Applications & Forms

Well

  • Well Permit - Apply by registering for an account on our online portal and submitting the application for well drilling (water supply and geothermal).
  • Well Record Form - Pursuant to 567 IAC 82.12, well record submittal is a requirement for all wells drilled in Iowa.
  • Well Plugging/Rehab - Claim Form (PDF) - Use this form to request reimbursement up to $500 for expenses associated with the plugging of a well. An itemized bill for the work performed and the Iowa DNR "Abandoned Water Well Plugging Record - Form 542-1226" should be attached. Please contact the Health Department at (515) 382-7252 to discuss qualification of the project.
  • Water Well Plugging Record # 542-1226 (PDF) - Use this form to document your well plugging and submit it to the Health Office.
  • Water Well Rehab Record #542-1519 (PDF) - This is the form that needs to be submitted to the Health Office or the IDNR when improvements are made to existing water supply wells.
  • Well Chlorination Table - Liquid Bleach (PDF) - This table will help you determine the amount of liquid chlorine bleach needed to disinfect your private water supply well

Septic

  • Septic Permit - Apply by registering for an account on our online portal and submitting the application for new septic construction and alterations.
  • NPDES #4 (PDF) - This is the Iowa Department of Natural Resources (IDNR) "Notice of Intent to Discharge" form that is REQUIRED if you have a wastewater treatment (septic) system that has any type of discharge port. Learn more about the NPDES #4 form.
  • Time of Transfer

Acknowledgement

Demolition Waiver

Inspection Report (PDF)

Future Installation Agreement