Glynn County Enviromental Health Department

Glynn County Application for Construction and/or Site Approval

for an On-Site Sewage Management System

New systems require a Level 4 Soil Report as of 11/2014. Repairs are on a case by case. See attached.

$35.00 …. EXISTING SYSTEM EVALUATION

$35.00 …. MOVE ON SEPTIC INSPECTION

$35.00 …. REPAIR EXISTING SEPTIC SYSTEM

$70.00 …. LOT EVALUATION FOR NEW SEPTIC SYSTEM

$35.00 …. VACANT LOT EVALUATION

$35.00 ….WATER SAMPLE TESTING FOR COLIFORM ** A 4” thick 4’x4’ concrete slab must surround the

well casing, power must be turned on to draw a water sample. Well casing needs to be 12” above grade.

Water samples are only drawn Monday thru Wednesday.

$50.00 ….WELL INSPECTION or NEW WELL LOCATION ON LOT WITH SEPTIC

$35.00 …. POOL INSTALLATION ON LOT WITH SEPTIC

$105.00 .. COMMERCIAL SYSTEM PERMIT

Property Address/Location: ______City ______Zip ______
Subdivision______Phase______Block______Lot: ______Parcel#: ______
Detailed Property Directions:
I am the owner or have permission from the owner to apply for this permit or can provide written permission & contact information for owner
Signature: (Owner or Applicant) / Date:
Property Owner’s Name: / Phone:
Property Owner’s Address: (Include City, State & Zip code)
Permit Applicant’s Name: (if different) / Phone:
Permit Applicant’s Address: (if different) (include City, State & Zip code)
Agent/Realtor Name: / Phone:
Buyers Name: / Phone:
Sellers Name: / Phone:
Type of Facility:
Residence Church Motel Restaurant, Other / Residence - # bedrooms or gpd / Commercial - # of patrons per day or gpd
I will provide adequate space for drain field replacement: YES NO / Do easement, wetlands or other sensitive areas exist on the property? YES NO
Water Supply or Well Type:
Public water Community Well Private Well Irrigation Well
Lot Size: Sq. Ft./Acreage: / Living Area: Sq.Ft.:
Garbage Disposal (a device installed under the kitchen sink that shreds food waste into pieces small enough to pass through plumbing) YES NO
Any other pertinent Information? Ie…easements, water bodies, marsh, wetlands

I hereby apply for a lot evaluation and/or a construction permit to install an on-site sewage management system, existing system repair, or a pool on an existing lot and agree that the system will be installed to conform to the requirements of the rules and regulations of the Georgia Department of Human Resources, Chapter 511-3-1. I understand that a permit is required prior to installation of an On-Site sewage management system and a fee is charged for such a permit.

If a permit is granted to install the on-site sewage management system described above. The permit is not valid unless properly signed by both Applicant and Health department representative. The permit expires 12 months from date of issue.

Any grading, filling, or other landscaping subsequent to issuance of a permit may render permit void. Failure to follow site plan may render permit void. Any grading, filling, or other landscaping subsequent to final inspection by County Health Department, which adversely affects the function of the on-site system, may render approval void. Installation contractor is responsible for locating system proper distances from buildings, wells, property lines, etc.

I understand that final inspection is required and I will notify the County Health Department upon completion of construction and before applying final cover. I am also aware that once completed, this evaluation/construction becomes public information and is subject to review by anyone.

I understand the Issuance of a construction permit for an on-site sewage management system, and subsequent approval of same by representatives of the Georgia Department of Human Resources or County Board of Health shall not be construed as guarantee that such system will function satisfactorily for a given period of time; furthermore, said representatives do not, by any action taken in effecting compliances with these rules, assume any liability for damages which are caused, or which may be caused, by the malfunction of such system. (DHR Rules 511-3-1.03; general requirements for on site sewage management systems (3)(b)

I understand the water test is only for the presence or absence of Coliform bacteria and no other water test will be performed. I also understand the test results are only valid for the date of the test.

I am the land owner or have permission from the land owner to grant access to representatives of the Glynn County Environmental Health Department to the above-mentioned property for this evaluation, test and/or inspection.

Signature: ______Date: ______

The Environmental Specialist who will inspect your septic system and/or property will be allowed to have 21 days to prepare the report or permit you are requesting. It is possible that it may not take that full amount of time but we offer no guarantees on providing such reports or permits prior to that time allowed by the State of Georgia. We ask that calls inquiring about the status of your permit or report wait until after the 20th day.

The 21 day count down does not start until ALL REQUIREMENTS ARE MET.

ALL of these must be done BEFORE submitting your application.

1. Signed application with at least 2 phone numbers. If someone else will be picking up the permit or communicate with our office they must be identified on the application or provide us with your written permission to be an authorized agent.

2. Circle at the top of the application which service is needed.

3. Fee for requested services must be PAID in Full

4. Property must be clearly MARKED: address/lot number readable from nearest road.

5. Property must be cleared, partially cleared or partially cleared to allow access to the proposed septic locations.

6. All water wells within 100’, and all wetlands, marshes, and ponds within 50’. And they must have a sanitary seal and a concrete pad surrounding the well head that measures 4 feet by 4 feet by 4 inches thick.

7. Provide a Floor Plan of the proposed construction or Mobile Home to be build or moved on to the site.

8. You Must obtain from a certified septic pump company a “Pump Out” report or proof of a pump out having been done within the past 5 years.

9. All 4 corners of lot must be Marked/Staked, or FLAGGED. Mark, expose, or locate and mark property pins or survey markers. WE WILL NOT GO TO THE PROPERTY UNTIL YOU TELL US ALL PINS ARE MARKED.

10. A soil report from a Georgia Certified Soil Classifier is required with all applications for on-site sewage management (septic) systems serving new construction. For septic system repairs the need will be handled on a case by case basis.

11. An accurate plot plan (AKA: site plan) is required because it is your representation of the legal definition of the boundaries of the property. We will take the picture on GIS ONLY AS A LAST RESORT. The plot plan (AKA: site plan) submitted must show all of the following: If these are not already on the site plan YOU MUST DRAW THEM IN.

(a) Show and label all roads.

(b) Show proposed house location.

(d) Driveways.

(e) Sidewalks.

(f) Pools and planned pools.

(g) All wells must be shown on the site plan. Even wells used strictly for agriculture and yard watering.

(h) All wetlands, lakes, ditches, swales or drainage features on the site or surrounding property within 100’ of property line.

(i) Other improvements proposed must be shown on the site plan.

A $20 per trip fee will be charged if the environmentalist cannot find the correct lot due to inadequate clearing, marking, or flagging.

A $20 per trip fee will be charged if the environmentalist must make a second site visit to re-inspect the installation of a well pad and/or

sanitary seals.c