Septic Permits and Insptections




  1. Obtain an application for permit from the Polk County Health Center.
  2. Have a soil morphology test done.
  3. Fill out the application. The front page of the application tells you how to do this. Use your installer to figure, type, size, and design of the sewer system.
  4. Return the completed application, soil test report adn the appropriate fee to the Polk County Health Center. Allow 1-7 working days for processing of the application and, if there are no problems, we will approve your application.
  5. A construction permit will be issued for the approved application.
  6. Post this permit where it can be seen from the road
  7. You can now begin construction.
  8. Call Polk County Health Center to check construction before covering the system.
  9. After the system is checked, if there are no problems, it is approved (note: all lagoons must have a fence constructed before approval can be made).
  10. Landowner will receive a final inspection forn for their records. Keep it with other important papers about your property.


On-site Sewage Disposal Construction Permit Application Packet

Please print all information clearly.  Provide all requested information accurately and completely.  Incomplete applications will be returned for completion before a permit will be issued.  Follow the check off list, complete the application and return to Polk County Health Center.

Property Owner: The name of the owner as stated on the current deed, as recorded with the County Recorder.

Site Address:  The address of the actual construction site of the system, include county, legal description (1/4 of ¼ section, section, township, range), subdivision name and lot number.  Use the County Parcel Identification Number when known.  Ask the County Assessor or check the real estate tax bill for this information.

Mail Address:  The address that correspondence, permits, and other communications may be sent to.  Include daytime and evening telephone number for the owner of the property.

System Is:  Check the appropriate box if the system is a new construction (no system existed prior to this construction); or repair of an existing system (major repair, modification, or replacement of a currently existing system).

System Serves:  Check residence or business whichever is applicable.  If a residence is attached to a business, check “Business”, but include residence in the system design.  Provide the requested information below the appropriate box.

Water Supply:  Check the appropriate box for your drinking water supply.  City water, public water supply district, or a community system that meets Missouri Department of Natural Resources definitions of community public systems or non- community public systems are “Public”; provide the name of the supply.  For “Private” supplies give the type of supply.  Locate the supply (well), neigh boring supplies (wells) and water lines on the layout.

Lot:  Provide the lot size in acres or square feet.  Give the percent slope and indicate on the Site Layout the direction of the slope and show a cross section of the slope and proposed system on the Slope Diagram.

Soil Information:  Obtain soil data at the site with a soil morphology report provided by a soil scientist meeting the definition in 19 CSR 20-3.060 (1) 61.  Provide the information requested for a soil morphology.  Include the soil scientist report forms with the application.

Soil Scientist:  Provide the name, address, and telephone number of the person providing the data.

Proposed System:  Provide brief basic information about the proposed system, choose A, B, or C depending on type of system.  Provide the information necessary for that system.  A Registered Professional Engineer must design systems checked as “Other”, include all data, calculations, drawings, or other information used to determine the design.  Also include the Professional Engineer’s name, address, telephone number, and seal.  Locate the proposed system on the Site Layout (item 13) and show all setback distances, property lines, easements, and any other information requested.

Installer:  Provide the name, address, telephone number, and county registration number of the person constructing the system.  Indicate if the installer is also state certified.

Signature:  The property owner or the designated agent must sign the form to attest to the accuracy and completion of the information in the packet.

Site Layout:  Provide a drawing of the proposed system.  Include all requested information from the application on the Site Layout section.

Make sure form is signed and dated.  Make sure people providing reports sign soil test and/or engineering report.

Make copies of the application, Site Layout, test results, reports, and drawings for your records.

When you have completed the application, submit it with soil test, engineer’s report (if applicable), permit fee form (files/1447106937_sewagepermitform.pdf) , and permit fee to:

Polk County Health Center
1317 W. Broadway
P.O. Box 124
Bolivar, MO  65613

Make check or money order payable to the Polk County Health Center

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