Forms

Commercial Swimming Pools

Swimming Pool Injury Report (20 kb)

Daily Log Form (65 kb)

Swimming Pool Signage (101 kb)
List of required signs at public swimming pools.

Pool Operator Info (71 kb)
General information and reminders for public swimmng pool operators

Elkhart County Swimming Pool Ord (165 kb)

Keeping Afloat (486 kb)

Pool License Application (43 kb)
Commercial Swimming Pool License Application

Swimming Pool Plan Review Applic (38 kb)

Emergency Response

Spill Packet (76 kb)
This packet includes a list of clean up contractors with the ability to to respond to hazardous materials spills and a form that can be used to document spill reporting and clean up response activities.

Food Service Sanitation

Elkhart County Food Ordinance (81 kb)

Food Service Self Checklist (43 kb)
Food Service Operators can use this checklist as a self evaluation tool to promote and ensure safe food handling in their facilities.

Home Based Vendor Guidelines (107 kb)

Mobile Food Service Requirements (184 kb)
Lists the minimum requirements that must be met to operate a mobile food service in Elkhart County.

Consumer Advisory (15 kb)

Sample Employee Health Policy (745 kb)

Sample Employee Health Policy Qu (23 kb)

Not for Profit Registration Form (108 kb)

Temporary Event Coordinator App (155 kb)
Temporary Event Coordinators must fill out this application and submit by fax or mail at least 30 days prior to their event.

Food Service License Application (174 kb)

Temporary Food Guidelines (116 kb)
Guidelines for operating a temporary food service in Elkhart County.

Food Safety News (827 kb)

Plan Review Packet (851 kb)
This packet will help prepare plans for constructing or remodeling a food service. Please follow the instructions carefully.

Groundwater

IDEM Open Burning Brochure (102 kb)
This brochure from the Indiana Dept. of Environmental Management explains the State's open burning law and gives alternatives to burning.

Conrail Superfund Site (143 kb)
Provides information about the Conrail Superfund site in Elkhart and Saint Joseph Counties including location, contaminants and, answers to frequently asked questions.

Groundwater Protection Ordinance (124 kb)

Drinking Water Testing Labs (379 kb)

Wastewater Characterization (409 kb)
This a list of laboratories or consultants capable of doing wastewater characterizations required by Elkhart County Groundwater Protection Ordinance.

GW Registration Brochure (97 kb)
This brochure gives a brief overview of the Groundwater Protection Ordinance requirements and includes a registration form facilities can use to register with the Health Department.

Meth Lab Fact Sheet (104 kb)

Insect, Vector, and Rodent

Stop Raising Mosquitoes (191 kb)
This pamphlet provides information on ways to reduce mosquito breeding sites around your home.

Mosquito Borne Diseases (344 kb)
This pamphlet contains information about several diseases spread by mosquitoes.

Ticks and Disease (201 kb)
This pamphlet provides information about several species of ticks and the diseases they can carry.

Onsite Wastewater Disposal

Application For Septic Permit (24 kb)
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 (21 kb)
Checklist for Septic System Plan Submittal for New, Repair/Replacement Onsite Sewage Disposal Systems

Marking Utilities (18 kb)
This is an information sheet concerning marking of utilities before construction and soil evaluations/soil borings.

ECHD Septic Ordinance Section 5 (18 kb)

Septic Lookup Request (11 kb)
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 (548 kb)
"To Scale" drawings are required with all application submissions for an onsite sewage disposal system permit.

Flood Dose Worksheet (84 kb)
This worksheet must be submitted at the time of application when minimum requirements indicate a flood dose installation.

Mound/Press Dist Worksheet (18 kb)
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 (517 kb)
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 (177 kb)
A guide for the homeowner's care of their onsite system.

Development standards (161 kb)
Environmental Health Technical Review and Development Standards

Wastewater Treatment Matrix (95 kb)
Wastewater Treatment Assessment Matrix

ECHD Septic Ordinance (1244 kb)
Ordinance No. 2012-153
An ordinance regulating private sewage disposal systems in Elkhart County.

Minimum Requirements (36 kb)

Septic Permit Procedure Guide (70 kb)
This guide explains the process for obtaining a private sewage disposal system permit, for new construction.

Installer Registration Form (5 kb)
This form is used to register septic installers in Elkhart County.

Fee Schedule

EHS Fee Schedule (9 kb)

Lead

Protect Your Family (690 kb)
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 (664 kb)
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 (1362 kb)
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 (1991 kb)
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).

Reducing Hazards during renovati (670 kb)
This pamphlet is designed for contractors to help them determine what they can and cannot do when disturbing lead-based paint.

Prerenovation Education Rule (368 kb)
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.

Property Manager Responsibilitie (559 kb)
This pamphlet is designed for landlords and apartment managers who are committed to providing a safe and habitable property for their tenants that complies with state and federal laws.

New Indiana Habitability English (53 kb)
This brochure details landlord obligations, liabilities, and disclosure rules for Indiana properties (English).

New Indiana Habitability Spanish (46 kb)
This brochure details landlord obligations, liabilities, and disclosure rules for Indiana properties (Spanish).

EPA and HUD disclosure (42 kb)
This brochure has questions and answers pertaining to federal lead disclosure laws.

Lease Disclosure English (167 kb)
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 (173 kb)
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 (167 kb)
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 (168 kb)
EPA Title X requires sellers to disclose lead hazards by giving this form to buyers of most residential homes built before 1978 (Spanish).

Finding a qualified Lead Profess (103 kb)
This pamphlet will help you find a lead professional who will tell you if your home has lead paint in a form that may pose a hazard to your children.

Lead Contractors and Home Testin (57 kb)
This is a list of regional and local lead contractors and appropriate cleaning and home testing suppliers.

Evaluating homes for lead (491 kb)
This pamphlet is designed for the risk assessor, inspector, and clearance examiner so they understand their role in evaluating property and their responsibilities and to better inform their clients.

Lead- Who's at risk? (238 kb)

Lead- Who's at Risk? Spanish (182 kb)

Elkhart County Lead Elimination (43 kb)

Consolidated Plan for Housing an (8991 kb)

Participation Interest Form, HUD (13 kb)
HUD Lead Grant Participation Interest Form

Records Request

Records Request (110 kb)
This form can be used to request any public records from Environmental Health Services. Print this form and submit by mail, fax or deliver in person.