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Applications & Forms
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Application Forms Can Now Be Submitted and Paid for Online

Applications may still be printed and submitted manually along with the proper payment by using the links below.
 Well Septic
  • Well Permit Application - Application for well drilling (water supply and geothermal).
  • Well Inspection Request - Use this form to request a property sale/transfer water supply inspection for any property within Story County that has a private water supply well.
  • Well Plugging/Rehab - Claim Form - 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 - Use this form to document your well plugging and submit it to the Health Office.
  • Water Well Rehab Record #542-1519 - 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 - This table will help you determine the amount of liquid chlorine bleach needed to disinfect your private water supply well.
  • Septic Application - Application for onsite wastewater treatment system new installation and repair.
  • NPDES #4 - 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 moreabout the NPDES #4 form.
  • Time of Transfer
                 Acknowledgement
                 Demolition Waiver
                 Inspection Report
                 Future Installation Agreement