Polk County Health & Human Services Agency
Economic Services | Public Health | Senior Services | Social Services | Public Transportation | Veteran Services
Main Office
40 Courthouse St
Columbus, NC 28722
828-894-2114
Public Health
WIC/Clinic Services
161 Walker St,
Columbus, NC 28722
828-894-8271
Public Health
Environmental Health
35 Walker St,
Columbus, NC 28722
828-894-3739
Social & Economic
Services
231 Wolverine Tr
Mill Spring, NC 28756
828-894-2100
Senior & Veteran
Services (VSO)
75 Carmel Lane
Columbus, NC 28722
828-894-0001
828-894-0003 (VSO)
Public
Transportation
3 Courthouse Square
Columbus, NC 28722
828-894-8203
Environmental Health Records Request Form
General searches must be requested in writing at least a week prior to the requested search
date. Please be advised that septic records prior to 1970 are often Non-Existent.
Property Information:
(Information can be found via a deed search on the Polk County, NC Register of Deeds website at:
http://cotthosting.com/ncpolkexternal or in person at the Registrar of Deeds office)
1. Name of original owner (when system was installed): _______________________________
Name of original builder (when system was installed): _________________________________
2. List all possible names permit could be filed under (i.e. previous or current owner, etc.):
_______________________________________ _____________________________________
_______________________________________ _____________________________________
3. Tax Parcel I.D.# (PIN): __________________________________________________________
4. Address/Road Name: __________________________________________________________
5. Year Home Built: ______________________________________________________________
6. Year Septic/Well Installed: ______________________________________________________
7. Subdivision & Lot #: ____________________________________________________________
All information on 1 - 7 MUST be completed in order to perform a Records Search (Incomplete
requests will be returned)
SEND INFORMATION TO:
Name: ____________________________________________ Date:______________________
Email: ________________________________________________________________________
Phone: ____________________________________ Fax: _______________________________
The first copy of any record request is no charge. There will be a fee for subsequent copies,
according to the current fee schedule.
For Office use ONLY:
RECORDS REQUEST SEARCH: Date Returned: _________________
□ Record Not Found □ Request Incomplete □ Emailed □ Faxed □ In Person
Send request to Marley Alejo - malejo@polknc.org
