Permit Numbers: _________________
____
Master Site
Review
:
_____
_______________
Date
Received:
_________________________
Permit Tech:
__
________________
_
________
_
Acknowledgment and Permission to Enter
I understand that any permits issued by Lewis County, consistent with the attached site plan, are valid ONLY if
construction is in according to this plan and all other conditions of the permit are followed.
Further I understand that County regulations require permission to County personnel to enter private property to
conduct inspections.
By my signature below, permission is granted for representatives of Environmental Services to enter and remain on
and about the property for the sole purposed of performing required inspections relating to this permit.
By my signature below, I certify that I am either the current legal owner of this property or their authorized representative.
With this document, I take full responsibility for the lawful actions that this document allows.
Prior notification of the date of inspections will take place is:
Lewis County Public Health & Social Services
Individual Well □ Shared Well Public/Municipal/ID #: __________________________ Other: ________
Required
Not Required
(_________) ___________________ (Phone Number to contact before visit if required)
Signature: __________________________Date: _____________
Owner
Authorized Agent
Location of Property:
Is Access Blocked by Gate?
Detailed Directions to Site:
New Construction/Expansion
Repair/Alteration
Soil Evaluation
Operation/Maintenance
Connect/ Reconnect to #: __
______________
Other: ________________________________
Application Expiration:
Incomplete applications or
applications that do not result in
permit issuance shall expire one (1)
year from the date of application as
specified in Lewis County Code
Chapter 8.40.090.
Right
to Appeal:
Any person aggrieved by a decision
of an inspection or notice made by
the health officer shall have the right
to appeal the matter as specified in
Lewis County Code 8.40.260
Project Information:
Acrea
ge: ___________ Number of Bedrooms: ________
Yes
No
Access is required
SEPTIC PERMIT
Project Description: Residential Commercial
Tax Parcel Number: ______________________
Site Address: _______________________________________________________
Owners Name: ____________________________ Phone Number: _____________
Owner's Mailing Address: ______________________________________________
Applicant Information: Same as Owner
Authorized Agent
Name: ______________________________ Phone Number: _________________
Mailing Address: _____________________________________________________
Water Source
Environmental Services Division
2025 NE Kresky Ave, Chehalis, WA 98532 Phone: (360) 740-1146 ● Fax: (360) 740-1245
(City)
(ZIp Code)
S:\COMMUNITY DEVELOPMENT\Forms
Updated October 2018
click to sign
signature
click to edit
For Official Use Only:
Permit/ Application Number: _______________________
Master Site Review Number:________________________
Fee $: _________ Receipt #________________
Site Inspection
Soil Class______________________________________
Septic
Tank(s) _______ gal. Pump Reqd: Yes No
Maximum Trench Depth ________ in.
Distribution Line Total _______ ft.
Filtration Area: ___________ sq. ft.
Application Rate: _________ gal./sq. ft./ day
Design Flow: _____________ gallons/day
Fill Required: ______________ in.
System Designer: _____________________________
Site Characteristics/Comments: _____________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Permit Approved: By ________________
Date __________
Permit Denied: By _________________
Date __________
Sewage Permit Issued: _________
Expires: _________
Additional comments/information/conditions:
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
Previous Records: ___________________
S:\COMMUNITY DEVELOPMENT\Forms
Updated October 2018
SEPTIC APPLICATION HANDOUT
Once a complete application is received it will be forwarded to the Environmental Health Specialist
for review and processing. You will be notified by phone or mail of any additional requirements.
Incomplete applications may not be accepted and could result in a delay in permit issuance.
Note: Applications expire one year from the date of submittal if a permit cannot be issued.
Fees cannot be refunded on expired applications.
Site Preparation:
Do NOT clear the property. It is okay to cut down the brush (except wetland plants or streamside
buffers), but do not disturb the soil or drive equipment over it when it is wet. Disturbing the soil
(scraping off the topsoil, bringing in fill material, making ruts, etc.), changes the structure and/or
the amount of soil. It is the amount, type, and structure of soil that is looked at when determining
potential for sewage treatment. Every inch of soil counts, drain-fields cannot be permitted in
disturbed soil and/or fill material.
Be sure that the development site is located at least 125 feet from any mapped wetland or hydric
soils. If any part of your proposal (including structures or the septic system) is located within 125
feet of wetlands or hydric soils, you may be required to hire a wetland consultant to confirm and/
or map wetlands in order to maintain setbacks. The Permit Center can provide more information
about your property and the potential for wetland or hydric soils.
Drain-fields must be located 100 feet from all wells and surface water (tanks 50 feet). Make sure
the test holes are dug accordingly.
Test hole requirements: (See attached examples)
Test holes must be a minimum of 6 feet deep, 3 feet wide, and graded at an angle no less than 35 degrees.
An inspector will be walking into the holes to determine the soil characteristics. Test holes must allow for
safe entry and egress.
Dig at least three (3) test holes
50 feet apart from each other.
Two (2) in the primary drain-field area
One (1) in the reserve drain-field area.
It is OK to dig more than three test holes. We are looking at the depth of unsaturated, original, undisturbed
soil between the bottom of the proposed disposal component and the highest seasonal water table,
restrictive layer, or a gravelly, sandy soil.
Submit application with fee payment
Sewage permit application $375 for residential site and $455 for a commercial site*
Planning Department Review fee of $200 required with each septic application for new
construction if prior reviews have not been completed for the site. This fee will not be required for
septic repair permit applications.
Design Review fee $225 for residential site (required if sewage system must be designed) and $450
for a commercial site*
Other fees may apply depending if your site is located in a flood zone, shorelines, etc.
*
Contact PERMIT CENTER at 360-740-1146 for current fees.
Environmen
tal Services Division
2025 NE Kresky Ave, Chehalis, WA 98532 ● Ph
one: (360) 740-1146 ● Fax: (360) 740-1245
Lewis County Public Health & Social Services
S:\COMMUNITY DEVELOPMENT\Forms
Updated October 2018
DOH337110
FormoreinformationcontactWashingtonStateDepartmentofLaborandIndustries,yourlocalhealthjurisdiction,orthe
WashingtonStateDepartmentofHealth.
TestPitConstruction
Call811tolocateundergroundutilitiespriorto
diggin
g.
Alltestpitsmustbeevaluatedforstabilitybya
competentpersonperWAC296155657.Testpits
shallnotbeenteredifdeemedunstable.
Usetheleaststablesoilforevaluatingtestpitstability
whenthereisalayeredsoilprofile.
Regardlessofsoi
ltype,atestpitthatshowsdistress
suchasfissuresorcracksisdeemedunstable.
Benchingfortestpitstabilitycanonlybedonein
unsaturatedsoilswithgreaterthan 15%fines(siltand
clay).ThismeanssomeDOHType1,Type2,andType
3soilsandsoilsseepingfreel
ymaynotqualifyforTest
PitOptionA.
Thethreetestpitoptionsdonotallowanevaluatorto
enterthetestpittoade
pthgreaterthan4feet.To
entertoadepthgreatertha
n4feet,additional
requirementsinWAC296155657mustbefollowed.
Everytestpitmusthavearampthatprovidesforentry
andexitintothetestpitwithouttheneedofaid.
Allspoilsmustbepla
cedatleast2feetfromtheedge
ofthetestpit.
Allequi
pmentwithin20feetofthetestpitshouldbe
shutdownwhenapersonisinthetestpit.
ForLargeOnsiteSewageSystems(LOSS)anexcavator
mustbeonsite.
Testpitsshallnotbeleftop
enforanextendedperiod
unlessproperlybarricadedperL&I
regulation.An
exampleofaproperlybarricadedtestpitisorange
constructionfencingsurroundingtheentiretestpit
andsecuredbymetalfenceposts.
GuidelinesforTestPitConstruction
forOnsiteSewageSystems
Safetyandsoilcharacterizationarebothimportantwhenconstructingatestpitforanonsitesewagesystemsoilreview.Thethree
testpitoptionsinthisguidancewillmeettheWashingtonStateLaborandIndustries(L&I)safetyrequirementsinChapter296155
WAC.ThethreeoptionscanbeusedforallsoiltypeslistedinOnSiteSe
wageSystemsChapter246272AWACandChapter246
272BWACexceptasnotedbelow.
LocalHealthJurisdictionsmayhavemorespecificguidancefortheirlocalarea.Thereviewing
agencyshouldbeconsultedbeforetestpitsareconstructed.
S:\COMMUNITY DEVELOPMENT\Forms
Updated October 2018