Churchill County Building Department
155 N. Taylor St. #170
Fallon, NV 89406
775-428-0264
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# of Rocks Installed Over Each Pipe
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GENERAL INSTRUCTIONS:

  • FILL OUT THIS APPLICATION IN FULL.
  • DO NOT LEAVE BLANK SPACES OR YOUR PERMIT MAY NOT BE ISSUED.
  • TWO (2) PERCOLATION TESTS AND A SOIL PROFILE ARE REQUIRED FOR EACH INDIVIDUAL SYSTEM YOU PLAN TO INSTALL.
  • FEES ARE DUE WHEN THE APPLICATION IS SUBMITTED, AND BEFORE THE CONSTRUCTION PERMIT IS ISSUED.
  • PLEASE MAKE CHECKS PAYABLE TO: CHURCHILL COUNTY BUILDING DEPARTMENT.

Please see our website for more details regarding application for a Septic Permit

  • Contacts
  • Septic System Details
  • Attachments and Fees
  • Certification
General Property Details
Lookup by Contractor Business Name
Address
Address
Property Owner Details
Name
Name
Parcel Size
State
City
Name
Installer is the Owner?
Email
State
State
Email
Address 2
License #
Contractor Details
ZIP
Installer Details
Construction Address
Email
Email
Applicant Details
Phone #
Has the septic tank been pumped OR inspected within the past three years?
Address
ZIP
Phone #
Assessor's Parcel #
City
Last Name
First Name
ZIP
Phone #
City
Address
Leach Field Details
Depth of Bottom of Trench
Are you now experiencing any of the following problems with your system? (check all that apply)
Cover Material

NOTE: THE WELL MUST BE DRILLED PRIOR TO FINAL SEPTIC INSPECTION.

# of Bedrooms in Dwelling
Septic System Details
Well Construction Details
Total # of Chambers
Distance Between Lines
Sewage backs up into home
Manufacturer
Diameter
Water Source Details
Length of Each Line
# of Chambers/Line
Depth
# of Lines
Name of Public Water System
My system operates trouble-free
There is surface ponding and/or septic water breakout over the septic field
# of Feet of rock under each pipe
Distance Between Lines
# of Lines
Distance from Nearest Neighboring Well(s)
Septic Tank Details
# of Units
Soil Type
Trench Width
Water Source Type
Size
System Type
The Septic System Serves
Casing Depth
Distance from Dwelling Foundation
Length of Individual Chamber
Trench Depth (Bottom of Chamber)
Distance From Well
Chamber System Details
Purchased Where?
Septic odors are present
Cover Material
Amount of Rock under Chambers
Other Malfunction; Specify:
Application Fee:
Required Attachments

  • THE FOLLOWING ATTACHMENTS ARE REQUIRED

    1. Plot Plan. (Mandatory)
    2. Soil Test Pit Inspection if performed by other than Churchill County Building Department. (if available)
    3. Percolation Test Results. (if available)

    MISSING INFORMATION WILL DELAY PERMIT PROCESSING TIME

    THE FOLLOWING ITEMS SHALL BE SHOWN ON THE PLOT PLAN:

    1. Location as to roads and streets.
    2. Location and distance to well and sewage systems on surround lots (if vacant, so indicate).
    3. Direction of North clearly indicated.
    4. The distance to any watercourse (pond, lagoon, stream, irrigation ditch or drain ditch) within 500 feet.
    5. The location of the percolation test sites and the soil profile test pit must be shown on the plans.
    6. The location and depth of the well (existing or proposed). Indicate the depth of the casing or surface grout seal.
    7. All septic system components must be properly marked and located at the specified distances.
    8. The distance to community sewerage. If none, so indicate.
    9. Distance of septic system components and well to the property line.
    10. The capacity of the septic tank.
    11. The maximum slope across the absorption system (leach field) area.
    12. Lot dimensions.
    13. Depth, length and width of trenches and distance between trenches (between center lines of trenches)
    14. Water supply lines and sewer lines.
    15. Location of all structures, paved areas and areas of vehicular traffic.

The Fee Schedule is as follows:

Type Fee
Rock System $200.00
Chamber System $200.00
Tank Replacement Only $100.00
Gray Water System $200.00
Repair Rock System $100.00
Repair Chamber System $100.00
Fee Schedule
Type Full Name :
Sign With Hand
Signature Date
Certification
I hereby apply for a license to operate, use and maintain an onsite subsurface wastewater disposal system to serve the above property in Churchill County.
I certify that to the best of my knowledge, the information being furnished is true and correct.
Signature