Below is a complete listing of available Foothills Health District Environmental Forms.  They are grouped as close as possible to the program they relate to. 


Foothills Health District Environmental Fee Schedule (FH 4001.001)   Image of PDF Icon 
Refund Request Form (FH 4001.019)   Image of PDF Icon 

Documents Pertaining to Septic Systems

Application for Well or Septic System Services (FH 4001.066)  Image of PDF Icon 
Septic System Repair Application (FH 4001.034)   Image of PDF Icon 
Existing System Application (FH 4001.064)Image of PDF Icon
Property Owner Consent Form (FH 4001.065)Image of PDF Icon
Environmental Health Records Request (FH 4001.045)  Image of PDF Icon 

Misc. Septic System Documents

Pump Tank Diagram (FH 4001.035)   Image of PDF Icon 
Health Department Site Evaluation Sign – Orange (FH 4001.005)   Image of PDF Icon 
Septic & Well Application Site Plan Requirements (FH 4001.038)   Image of PDF Icon 
Septic Installer List Page (from State of North Carolina)

Documents Pertaining to Water Wells

Water Sample Request Application (FH 4001.020)   Image of PDF Icon 
Home Owner Well Repair Application (FH 4001.039)   Image of PDF Icon 
Water Quality Guide (FH 4001.040)   Image of PDF Icon 
Well Disinfection Brochure (Link to State of North Carolina)
Foothills Health District Well Procedures (FH 4001.017)   Image of PDF Icon 
Well Owner Statement (FH 4001.042)   Image of PDF Icon 
Well Repair & Pump Repair Notification (FH 4001.018)   Image of PDF Icon 
Application for Well Abandonment (FH 4001.069.pdf)  Image of PDF Icon 
Well Driller Listing (Link to State of North Carolina)

North Carolina Law Pertaining to Water Wells

Well Construction, Monitoring & Abandonment Link from NC Divisions of Water Quality
Well Construction Record (Form GW-1)  Image of PDF Icon 
Well Abandonment Record (Form GW-30)  Image of PDF Icon 

Documents Pertaining to Child Care Facilities

Child Care Facility Application (FH 4001.043)   Image of PDF Icon 

Documents Pertaining to Tattooing

Application for Tattooing Permit (State Form DENR 4015)

Documents Pertaining to Swimming Pools

Public Swimming Pool Application (FH 4001.054)   Image of PDF Icon 
 Swimming Pool Plan Review (CONSTRUCTION) (FH 4001.058)   Image of PDF Icon 
 Swimming Pool Packet  (FH 4001.071)   Image of PDF Icon 

Documents Pertaining to Food Service Establishments

Food Service Establishment Application (FH 4001.057)   Image of PDF Icon 
Application For Pushcart Or Mobile Food Unit (FH 4001.055)   Image of PDF Icon 
Boil Water Advisory Fact Sheet – Rutherford (FH 4001.061R)
Boil Water Advisory Fact Sheet – McDowell (FH 4001.061M)
Flood Permit Suspension (FH 4001.062)
Food Service Inclement Weather Action Plan – Rutherford (FH 4001.063R)
Food Service Inclement Weather Action Plan – McDowell (FH 4001.063M)

Documents Pertaining to Temporary Food Establishments

Temporary Food Establishment Packet (FH 4001.002)   Image of PDF Icon 
Temporary Food Establishment Coordinator Sheet (FH 4001.003)   Image of PDF Icon 
Rules Governing the Sanitation of Food Service Establishments (NC Administrative Code) – New Link Coming Soon!

Documents Pertaining to Resident Camps

 Advance Notification For Seasonal Operation (DENR 3602) 

State Water Lab Sample Lookup

Inorganic Sample Lookup
Inorganic Sample Results Explanation
Bacteriological Sample Lookup

EPA Primary Drinking Water Standards
EPA Secondary Drinking Water Standards

General Environmental Health Forms

Environmental Health Customer Satisfaction Survey – English (FH 4001.022)   Image of PDF Icon 
Environmental Health Customer Satisfaction Survey – Spanish (FH 4001.032)   Image of PDF Icon