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Septic Pump-Out Program Application

  1. Please enter month and year if known. Enter UNKNOWN if you don't know the date.

  2. Please refer to the chart on our Septic Pump-Out Program page for income eligibility (200% of the Federal Poverty Guidelines for the number of people in your household). Approved applicants may be asked to provide more information to verify their annual household income.

  3. Are you renting the property?*

    Select one.

  4. If you answered "Yes" to the question above, are you responsible for the maintenance of the property's septic system?

    Optional - select one.

  5. Applicant Acknowledgments

    Please acknowledge the information below by checking the box.

  6. Leave This Blank:

  7. This field is not part of the form submission.