Page 1 of 2 Application Checklist Application Checklist for the following types of applications: • Septic System Improvement Permit (Evaluate and Permit New Septic System, or Expand/Relocate current Septic System) • Septic System Construction Authorization (Permit to Install a New, Expansion or Relocation of a Septic System) • Septic System Repair Permit (Current Septic System is not working and needs repair/replacement) • Reuse of Existing Septic System or Well (Compliance Permit for an Addition to property or Change of use) • Well Permit (Permit to install/repair a drinking water well) All documentation must be submitted at time of application and uploaded to https://www.nhcgov.com/coast/. ☐YES I have completed and signed the Application for On-Site Water Protection Program (OSWP) Septic and/or Well. ☐YES ☐ N/A Signature of the owner or owner's legal representative document (only if applicant is not the owner). ☐YES Provided a site plan, survey or plat of the property, drawn to scale, between 1” = 10’ and 1” = 60’ Please show all of the following that are applicable to your property: • Property dimensions and boundaries • All easements (utility, drainage, access, etc.) • All existing and proposed facilities, structures, and additions • Any other appurtenances (including: driveways, walkways, sheds, decks, porches, steps/landings, swimming pool, underground storage tanks, etc.) • Surface waters, ponds, streams, ditches, swales, creeks, marshes, wetlands, storm water areas, mean high water lines, CAMA setbacks, etc. • Existing septic system; show setbacks to property lines and other fixed reference points; • All wells within 50-100’ of the property lines • All plumbing connections to sewer and water • All topography lines • Include north arrow *Additional information may be needed if it is not provided on the site plan or survey. ☐YES ☐ N/A A copy of the deed or recorded plat or subdivision plan: showing date recorded; and any previous deeds that show subdivision of the property (Not required for replacement well). ☐YES ☐ N/A Completed Homeowner Interview form (required only for Septic System Repair Permit). ☐YES ☐ N/A Written documentation from the nearest provider of sewer and/or water (CFPUA or AQUA) stating that public sewer and/or public water is Not available to the property. (Without this documentation the application cannot be processed.)