Forms_files/Septic Packet 2015
FOR OFFICE USE ONLY Brown County Health Department Permit #____________________ Card #_________ 201 Locust Lane PO Box 281 Nashville IN 47448 812-988-2255 Fax 812-988-5601 www.browncountyhealthdept.org Scanned______________ Mapped_____________ Date of Issue________________________________ APPLICATION FOR SEPTIC PERMIT AND BEDROOM AFFIDAVIT (This form must be completed by property owner.) ____New Construction ____Residential ____Repair ____Commercial ____Alteration ____Tourist Home/Bed & Breakfast ____Addition Required documents: ___Application/Affidavit ___Warranty Deed ___Floor Plans/Elevations ___Plot Plan of Site ___Contractor’s Drawing ___Site Evaluation Property Owner:___________________________________________________________ Phone:___________________ Mailing Address:___________________________________________ City/State/Zip:_____________________________ Site Address: ______________________________________________ City/State/Zip:_____________________________ Subdivision:_______________________________________________________________________ Acreage:__________ Township: Water Source: ___Washington ___Cistern ___Van Buren ___Hamblen ___Drilled Well ___Lake Well ___Jackson ___Public Name: ______________________________ Is a municipal sewer located within 300 feet of the property? ___Yes ___No Please check if applicable: ___Basement ___1st Floor Number of bedrooms: _______ ___2nd Floor ___Loft ___Den ___Bonus Room ___Water Softener # of jetted bathtubs over 125 gallons: _____ Will this be the only dwelling on this parcel of land? ___Yes ___No I, the undersigned applicant, understand I am responsible for the maintenance and repair of the on-site sewage disposal system for which I have applied. I further understand that this permit is valid one year from the date of issue, is nontransferable, and must be available on site at the time of final inspection. SYSTEM MUST BE INSTALLED PRIOR TO ABOVEGROUND CONSTRUCTION OR PLACING A MOBILE HOME ON THE PROPERTY. Signature of Property Owner: ____________________________________________________ Date: ________________ BEDROOM AFFIDAVIT I, ______________________, affirm under the penalties of perjury that my home is considered to be a _____bedroom home, as described by the bedroom definition* and accepted by the Brown County Health Department. I understand that my septic system Permit #__________ has been issued and sized correctly for my home in regards to the number of bedrooms. I understand that if my septic system is not in compliance with said permit, the permit issued will be void. Signature of Property Owner: ____________________________________________________ Date: ________________ *Bedroom means any room that may be advertised as, reasonably implied to be, reasonably perceived as or potentially easily converted to a bedroom. An incomplete list of examples of such rooms includes: rooms that have a closet, rooms that are adjoined to a hallway, rooms that may be (but need not be) in close proximity to other bedrooms, rooms that may be equal to or approximated to size of other bedrooms, and rooms that may be (but need not be) adorned with or adjacent to a bathroom. (Brown County Ordinance #13-1609) Brown County Health Department SEPTIC PERMIT PROCESS CHECKLIST This checklist is placed in the procedural order to obtain a septic permit. The sections in bold are the steps the property owner is to take. The sections in italics are steps or information that should occur by another entity. All paperwork that you submit to the health department must be on 8 ½ x 11” paper. If you need to reduce your paperwork to fit that size, the *Recorder’s office can make you a copy for a fee. ____ Contact a Brown County Registered Septic Installer from the list provided to flag out a septic system on your property. If your septic system is in need of a repair, you will still need to contact a Septic Installer to find out if your system can be repaired or will need to be replaced. The Septic Installer will contact the health department to set a date/time to meet for the septic field layout and conduct the visual portion of the site evaluation. ____ Contact an Indiana Registered Soil Scientist from the list provided to obtain a soil analysis on your property. The Soil Scientist will develop a soil analysis report to send to the health department. The health department will create a Septic System Specifications Worksheet for the Septic Installer based on the soil analysis report. ____ Provide house plans with elevations (inside and outside) to the health department. The Septic Installer will contact the health department for a copy of the Septic System Specifications Worksheet. The Septic Installer will create a drawing of the proposed septic system and complete a Contractor Information Sheet. The drawing of the proposed septic system and completed Contractor Information Sheet must be turned into the health department. Once approved, the health department will contact the installer and/or property owner. ____ Call the health department at 812-988-2255 to ensure all is ready for permitting before making the trip to the office. Office hours are Monday through Friday, 8 am to 4 pm. You may pick up the rest of the necessary documents listed below in the same building. ____ Application/Bedroom Affidavit: This form is at the *Health Department and must be signed and dated by the property owner. ____ Warranty Deed: This is at the *Recorder’s office. ____ Plot Plan: This is at the *Surveyor’s office. ____ Make sure you have the following items when applying for your permit: Application/Bedroom Affidavit Warranty Deed Plot Plan of site Cash, check or money order for your permit fee: ($100 for pipe/gravel & chambers, $200 for Presby or mound) ____ Purchase permit at the health department. *The Brown County Health Department, Recorder’s office and Surveyor’s office are at the County Office Building, 201 Locust Lane, Nashville, IN Brown County Health Department PO Box 281 201 Locust Lane Nashville, IN 47448 812-988-2255 Fax 812-988-5601 www.browncountyhealthdept.org Septic system description: Contact the Brown County Health Department if you don’t have this information. Date system was installed: _________________ Installer: ________________________________ Phone: _________________________________ Tank size ___ gallons -- Capacity ____ bedrooms Type: Conventional Alternative (type) ________________ ________________________________ For more information about septic systems, contact: Brown County Health Department PO Box 281 Nashville IN 47448 812-988-2255 812-988-5601 fax www.browncountyhealthdept.org US Environmental Protection Agency www.epa.gov/owm/onsite/ Things to keep in mind: Inspect your system every 1 to 3 years and pump your tank as necessary (generally every 3 to 5 years). Use water efficiently. Don’t dispose of household hazardous wastes in sinks and toilets. Plant only grass over and near your septic system. Roots from nearby trees or shrubs could clog and damage the drain field. Don’t drive or park vehicles on any part of your septic system. Doing so will compact the soil in your drain field or damage the pipes, tank, or other septic system components. Septic System Maintenance Record Next Service Scheduled Activity Pumping Company/Phone Activities Completed Jan. 2014 Inspection Joe Pumper 555-1234 Inspection Comments Sludge layer okay – may need pumping next year. Keep this document for your records! Last Updated: 4/10/2015 Brown County Health Department PO Box 281 l Nashville, IN 47448 812-988-2255 l 812-988-5601 fax www.browncountyhealthdept.org Brown County Indiana Licensed Septic Contractors: Cell Phone Work Phone Email Locate Pump/ Dye Block Tank & Presby Septic Haul Test Alarm Set-up Company First Last Address City Zip A1 Septic & Excavating Greg Edwards 2819 US Hwy 31 South Franklin 46131 317-445-6228 317-736-8742 [email protected] √ Dave Axsom Excavating David Axsom 5047 Crooked Creek Road Nashville 47448 812-606-1592 812-606-1592 [email protected] √ BTR Excavating Jon Sciscoe 406 W. Second Street Bloomington 47403 812-360-7142 812-334-0092 [email protected] √ Jerry Cleefman Jerry Cleefman 8746 Nineveh Road Nineveh 46164 317-691-5119 317-933-2354 √ √ √ C. Marvin Cody and Sons, Inc. Marvin Jr. Cody 1784 S.R. 45 East Morgantown 46160 812-369-0542 812-988-2183 √ √ √ Complete Mechanical Solutions Wally Voils 1148 W. Three Story Hill Rd Morgantown 46160 812-340-9154 812-340-9154 [email protected] √ Fleetwood Excavating Vernon Fleetwood 6561 N. Lawson Road Morgantown 46160 812-345-9541 812-988-7076 √ Fowler Enterprises, Inc. Jim Fowler 4279 Peoga Road Trafalgar 46181 317-371-0083 [email protected] √ Mathis Excavating Mike Mathis 28 Kelp Grove Road Nashville 47448 812-322-0021 √ J.M. Miller Excavating, LLC John Miller 8500 Becks Grove Road Freetown 47235 812-345-9795 812-988-0698 [email protected] √ Monroe LLC John M. Simpson 4440 State Road 46 West Nashville 47448 317-847-2697 812-988-1615 [email protected] √ Reed Excavating Ernie Reed 7688 Ogle Road Freetown 47235 812-345-9083 812-988-7863 [email protected] √ John Smith Excavating John Smith 3009 Smith Road Nashville 47448 812-325-4658 812-988-7986 [email protected] √ T & M Transport & Excavating Tim Ford 4491 Hoover Road Nashville 47448 812-272-1931 812-988-2669 √ Rex Voils Homes Rex Voils 7255 Homestead Road Morgantown 46160 812-327-0680 812-988-9012 [email protected] √ Southern Indiana Earthworks Jared Lucas 5548 State Road 135 South Nashville 47448 812-345-6205 812-345-6205 [email protected] √ Wagler Brothers Excavating Dave, Ed, Neal Wagler 7117 Homestead Road Morgantown 46160 812-327-7432 812-988-4403 [email protected] √ Tim White Excavating Tim White 6987 E. SR 252 Morgantown 46160 317-439-7150 812-597-5393 [email protected] √ R.D. Woods Excavating Robert and Tyler Woods 2140 Owl Creek Road Nashville 47448 812-361-4343 812-988-4069 √ 47274 √ √ √ √ √ √ √ √ √ √ √ Indiana State Soil Scientists who perform soil analysis in Brown County: Chestnut Ridge Consulting Inc. Soils1®Soil Science Consultants John F. Bowen 7208 E. CR 100 S. Seymour James L. Brown 11329 W. Jim Brown Rd Campbellsburg 47108 812-521-0995 [email protected] 812-755-4195 Jack W. Coulter 652 N. 600 E Paoli 47454 812-723-2846 [email protected] Mark S. McClain 13230 Heroic Way Fishers 46037 765-212-7645 [email protected] John M. Robbins 1903 S. Finley Firehouse Rd Scottsburg 47170 812-752-7160 [email protected] Mike Salem 8419 Bob Allen Road Freetown 47235 812-216-1871 [email protected] Randy E. Staley 8034 S. SR 157 Clay City 47841 812-939-2752 Curtis E. Turner 12945 SR 23 Granger 46530 800-238-5413 Spencer Williams 1771 S. SR 3 Scottsburg 47170 812-889-3524 [email protected] Amber Willen 2658 Rey Cemetery Road Freedom 47431 812-859-6337 [email protected] Please call the front office staff (Judy Swift or Judy Hess) if you have any questions about: Septic Permits, Septic Searches or Spec Sheets.
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