Get Dbpr Interagency Dohdacsdbpr Onsite Sewage And Water Supply Evaluation Form

The Dbpr Interagency Dohdacsdbpr Onsite Sewage And Water Supply Evaluation Form is essential for evaluating whether regulated establishments have adequate water and sewage services before they open or expand. This guide will provide clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the evaluation form with ease.

1. Click the ‘Get Form’ button to obtain the evaluation form and access it for completion.
2. Begin with Section 1, where the applicant must input their information. Indicate whether the request is for a new facility, expansion/remodeling, or change in occupancy/tenancy by checking the corresponding box. Provide the appropriate licensing agency, permit number (if applicable), contact person, phone number, and any additional comments.
3. Next, provide establishment information, including the name, physical address, and type of business such as restaurant, convenience store, bakery, childcare, or adult living facility. Include a contact person and their phone number.
4. Proceed to Section 2, labeled 'Water.' This section must be completed by the Department of Health/County Health Department (DOH/CHD), Department of Environmental Protection (DEP), or Utility Authority. Indicate the type of water supply, either municipal/public water or onsite well system. Include the system name and permit number as required.
5. In Section 2, record the system evaluation result as either approved or denied and provide any relevant comments. Ensure that the Health Official’s name, title, signature, date, office address, and phone number are included for validation.
6. Move to Section 3, focused on wastewater. Similar to Section 2, provide the wastewater disposal system type and complete the evaluation. If served by municipal/public sewer or septic system, list the name of the supplier and permit number.
7. Record the wastewater system evaluation result, denoting approved or denied status along with conditions of approval if necessary. Include the name, title, signature, date, office address, and phone number of the Health Official for this section as well.
8. Once all sections are completed, review the form for accuracy. After verification, you can save changes, download the completed form, print it for physical submission, or share it with the appropriate licensing agency.

Complete and submit your Dbpr Interagency Dohdacsdbpr Onsite Sewage And Water Supply Evaluation Form online today to ensure timely approval.