Site Plan Worksheet
Rowan County Environmental Health
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ROWAN COUNTY ENVIRONMENTAL HEALTH SITE PLAN WORKSHEET
Check the box beside each item that has been indicated on your site plan. Incomplete site plans will be returned to you for completion.
Remember: Your property will not be scheduled for an evaluation until we have received a complete application , site plan and all proposed Items are marked on the property.
The dimensions of the property.
The proposed location of all structures (e.g.facility, wells, water lines, out buildings, pools, etc.). Show the distances from the road and the side property line to all structures. Be sure to give the dimensions for all the structures.
If you are unsure as to the structure size, please show the dimensions of the MAXIMUM area of the lot that you anticipate the structure will cover.
The preferred septic system location.
The preferred driveway location.
The proposed well location. A north arrow or other sufficient directional Indicator.n.
Any proposed structures or Improvements to the property such as garages, workshops, pools, etc.
The location of any existing septic systems and wells on your property and on the adjoining property within 100' of your property line.
The location of any easements or rights of way on the property.
The location of any designated wetlands on the property.
The location of any burled debris pits on the property.
15A NCAC 18A .1937 (d) The application for an Improvement Permit shall contain at least the following Information: owner's name, mailing address, phone number, location of the property, plat of property or site plan, description of existing and proposed facilities or structures, number of bedrooms, or number of persons served, or other factors required to determine wastewater system design flow or wastewater characteristics, type of water supply Including the location of proposed or existing well(s), and signature of owner or owner's legal representative. The applicant shall Identify property lines and fixed reference points In the field. The applicant shall make the site accessible for an evaluation as required in Rule .1939 of this Section. The applicant shall notify the local health department on the application of the following:: 1) the property contains previously Identified jurisdictional wetlands; 2) wastewater other than sewage will be generated; or 3) the site Is subject to approval by other public agencies.
Applicant Name & Signature
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