Septic Permit Application Form printable pdf download

Town of Castle Valley

Septic Permit Application

This permit must be submitted and approved before construction of septic system begins.

STEPS:

1) Contact Southeastern Utah Health Department (SEUHD) for a site visit (435-259-5602).

2) Complete percolation test and/or soil evaluation according to SEUHD guidelines.

3) Obtain design approval from SEUHD.

4) Submit SEUHD approved design with this application to the Town of Castle Valley (TCV) for

zoning approval before construction begins (435-259-9828).

5) A copy of the final approved SEUHD application must be submitted to TCV before a residential

building permit can be approved.

_____________________________________________________________________________________

Application Date

Applicant________________________________________________________________________________Lot #_____________________

Physical Address__________________________________________________________________________________________________

Mailing Address___________________________________________________________________________________________________

Telephone_________________________________________________________________________________________________________

Contractor_______________________________________________________________Telephone_____________________________

SETBACKS:

Septic systems must be at least 50 feet from easements and property lines.

Septic systems must be a minimum of 100 feet from ALL neighbors’ wells (200 feet is recommended).

Septic systems must be 100 feet from ALL neighbors' septic systems.

Proposed Setbacks: From road easement_____________________________________________________

From near side property_________________________________________________

Proposed # bedrooms_____________________

6) Applicant provides:

a) Plot plan drawn to scale

Plan Shall Include:

1. Lot #, name, address, phone #, and signature of lot owner and contractor.

2. Property lines, road easement lines and setbacks.

3. Location of well and septic system on applicant’s lot.

4. Location of wells and septic systems on adjacent properties.

5. Existing structures (designate use).

6. Proposed construction (designate use).

7. Dimensions locating above on property.

b) Copy of SEUHD-approved septic system design.

c) $15 (check payable to the “Town of Castle Valley”)

7) Approval:

Applicant (or Contractor)__________________________________________________________Date_________________________

Building Permit Agent______________________________________________________________Date_________________________

Rev 2-3-16

Septic Permit Application Form