Fulfilling the crucial step of managing wastewater and ensuring environmental health, the OSSMS Permit Application form, provided by Newton Environmental Health Services, lays the foundation for residential and commercial property owners in Covington, GA, to navigate the legal and procedural requirements for new construction, repair, or modification of on-site sewage management systems. With a clear distinction between the types of applications—ranging from new installations to repairs or extended modifications—this comprehensive document addresses the owner and applicant's information, the property details, and the specificities of the proposed or existing sewage system. The form demands precise information including property location, lot size, the number of bedrooms for residential applications, gallons per day for commercial entities, and existing environmental features that could impact the system's functionality. Significantly, it encourages the submission of a site-specific soil report and consults with engineering expertise, underlining the importance of tailored solutions and professional guidance in the management of on-site sewage systems. Moreover, it informs applicants about the necessity of a permit issuance, which is vital for legal compliance and operational success but also clearly states the non-assurance of system performance, highlighting the inherent complexities and responsibilities involved in managing such essential systems. This form serves not only as a permit application but as a comprehensive guide for individuals and businesses to understand and act within their roles for environmental stewardship and public health protection.
| Question | Answer |
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| Form Name | Ossms Permit Application Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Septic System Application NHC mtcc marion nc form |
Newton Environmental Health Services
1113 Usher Street – Suite 303
Covington, GA 30014
Phone: 770.784.2121
Fax: 770.784.2129
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OSSMS Permit Application Form |
www.newtonhealthdept.com |
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Application Date: ______________________ |
Residential |
Commercial |
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New Construction |
Repair of failing system |
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Addition or system modification |
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OWNER INFORMATION |
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APPLICANT INFORMATION (if other than owner) |
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Name _____________________________________________ |
Name ___________________________________________ |
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Address ___________________________________________ |
Business Name ___________________________________ |
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City,State,Zip ______________________________________ |
Address _________________________________________ |
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Home Phone ( |
) _________________________________ |
City,State,Zip ____________________________________ |
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Work Phone ( |
)__________________________________ |
Home Phone ( |
) _______________________________ |
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Fax ( |
) ________________________________________ |
Work Phone ( |
)_______________________________ |
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Other Phone ( |
) _________________________________ |
Fax ( |
) _____________________________________ |
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*Contractor: _______________________________________ |
Other Phone ( |
) _______________________________ |
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*If you have chosen a septic contractor, they may act as your agent in |
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applying and picking up a repair permit. However, you must indicate this is |
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the contractor of your choosing. |
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Property Address: _________________________________________ City, State, Zip ____________________________________
Subdivision ____________________________________________________________ Lot _________ Block ________
Current or Proposed # Bedrooms ________ |
Number of Gallons Per Day if Commercial __________ GPD |
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Garbage Disposal: |
yes / no |
Property Water: public / well |
Lot Size (Sq. Ft.)** _______________ |
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Stub out location: basement |
/ crawl space / slab (basement w/plumbing) |
Distance to Structure______________ |
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Check all below that are on or within 100’ of property and indicate location: |
(From Front Property Line) |
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___Creeks ___Ponds |
___ Well, Spring, Sink Hole |
___Embankments ___ Gullies |
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Soil Report (It is strongly recommended that the owner obtain a site specific soil report as well as consult with an engineer experienced in onsite sewage disposal systems.)
Type of Structure: single family residence /
Repair or addition please complete this section |
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Original Septic Installed Date (If known) _______________ |
Year home constructed __________________ |
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When was tank last pumped?_________________ |
O.K. to enter yard Fence with gate Dogs in yard |
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Laundry Loads per week _______ |
Tank size (if known) _______________ |
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Check if sewage is: Backing up in house/business |
Surfacing in yard |
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A permit is hereby granted to install or construct the
PROPERTY OWNER'S/AUTHORIZED AGENT'S SIGNATURE: _________________________________________________________________________
OFFICIAL USE ONLY
No record on file |
Drawing of existing system attached |
Failure Report Completed |
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Complaint on file: |
No |
Yes |
Assigned to __________ |
Complaint #: ______________ |
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Name & Date approved: _______________________________________ |
Disapproved _________________________________ |
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Fee paid _________________________________ |
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PLEASE WRITE DIRECTIONS TO PROPERTY ON BACK OF FORM |
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*Square Feet = Acres x 43,560 |
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2Randall Estates II Exempt Plat Review Comments October 5, 2006