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]
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Dave Axsom Excavating
David
Axsom
5047 Crooked Creek Road
Nashville
47448 812-606-1592 812-606-1592 [email protected]
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BTR Excavating
Jon
Sciscoe
406 W. Second Street
Bloomington
47403 812-360-7142 812-334-0092 [email protected]
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Jerry Cleefman
Jerry
Cleefman
8746 Nineveh Road
Nineveh
46164 317-691-5119 317-933-2354
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C. Marvin Cody and Sons, Inc.
Marvin Jr.
Cody
1784 S.R. 45 East
Morgantown
46160 812-369-0542 812-988-2183
√
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Complete Mechanical Solutions
Wally
Voils
1148 W. Three Story Hill Rd
Morgantown
46160 812-340-9154 812-340-9154 [email protected]
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Fleetwood Excavating
Vernon
Fleetwood 6561 N. Lawson Road
Morgantown
46160 812-345-9541 812-988-7076
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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
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47274
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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.