Onsite Sewage Forms and Application Fees

On this page you will find the forms, guidance documents, and fee information needed to file an application for an onsite sewage system and/or private well.

OBTAINING PRIVATE SECTOR SERVICES

VAC Code	Regulation	Applicable Forms
12 VAC 5-570	Sanitary Regulations for Marinas and Boat Moorings	Alternate Pump-Out Agreement Application for Construction or Expansion of Sanitary and Sewerage Facilities at Marinas and Other Places Where Boats are Moored CVA Application
12 VAC 5-610	Sewage Handling and Disposal Regulations	See GMP 2017-01 for Forms 1-14 Form 1: Application for a Sewage Disposal System andor Private Well Construction Permit Form 2: Cover Page Form 3: OSE/PE inspection form Form 4: Example request for subdivision review Form 5: Request for professional courtesy review Form 6: Site and soil evaluation report Form 7: Construction drawing page Form 8: System specifications worksheet Form 9: Private well worksheet Form 10: Private well abandonment worksheet Form 11: Request for Survey Waiver Form 12: Verification of Sewage System Location Form 13: Refund Affidavit Form 14: Malfunction Assessment Application for Sewage Handling Permit Application for Pump and Haul Storage Facility Construction Permit Field Guide to Soil Textures (Appendix F) Percolation Test Procedure (Appendix G) Soils Evaluation Percolation Test Data Completion Statement GMP 2017-03 Appendix 2b Request for Health Department Review
12 VAC 5-613	Regulations for Alternative Onsite Sewage Systems	See forms for 12 VAC 5-610
12 VAC 5-620	Regulations Governing Application Fees for Onsite Sewage Systems and Private Wells	Onsite Sewage and Well Fee Information
12 VAC 5-630	Private Well Regulations	Application for a Sewage Disposal System and Private Well Construction Permit Application for an Express Class IV Well Construction Permit GW-2 Uniform Well Completion Report Guidance on Completing Uniform Well Completion Report GW-5 Well Abandonment Form Form 2W: Well Only Cover Page Form 7W: Well Only Construction Drawing Page Form 9: Private Well Worksheet Form 10: Private Well Abandonment Worksheet
12 VAC5-635	Rainwater Harvesting System Regulations	Application for a Tier 4 Rainwater Harvesting System Construction Permit
12 VAC 5-640	Alternative Discharging Sewage Treatment Regulations for Individual Single Family Dwellings	COMBINED APPLICATION 04 28 2014 fillable COMPLETION STATEMENT 04 28 2014 fillable PERMIT TRANSFER UNDER 220 E 02 02 2016 fillable
12 VAC 5-650	Schedule of Civil Penalties	No forms at this time

ONSITE SEWAGE APPLICATION FEES (Effective July 1, 2019)

Application Type	Fee
Certification letter with OSE/PE documentation, <1,ooo gpd	$320

Certification letter with OSE/PE documentation, >1,000 gpd	$1,400
Construction permit for onsite sewage system only, no OSE/PE documentation	$425
Combined well and onsite system construction permit, no OSE/PE documentation,	$725
Combined well and onsite system construction permit with OSE/PE documentation, <1,000 gpd	$525
Construction permit for only onsite sewage with OSE/PE documentation, <1,000 gpd	$225
Construction permit for only onsite sewage with OSE/PE documentation, >1,000 gpd	$1,400
Combined well and onsite system construction permit with OSE/PE documentation, > 1,000 gpd	$1,700
Private well construction or abandonment permit, with or without OSE/PE documentation	$300
Closed-loop geothermal well system (one fee per well system)	$300
Alternative discharge system inspection fee	$75
Minor modification to an existing system	$100
Appeal before the Review Board	$135
New Fee Effective 7/1/19: Repair permit for a treatment works, < 1,000 gpd without OSE/PE documentation	$425
New Fee Effective 7/1/19: Repair permit for a treatment works, < 1,000 gpd with OSE/PE documentation	$225
New Fee Effective 7/1/19: Repair permit for a treatment works, > 1,000 gpd with OSE/PE documentation	$1,400
New Fee Effective 7/1/19: Voluntary upgrade for a treatment works, < 1,000 gpd with OSE/PE documentation	$225
New Fee Effective 7/1/19: Voluntary upgrade for a treatment works, > 1,000 gpd with OSE /PE documentation	$1,400
New Fee Effective 7/1/19: Safe, adequate, and proper evaluation without OSE/PE/Installer/Operator documentation	$150
New Fee Effective 7/1/19: Safe, adequate, and proper evaluation with OSE/PE/Installer/Operator documentation	$100

Beginning July 11, 2019, applicants seeking evaluation and design services from VDH must submitted a petition for VDH Services and meet means testing criteria or the VDH Hardship Guidelines.

Applicants whose family income falls below the Federal Poverty Guidelines are eligible for a fee waiver. Applicants for onsite sewage system repairs or voluntary upgrades whose family income falls below 200% of the Federal Poverty Guidelines will be eligible for a fee waiver.

Contact your local health department for more information about fees.

Last Updated: February 4, 2025