Septic System Complaint/Report Form | Wake County Government

Wake County’s Wastewater Program is responsible for all permitting and inspecting activities that require a septic system for wastewater disposal.

Please use this form as an application to report any septic system issues you maybe experiencing such as odor, surfacing wastewater, wastewater backups, wastewater flow to other properties, etc. For anonymous complaint, please check "Report anonymously" below.

Click here to see if you might qualify for financial assistance to correct this problem.
If you are a staff member submitting this request, please enter your name here:
Report anonymously?
Name
(Leave blank to remain anonymous.)
Site/Property Address*
Are you the (check all that apply):*

Property ownerComplainantContractor
Email*
Phone*
Applicant Address*
Site/Property Address (if different from applicant address)
(If you don't know the address, please describe the area as best you can.)
What type of property?*
What septic system failures have you observed at the property listed above?*

OdorWastewater backup to the houseWastewater flow to other propertiesCracked septic/pump tankWastewater flow into a creek or pond
Other system failures
Details
Type of Business*
Number of Employees per Shift
Number of Shifts per Day
Number of Days per Week of Operation
Start Date (When did the system start to fail?)*

MonthDayYear
Date
How frequent is this problem? (after rain, every day, only in spring, etc.)*
Have you reported this system failure previously? If so, when?*
What type of water?*

Individual WellCommunity WellShared WellPrivate WellPublic WaterUnknown
Rental Property?
Dogs?
Part of Real Estate Transaction?
Attach a Certified Septic Inspection Report*

One file only. 2 GB limit. Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Cancelof
Number of Bedrooms
Other Rooms with Closets
Number of Units
Number of Bedrooms in Units
Basement?
Damaged?
Has your tank been pumped recently? (less than 6 months)
Waste Water Strength
Garbage Disposal? (Garbage disposals are no longer permitted for use.)
Does the property contain previously identified jurisdictional wetlands?*

YesNoUnknown
Will wastewater other than sewage be generated?*

YesNoUnknown
Is the site subject to approval by other public agencies?*

YesNoUnknown
Are the property lines readily identifiable in the field?*

YesNoUnknown
I certify that all of the statements made on this form and on any attached documents are true, complete and correct to the best of my knowledge and belief and are made in good faith. I acknowledge that checking this box and electronically submitting the complaint form to Wake County Health & Human Services functions as my certification to the statements above.
I certify that all of the statements made in this application and on any attached documents are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that false information may be grounds for rejection of this application or revocation of any permits issued based on this information. Authorized Health & Human Services representatives are granted right of entry to make evaluations or inspections and to release information upon public request. I acknowledge that checking this box and electronically submitting the completed repair application to Wake County Health & Human Services functions as my certification to the statement above.
Signature of Owner or Authorized Agent*
Type in name above if completing form by email.
Today's Date*

MonthDayYear
Date
This report is based in part on information provided by the homeowner or his/her representative in the application submitted for this permit. The Environmental Health Specialist is not responsible for false or misleading information contained in the application. The Environmental Health Specialist is also not responsible for concealed conditions on the property or for statements in this report that may have resulted from false or misleading statements provided to him in the application. Neither Wake County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable.
Call 811 before digging!

Please call 811 to contact NC No Cuts to locate all underground utilities.
Please verify that you are human*
Should be Empty:

Call 811 before digging!