Type Full Name :
Sign With Hand
Last Name
Organization Name
Name
Lot
Last Inspection Date
Sewage backs up into home
# of Bedrooms
{[PNAME]}
Begin typing Address and select from the populated drop-down
There is surface ponding and/or septic water breakout over the septic field
Property Address
Other Malfunction; Specify:
Type of Business
Address 2
Total Fee
First Name
# of Employees
Applicant Details
Email
Fee Schedule
Application Details
State
Once Montgomery Township approves your application you will get emailed a link to pay online.
Address 2
ZIP
Signature
The Septic System Serves
Address
Required Attachments
Note: Alternative technology system licenses must be renewed annually. Failure to renew the septic management license may result in fines/penalties prescribed by Board of Health Codes.

I hereby apply for a license to operate, use and maintain an onsite subsurface wastewater disposal system to serve the above property in Montgomery Township. I certify that to the best of my knowledge, the information being furnished is true and correct.

Application Type
Block
My system operates trouble-free
Phone #
Tank Size (in gallons)
City
Certification
Application Fee $25.00
Late Fee $15 per Month after Expiration Date
100 Community Dr.
Skillman, NJ 08558
{[APHONE]}
{[AWEBSITE]}
Year of Installation
ZIP
Septic System Details
Address
Are you now experiencing any of the following problems with your system? (check all that apply)
Septic odors are present
To renew your license:
a. Attach a copy of the pumping/inspection receipt showing gallons pumped and the date of pumping/inspection.
b. Include a copy of the annual inspection conducted by the system manufacturer or manufacturer’s agent
c. A copy of your current maintenance contract
Property Owner Details
City
State
City, State, ZIP