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Thank you.

Thank you for helping Orange County Environmental Health ensure equity and accountability in services. Records are public.

Which gender identity applies to the applicant?*

Which race applies to the applicant?*

Which ethnic identity applies to the applicant?*

Hispanic/ LatinX
Non-Hispanic
Other than listed
Prefer not to respond/ No response

CURRENT OR PLANNED Water Source *

New Well

Existing Well

Community Well

Public Water

Are there any recorded easements or rights-of-way on this property?*

Yes
No

Does this property contain streams, ponds, or floodplains?*

Yes
No

Does this property contain any jurisdictional wetlands?*

Yes
No

Will this parcel contain any stormwater control measures (SCMs)?*

Yes
No
Unknown at this time, but I will submit additional information if this changes.

Is this project subject to approval of another agency (e.g. Planning, U.S. Army Corps of Engineers, etc.)?*

Yes
No

Agency (or Agencies) who must approve this project*

Project Type*

Please select the category that best matches your project.

New Residential (Single Lot) Septic and/or Well
Residential Subdivision/Recombination
Existing System Authorization
Residential Addition/Remodel (no additional bedrooms)
Residential Septic Repair (no fee)
Residential Expansion
Revision to Application for Residential Permit(s)
Septic System Abandonment (no fee)
Well Repair

Have you consulted a Licensed Soil Scientist?

If you have and you would like to provide a copy of their report, please attach a copy on the final page of this application.

Yes
No

Is this application for a privatized permit using the report from the Licensed Soil Scientist?*

Yes
No

Please Review the Following Statement:*

The LSS Evaluation attached to this application is to be used to produce design and construction features for permitting in accordance NCGS.

Yes
No

New Residential Permit(s) Requested*

Check all that apply.

New Improvement Permit
New Construction Authorization
New Well Permit (Private Drinking Water or Irrigation)
New Well Permit (Geothermal or Monitoring)

Project Description*

Please describe your project.

Improvement Permit Number (If one has been issued and is still valid)

example: IP20-0500, IP21-0692, etc.

Is this project for a single family or multi-family dwelling?*

Single family
Multi-family

Other preferred system type.

Please check the box if any of the following will be included in the proposed structure:

Project Description*

Please describe your project.

Does the property contain any existing septic systems or water supply wells?*

No
Yes. There is a septic system, and it is in use.
Yes. There is a well, and it is in use.
Yes. There is a septic system, but it is NOT in use.
Yes. There is a well, but it is NOT in use.

New Permits Requested *

Check all that apply.

NOTE:

An Operation Permit Revision is required for existing systems that have: 1) a previously designated repair area, and 2) the proposed property line does not encroach the designated area.
An Improvement Permit is required for an existing system that does not have a previously designated repair area.

New Improvement Permit(s) for Proposed Lot(s)
Improvement Permit to Designate Repair for an Existing System
New Construction Authorization(s) for Proposed New Lot(s)
New Well Permit(s) for Proposed New Lot(s)
Operation Permit Revision for Existing System

Other system type

Project *

Remodeling (interior only)
Addition other than bedroom (e.g. deck, porch, patio, pool, etc.)
Accessory structure(s) without bedroom(s)
Solar panel installation (no fee)
Return an existing septic system to use
Connect a new structure to an existing system
Mobile Home Park new home

Solar installation*

Ground mounted solar array
Rooftop mounted solar array

Project Description*

Please describe your project.

Please describe the problem*

Check all that apply. There are no fees with Septic Repair Permits. Installing a new system or tank where there is no known failure of the system is not a Repair. Please go back to New Improvement Permit and Construction Authorization.

Backing up into home or facility
Septic tank overflowing
Damage to system
Discharge of sewage on the ground
Need to pump the tank(s) often
Other (USE THE TEXT BOX BELOW TO DESCRIBE THE PROBLEM(S))

Other problem description

Have you consulted a certified septic installer or inspector?*

Yes
No

Is the problem worse after heavy rain?*

Yes
No

Is the problem worse when clothes are washed?*

Yes
No

Is the problem worse when there are visitors?*

Yes
No

Have you checked for leaking fixtures?*

Yes
No

Do you have water treatment plumbed to the septic tank?*

Yes
No

Has there been any recent work to the property such as digging, tree removal, driving of heavy equipment, etc.?*

Yes
No

Are there any strong cleaners, disinfectants, or medications in use?*

Yes
No

Does your home contain any of the following?*

Check all that apply.

Basement with plumbing
Garbage disposal
Sewage lift station

Is this expansion to add bedroom(s) to an existing dwelling, or is this expansion for bedrooms in a new Accessory Dwelling Unit?*

Additional bedroom(s) in an EXISTING dwelling
Bedroom(s) in a NEW Accessory Dwelling Unit

Will the number of bedrooms in the existing dwelling change?*

No
Yes, it will increase
Yes, it will decrease

Permit Numbers of All Permits for which Revision is Requested*

Example: IP21-0789, CA21-0543, W21-0497

Components to be Abandoned*

Check all that apply.

Septic Tank
Pump Tank

Reason for Abandonment *

Permit Requested*

Please check all that apply.

Repair with bacteria water sample ($75)
Repair with full water sample suite ($175)

Is a well liner needed*

Yes
No
Unknown at this time

If a liner is deemed necessary, a well camera report and additional fee ($100) are required.

Liner Report Upload

Site Preparation Verification*

Please verify each site preparation is complete by checking the box below. Signature below certifies that the site is prepared.

Contact information is correct
Vegetation has been thinned to permit access
Property lines and property corners have been marked on site
All proposed structures and appurtenances have been marked on site
All stream, flood plain, and/or wetland buffers (if present) have been marked on site

NOTE:

Failure to prepare the site may cause long delays in permitting, may result in a Notice of Incomplete Application, and/or result in a $50 re-inspection fee.

Meeting on site is not a substitution for having the site properly prepared.

Markings and Site Preparation Completed by:*

Owner
Owner's Representative/Applicant
Registered Land Surveyor
Other Consultant

ABOUT PLANNING APPROVAL

FORM: Planning Approval outside of the County Jurisdiction

Effective August 12, 2025, anyone applying for a Construction Authorization for a new septic system and Existing System Authorizations for building additions (expanding footprint, accessory structures, pools, etc.) from the Orange County Health Department must first review their site plan with the local planning and zoning jurisdiction. Please note, the site plan you submit to Environmental Health must match the one on record for the Building Permit. If the two site plans are different, your Environmental Health Permits may be revoked.

Acknowledgement

This application has been signed by the current OWNER of the property or the OWNER'S LEGAL REPRESENTATIVE (documentation required) who has entered into a contract or lease with the owner and who may legally represent the property OWNER in the transactions regarding the property. I, the undersigned, am the property OWNER or the OWNER'S LEGAL REPRESENTATIVE. By signing this application, I grant the Orange County Health Department, Environmental Health Division, right of entry to the property to perform the service(s) requested.

Fine Print

NOTE: CARD CHARGES WILL BE FROM WEB E-HEALTH ON YOUR STATEMENT.

Credit card payments are subject to service fees. All invoices sent to applicants have the service charge added.

You may pay by check by mailing Orange County Environmental Health, P O Box 8181, Hillsborough, NC 27278. The service fee will be deducted.

You may pay in person with check or cash at 131 W. Margaret Lane, Hillsborough. The service fee will be deducted.

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