On‐Site Sepc Installer:
On‐Site Sepc Designer:
Total Number of Bedrooms (including proposed addions):
Failed System: YES NO Building Occupied: YES NO
Water Supply: Well Public Water
Name of Public Water System:
Describe Failure:
P.O. Box 68
South Bend, WA 98586
(360) 875‐9356 FAX (360) 875‐9304
On‐Site Sepc/Well Permit Applicaon
Pacific County Department of Community Development
Internet Address: www.co.pacific.wa.us
7013 Sandridge Road
Long Beach, WA 98631
(360) 642‐9382 FAX (360) 642‐9387
Sepc Evaluaon
Sepc Installaon*
Sepc Evaluaon/Installaon*
Abandoned System Evaluaon
Abandoned System Evaluaon/Install*
Sepc Repair*
Sepc Expansion/Modificaon*
Tank only
Cistern/Rainwater Catchment
Grinder/Pump Vaults
Tax Parcel ID #:
Well Driller:
Phone: Phone:
State License #:
On‐Site Sepc Permits for new construcon and evaluaons are valid for two (2) years from the date of issuance. Repair permits
are valid for six (6) months from the date of issuance. Well permits are valid for two (2) years from the date of issuance.
All permits/evaluaons are non‐renewable.
The contractor is required to schedule a final inspecon with the Department of Community Development prior to the expiraon of
the permit. The system shall remain open unl the Environmental Health Specialist has given final approval to cover. Failure to do
so will require re‐applicaon for a new on‐site sepc permit and be subject to all fees associated with a new on‐site sepc permit.
*These types of projects will require 2 sets of an on‐site sepc design prepared by a licensed on‐site sepc designer or profession‐
al engineer.
An on‐site sepc evaluaon or site evaluaon means the evaluaon of the soil profile, ground water lev‐
els, and landscape features of a specific lot and locaon by an Environmental Health Specialist for the
purpose of determining whether the site will meet the minimum requirements for the installaon of an
on‐site sepc system.
Test holes are excavated areas which are required to be dug for the purpose of evaluang the soil pro‐
file and ground water levels during the evaluaon. Three test holes must be located in, or adjacent to,
the areas designated as the primary and the reserve drainfield. In sandy soils, each test hole should be
approximately 18 inches in diameter and at least 3 feet deep. In other soils, test holes must be 2 feet
wide and 4 feet deep with a ramp cut into the ground for gaining access into the hole. If test holes dug
in non‐sandy soils do not have an adequate ramp, or if the spoils of the holes are too close and present a
safety hazard, the site will not be evaluated.
Due to a wide fluctuaon in ground water levels, the site may be required to be placed on a winter eval‐
uaon to accurately determine the winter water table. A winter evaluaon requires a bi‐weekly evalua‐
on of the site by an Environmental Health Specialist during the months of December, January, and Feb‐
ruary. The results of the winter evaluaon will then be reviewed and the County will nofy you whether
adequate site condions exist for the placement of an on‐site sepc system. An addional fee will be
assessed for this service payable before December 1st in order to be placed on the winter evaluaon
The installaon of an on‐site sepc system requires an in‐depth site and soil evaluaon and the sub‐
mial of a detailed sepc design demonstrang compliance with applicable state and local rules and
regulaons. If you are planning to install an on‐site sepc system, you must secure the services of an On
‐Site Sepc System Designer or Professional Engineer. Both are licensed by the Washington State De‐
partment of Licensing (DOL). The designer or engineer will evaluate your property by looking at the size
and topography of the site, soil condions, proximity to surface water, and other pernent condi‐
ons. You will want to work with your designer or engineer to develop a site plan that has all the neces‐
sary informaon required for an on‐site sepc system and any future development you may be plan‐
ning. This is required to be included in the design and has to be consistent/idencal with the site plan
that was submied with other applicaons.
When the on‐site sepc designs are complete, you will be required to submit two sets of the designs
with your applicaon packet. An Environmental Health Specialist from the Department of Community
Development will review the site along with the applicaon and design to make sure that it is an appro‐
priate design in compliance with the state and local rules and regulaons.
Item Requiring Setback Primary & Replacement
Drainfield (.)
Sepc Tank &
Pump Chamber (.)
Well or Sucon Line 100 50
Water Supply Line Under Pressure 10 10
Surface Water 100 50
Building Foundaon 10 5
Property Line or Easement Line 5 5
Curtain Drain or Culverted Ditch
Upgradient from system component
Downgradient from system component
Horizontal Setbacks Requirements for System Components