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Applications & Forms

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
                 Demolition Waiver
                 Inspection Report
                 Future Installation Agreement