Fillable Request of Community Sewer Service Provider to Provide (Merced County, California)

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Request of Community Sewer Service Provider to Provide (Merced County, California)

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O:\Programs\On Site Septic\MOUs with Cities\Sewer Availability Form for Provider 030921 blc vj FINAL.docx
Vicki Jones, MPA, REHS
Jessica Montoya-Juarez, MS
Yadira Vazquez, MBA
James Clark, MICP, MHOAC
Environmental Health Division Director
Assistant Public Health Director
Assistant Public Health Director
EMS Administrator
260 E. 15
th
Street, Merced, CA 95341 | Main: (209) 381-1200 | Environmental Health: (209) 381-1100 | www.countyofmerced.com/health
Rebecca Nanyonjo-Kemp, DrPH
Director
Salvador Sandoval, MD, MPH
Health Officer
Request of Community Sewer Service Provider to Provide Requirement and
Availability of Community Sewer Service to a Parcel
This form is to be completed by the community sewer service provider (municipality or special district) and
submitted to Merced County, Department of Public Health, Division of Environmental Health via e-mail to:
MCDEH@countyofmerced.com for review.
Address of parcel: _______________________________________________________________
APN of parcel (xxx-xxx-xxx): ____ - ____ - ____
Name of sewer service provider (municipality or district name):
______________________________________________________________________________
Contact information for sewer service provider representative:
Name: ___________________________________
Title: ___________________________________
Phone: ___________________________________
Email: ___________________________________
The community sewer service provider may require a parcel to connect to community sewer service. Such a
requirement may be regardless of cost to the property owner. This would be typical of an agreement put in
place at the time of annexation of the parcel to the city or district.
The community sewer service provider determines availability of community sewer service entirely on its own
criteria, which might include, but not be limited to, proximity of a sewer main and sewer system capacity.
MCDEH is not part of the city or district determination of availability.
• If community sewer service is available and the community sewer service provider requires
connection to sewer service, then MCDEH would require any existing septic tank(s) to be properly
destroyed/removed under an MCDEH permit. MCDEH would have no involvement related to the
community sewer service connection.
• If connection to community sewer service is not required by the community sewer service provider,
but community sewer service is available and the property owner wishes to utilize an onsite septic
system (not connect to community sewer), then MCDEH will determine if connection to community
sewer is required. Such requirement will be based on a comparison of the entire cost of sewer
connection with the entire cost of repair, replacement, or installation of a new/replacement septic
system per Merced County Code Ch. 9.54 and the Local Agency Management Program.
If the property owner wishes to utilize an onsite septic system (new system or repair or replacement of
existing system), then the Community Sewer Service Provider needs to answer the following questions (please
check “Yes” or “No” or “Not Applicable” below, as applicable):
1. Does the community sewer service provider require this parcel to connect to community sewer
service? Yes No
If Yes, make sure the information requested above is complete and submit the document to
MCDEH. Do not answer questions 2, 3, and 4. Arrangements for connection to community sewer
service will be made between the property owner and the community sewer service provider.
MCDEH will issue a permit for proper destruction of any existing septic tank(s). MCDEH will not issue
a permit to install a new septic system or to repair or replace the existing septic system.
If No, go to question 2.
2. Does this parcel have community sewer service available to it, as determined by the community
service provider? Yes No
If Yes or No, go to question 3.
3. Will the community sewer service provider agree to MCDEH issuing a septic system permit to repair or
replace an existing septic system? Yes No Not Applicable
If #2 is No and #3 is Yes, do not answer question 4. Submit the document to MCDEH. MCDEH will
issue a septic system permit if possible.
If #2 is Yes and #3 is Yes, provide MCDEH with an estimate of all costs involved with connection to
community sewer and do not answer question 4. Please make sure the information requested at
the top of this form is complete and submit the document to MCDEH. Based on a comparison of
costs, MCDEH will determine if MCDEH can issue a septic system repair or replacement permit or if
connection to community sewer is required. If connection to community sewer is required, MCDEH
will issue a permit for proper destruction of any existing septic tank(s).
If #3 is No or Not Applicable, go to question 4.
4. Will the community sewer service provider agree to MCDEH issuing a septic system permit to install a
new septic system (to serve a new structure)? Yes No Not Applicable
If Yes, provide MCDEH with an estimate of all costs involved with connection to community sewer.
Based on a comparison of costs, MCDEH will determine if MCDEH can issue a septic system permit or
if connection to community sewer is required.
If Yes, No, or Not Applicable, please make sure the information requested at the top of this form is
complete and submit the document to MCDEH.
If No, MCDEH will not issue a septic system permit and will refer the property owner to the
community sewer service provider for discussion about community sewer connection options.
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Request of Community Sewer Service Provider to Provide (Merced County, California)

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Completed 5 July 2021

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