Applications & Forms

Apply and Pay Online
Citizenserve

CLICK HERE FOR ONLINE SEPTIC APPLICATIONS AND PAYMENT OPTIONS

CLICK HERE FOR ONLINE WELL APPLICATIONS AND PAYMENT OPTIONS

Applications may still be printed and submitted manually along with the proper payment by using the links below.

Print and Submit

Well

  • Well Permit Application (PDF) - 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 Application (PDF) - Application for onsite wastewater treatment system new installation and repair.
  • 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