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 Well and Septic Forms

The following forms are for property owners, developers and any applicant needing assistance with well and septic systems. All forms are in PDF format and open to a new window.

  • Soil Percolation Test Application
    (Appendix A-1) – Use this form when applying for approval to perform percolation testing of soils to evaluate a property for subdivision of land or development using onsite sewage disposal systems (OSDS).
  • Perc Application Checklist
    (Appendix A-2) – This reference sheet provides a brief description of what information is required to process an application for a percolation test in Baltimore County. More detailed information about soil percolation testing is available in the Ground Water Management Policy Manual.
  • Justification for Variance to the Master Water and Sewerage Plan
    (Appendix A-3) – Any applicant may request to install a private well or OSDS to serve a property that is within an existing or planned public water and sewer service area.
  • Interim Agreement
    (Appendix A-4) – Request permission to install a private well or OSDS to serve a property that is within a planned public water and sewer service area in Baltimore County, but has obtained a Justification for Variance to the Master Water and Sewer Plan indicating that the property does not have reasonable access to existing public utilities.
  • Agreement for Ongoing Maintenance of a Conventional OSDS with Sewage Pretreatment  (Appendix A-5) – This form is to be used where Baltimore County Environmental Protection and Sustainability (EPS) is requiring a perpetual service agreement be maintained for use of a sewage pre-treatment unit (BAT) on approved OSDS for new construction. Call the office at 410-887-2762 to receive a copy of the most current form.
  • Agreement for Ongoing Maintenance of an Alternative OSDS (Appendix A-6) – This form is to be used where Baltimore County EPS is requiring a perpetual service agreement be maintained for use of an OSDS using "alternative" technology. Call the office at 410-887-2762 to receive a copy of the most current form.
  • Agreement and Easement for Installation of an Innovative OSDS (Appendix A-7) – This form is to be used where Baltimore County EPS and Maryland Department of the Environment is approving the use of an OSDS using “innovative” technology as defined in COBAR 01.03.01.02 B. Call the office at 410-887-2762 to receive a copy of the most current form.
  • Existing Well and OSDS Assessment Forms
    (Appendix A-8) – These forms are to be used by a property owner who is seeking a building permit or change-of-use permit for a property served by a well or OSDS. The information will be used by GWM to to assess the adequacy of the existing well or OSDS for the proposed use.
  • Holding Tank Agreement
    (Appendix A-9) – This form is to be used when requesting approval to utilize a holding tank for the disposal of domestic wastewater in Baltimore County.
  • OSDS Abandonment Form
    (Appendix A-10) – This form is to be completed by contractors who perform an abandonment of an OSDS.
  • Well Siting Agreement
    (Appendix A-11) – This form is used by developers of a major subdivisions to be served by individual well water supplies.
  • Water Well Yield Test Report
    (Appendix A-12) – This form is to be used by licensed well drillers and pump installers to document yield test data for domestic water wells.
  • Water Well Fracturing Report
    (Appendix A-13) – This form is to be used by licensed well drillers for wells that have been hydrofractured.
  • Geothermal Well Report
    (Appendix A-14) – This form is to be used by licensed well drillers for wells to be used as part of a geothermal heat pump system.
  • General Requirements for Hydrogeologic Studies
    (Appendix A-15) – This form is to be used by applicants proposing a major subdivision of land (four lots or more) or any non-residential development in Baltimore County.
  • Request to Install a UV Disinfection System
    (Appendix A-16) – This form is to be used by property owners seeking to obtain a variance from bacteriological requirements for domestic well water supplies by installation of a ultra-violet (UV) disinfection device.
  • Request for Permanent Deviation to the COP
    (Appendix A-17) – This form is to be used by property owners seeking to obtain a permanent deviation from the Certificate of Potability (COP) requirements for  a domestic well water supply.
  • Waiver of Chemical Quality Prior to Conveyance
    (Appendix A-18) – This form is to be used for property transfers in which the Buyer agrees to purchase an improved property without a well meeting the water quality requirements. According to Baltimore County Code, this waiver form must be submitted to the EPS at least six days prior to settlement.
  • Waiver of Yield Requirement for Improved Property
    (Appendix A-19) – This form is to be used for property transfers in which the Buyer agrees to purchase an improved property without a well meeting the minimum yield test requirements. According to Baltimore County Code, this waiver form must be submitted to EPS at least six days prior to settlement.
  • Waiver of Yield Requirement for Unimproved Property
    (Appendix A-20) – This form is to be used for property transfers in which the Buyer agrees to purchase an unimproved property without a well meeting the minimum yield test requirements. According to Baltimore County Code, this waiver form must be submitted to EPS at least six days prior to settlement.
  • GWM Concept Plan Review Standard Comments
    (Appendix A-21) – This form is to be used by GWM staff to review a Concept Plan submitted for a proposed subdivision to be served by private wells or OSDS.
  • Tank Closure Report
    (Appendix A-22) – This form is to by GWM Staff to document the removal of residential underground storage tanks.
  • Scavenger Inspection Report
    (Appendix A-23) – This form is to by used by GWM staff to document annual inspection of vehicles to be used for liquid waste hauling.

Revised March 14, 2016

 

Revised April 6, 2016        

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