner of sewer, whether property is located within service
   boundary

4. Existing easements

5. Ground surface contours

Max File Size: 2MB

Or for larger files provide a public link to DropBox, or GoogleDrive, so that we can download your files:

Application Signature

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