Health Department Forms

• Privacy Notice
• Notificación de Prácticas de Privacida

• Spill Packet
  This packet includes a list of clean-up contractors with the ability to respond to hazardous materials spills and a form that can be used to document spill reporting and clean-up response activities.

We are updating these files with information from the recent changes to the food code. We appreciate your patience. If you have any questions or concerns, please reach out directly to: 574-971-4600

• Conrail Superfund Site
  Provides information about the Conrail Superfund site in Elkhart and Saint Joseph Counties including location, contaminants, and answers to frequently asked questions. An older document of this can be found here.
• Groundwater Protection Code (GWPC)
• Drinking Water Testing Labs
• Wastewater Characterization
  This is a list of laboratories or consultants capable of doing wastewater characterizations required by the Elkhart County Groundwater Protection Code.
• GWPC Registration Brochure
  This brochure gives a brief overview of the Groundwater Protection Code requirements and includes a registration form facilities can use to register with the Health Department.

• Meth Lab Fact Sheet

• Stop Raising Mosquitoes
  This pamphlet provides information on ways to reduce mosquito breeding sites around your home.
• Mosquito-Borne Diseases
  This pamphlet contains information about several diseases spread by mosquitoes.
• Ticks and Disease
  This pamphlet provides information about several species of ticks and the diseases they can carry.

• Application For Septic Permit
  This form is provided to show what information is required to apply for a septic permit. This form must be filled out in original and can be obtained at the Environmental Health Services Division office.
• Plan Submittal Checklist
  Checklist for Septic System Plan Submittal for New, Repair/Replacement Onsite Sewage Disposal Systems.
• Marking Utilities
  This is an information sheet concerning the marking of utilities before construction and soil evaluations/soil borings.
• ECHD Septic Ordinance Section 5
• Septic Lookup Request
  Use this form to request information on existing onsite sewage systems either by fax or by presenting to our office. Note: There is no information available for homes/addresses constructed prior to 1967.
• Sample "To Scale" Drawing
  "To Scale" drawings are required with all application submissions for an onsite sewage disposal system permit.
• Flood Dose Worksheet
  This worksheet must be submitted at the time of application when minimum requirements indicate a flood dose installation.
• Mound/Press Dist Worksheet
  This worksheet must be submitted at the time of application when minimum requirements indicate an elevated sand mound system or pressure distribution system installation.
• Onsite Evaluation Request
  Use this form to request an onsite evaluation/soil boring from ECHD for residences. This form can be completed at the ECHD Environmental Health Services Office or it can be printed and mailed or faxed to our office at (574) 875-3376.
• Septic System Care and Feeding B
  A guide from the EPA for the homeowner's care of their onsite system.
• Development standards
  Environmental Health Technical Review and Development Standards.
• Wastewater Treatment Matrix
  Wastewater Treatment Assessment Matrix
• ECHD Septic Ordinance - Ordinance No. 2012-153
  An ordinance regulating private sewage disposal systems in Elkhart County.
• Minimum Requirements
• Septic Permit Procedure Guide
  This guide explains the process for obtaining a private sewage disposal system permit, for new construction.
• Installer Registration Form
  This form is used to register septic installers in Elkhart County.
• Application for Construction Permit

• Lead- Who's at risk?
• Protect Your Family
  This pamphlet is an excellent resource. Landlords and sellers of homes, built before 1978, are required by law to present this pamphlet to the new owners or tenants to warn about potential lead hazards in the home. This law applies even if the landlord or seller has no specific knowledge about lead hazards in the home (English).
• Spanish Protect Your Family
  This pamphlet is an excellent resource. Landlords and sellers of homes, built before 1978, are required by law to present this pamphlet to the new owners or tenants to warn about potential lead hazards in the home. This law applies even if the landlord or seller has no specific knowledge about lead hazards in the home (Spanish).
• Lead Paint Safety A Field Guide
  This guide is part of HUD's approach to lead safety in the home. It will show you how to safely perform work around lead in a residence built before 1978 (English).
• Spanish Lead Paint Field Guide
  This guide is part of HUD's approach to lead safety in the home. It will show you how to safely perform work around lead in a residence built before 1978 (Spanish).
• Prerenovation Education Rule
  This brochure outlines the requirements for contractors, property managers, and others who perform renovations for compensation in residential housing that may contain lead-based paint.
• New Indiana Habitability English
  This brochure details landlord obligations, liabilities, and disclosure rules for Indiana properties (English).
• New Indiana Habitability Spanish
  This brochure details landlord obligations, liabilities, and disclosure rules for Indiana properties (Spanish).
• EPA and HUD disclosure
  This brochure has questions and answers pertaining to federal lead disclosure laws.
• Lease Disclosure English
  EPA Title X requires landlords to disclose lead hazards by giving this form to tenants prior to leasing most residential homes built before 1978 (English).
• Lease Disclosure Spanish
  EPA Title X requires landlords to disclose lead hazards by giving this form to tenants prior to leasing most residential homes built before 1978 (Spanish).
• Sale Disclosure English
  EPA Title X requires sellers to disclose lead hazards by giving this form to buyers of most residential homes built before 1978 (English).
• Sale Disclosure Spanish
  EPA Title X requires sellers to disclose lead hazards by giving this form to buyers of most residential homes built before 1978 (Spanish).

• Death Certificate Application (English)
• Death Certificate Application (Spanish)

• Apostille