Septic Tank Pump-Out Program Application

Please Note: Rebates are limited to water customers of the Forsyth County Department of Water and Sewer and property owners whose residence currently uses a septic system for wastewater disposal. Refer to Frequently Asked Questions and Program Details prior to submitting the application. Only single-family residential homes are eligible.

Prior to completing this form, make sure you have the following documents ready to submit:

Receipt of service from a licensed septic service/pumping company clearly specifying the service address where the work was completed and the date the service was performed. Only Georgia Department of Public Health approved septic tank pumpers can be used for rebate eligibility purposes. A recent Forsyth County water bill that clearly displays the account number and the metered address.
The rebate is specifically for the property account address stated on the provided water utility bill. Forsyth County reserves the right to determine final eligibility. Only customers up to date on their water bills are eligible.

I. Customer Information
First Name
Last Name
Email Address
Phone
Phone Number
Please enter the address where the septic tank pump-out service was performed.

Address

Street Address
Street Address 2
City	Region
Postal Code	Country

Is your mailing address different from the septic tank pump-out service address?

No, mailing address is same as the septic tank pump-out service address
Yes, mailing address is different from septic tank pump-out service address
Forsyth County Water and Sewer Billing Account #
Please upload the following documents:
- Receipt of septic tank pump-out service clearly stating date of service and address at which the service was performed.
Receipt of Septic Tank Pump-Out Service Obtained
Filename
Size
Process
Status
Add Files
Current Water Bill
Filename
Size
Process
Status
Add Files
How did you hear about the program?

Word of mouth
Septic Service Company/Plumber
Water Bill Insert
Forsyth County Government Website
Forsyth County Health Department
II. Household Information
• Only single-family residential homes are eligible.
Number of People in Household
Year Home was Built
III. Septic Tank Information
What is the capacity of your septic tank? (gallons)
Are you aware that not maintaining your septic system can be detrimental to the water quality of Lake Lanier, the primary drinking water source for Forsyth County?

Yes
No
How long has it been since your last septic tank pump-out or inspection?
IV. Septic Tank Pump-Out Pilot Program Policy:
By submittal hereof, customer acknowledges that the rebate is a one-time rebate to be received only if the customer’s residence is eligible. Customer acknowledges that the maximum rebate per residence address is $100.00 dollars. Customer further acknowledges that the rebate pilot program is subject to available funds and may be cancelled at any time without notice. Rebate is available only for eligible customers of the Forsyth County Department of Water and Sewer.

I have read and understood the Septic Tank Pump-Out Program Application as stated above. I understand to receive this rebate, I must abide by all eligibility requirements. I also understand a site visit or other verification procedures may be conducted. The original receipt for the septic pumping service must be attached with this application for approval. I certify by my electronic signature below that I will comply with all of the requirements of the rebate pilot program, that this application is true and correct in all respects, and that any failure on my part to provide true and correct information may subject me to penalties.
Application Signature
Please type your name.

Septic Tank Pump-Out Program Application

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I. Customer Information

II. Household Information

III. Septic Tank Information

IV. Septic Tank Pump-Out Pilot Program Policy:

Water & Sewer