Septic-Well-Permit-Checklist 7-28-2023_v1Required Application Checklist for the following types of Applications:
Page 1 of 2 of the Required Application Checklist
Septic System Improvement Permit (Evaluate and Permit New Septic System, or Expand/Relocate current Septic System,
Septic System Construction Authorization (Permit to Install a New, Expansion or Relation of a Septic System),
Septic System Repair Permit (Current Septic System is not working and needs repair/replacement),
Reuse of Existing Septic System or Well (Compliance Permit for an Addition to Property or Change of Use),
Well Permit (Permit in install/repair a drinking water well)
All required documentation must be submitted at the time of application. To apply online via the COAST
Portal, please go to: https://www.nhcgov.com/coast/.
☐Yes I have completed and signed the Septic & Well Permit Application. (Application for On-Site
Water Protection Program (OSWP Septic and/or Well)
☐Yes ☐ N/A Included Documentation to Authorize an Owner’s Legal Representative (N/A if the owner of the
property is the applicant)
☐Yes ☐ N/A Provided a site plan, survey or plat of the property which includes all the following that are
applicable to the property.
•Property dimensions and boundaries
•All easements (utility, drainage, access, etc.)
•All existing and proposed facilities, structures, and additions with measurement to the
property lines
•Any other appurtenances (including driveways, walkways, sheds, decks, porches,
steps/landings, swimming pools underground storage tanks, etc.)
•Surface waters, ponds, streams, ditches, swales, creeks, marshes, wetlands, storm water
areas, mean high water lines, CAMA setbacks, etc.
•Existing septic system; show setbacks to property line and other fixed reference points
•All wells within 50-100’ of the property lines
•All plumbing connections to public sewer and water
•Include an arrow showing the direction of North
☐Yes ☐ N/A Completed Homeowner Interview form (N/A unless applying for a Septic System Repair Permit)
☐Yes ☐ N/A Email or other written documentation from CFPUA or Aqua (nearest provider of sewer and/or
water) stating that public sewer and/or public water is NOT available to the property. (We
cannot proceed without this documentation).
☐Yes ☐N/A A map from the nearest public sewer provider (CFPUA or Aqua) showing the location of existing
and/or proposed sewer mains, manholes, and lift stations. Any sewer easements on or within
100 of the property must be shown (Required for Well Permits).
☐Yes ☐N/A I have contacted a utility locator service who has/or will locate all underground public utilities
on the following date: __________________________ (A Date is Required for Septic System Re-
Use, Repairs, Expansion, or Replacements Applications.)
Page 2 of 2 of the Required Application Checklist
☐Yes ☐N/A The property is clearly staked and accessible. Includes: clear identification of all property
corners, sidelines, and easements, all underbrush removed or thinned. (Flags are available: See
below for directions)
☐Yes ☐N/A Proposed addition(s) to the property must be flagged or staked in the exact location on the site.
(Flags are available in the lobby of Environmental Health located at 230 Government Center Dr).
☐Yes ☐N/A If the reuse of an existing septic tank is proposed, the top of the tank must be exposed for
inspection. (Expose the top of the tank to the invert of the inlet and outlet of the tank
(approximately 9-12” around) and (If tank is not stamped, verification of liquid volume of the
tank may be needed).
☐Yes ☐N/A All underground well heads must be exposed to verify location(s).
☐Yes ☐N/A If applicable, approved or permitted storm water plans for subdivisions and commercial
developments are required prior to the issuance of a Septic Construction Authorization. (Mark
N/A if not applicable).
(Please be advised, if any of the above field items are not complete prior to the site visit by the
Environmental Health Specialist, a reinspection fee of $70.00 may be assessed and you will be notified as to
which field items are to be completed prior to the next site inspection.)
I, ______________________________________________ certify that I have fulfilled the above-referenced application
Please print/type full name of applicant/owner requirements and the property is prepared for a site evaluation.
__________________________________________________________ ___________________________________
Signature of applicant/owner (If completing online, please type name) Date
*Please note a separate fee (based on the type of septic system to be installed) is required for the Septic
Construction Authorization (CA) permit time of issuance.