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We've compiled forms and information related to private well water for residents of Appanoose, Davis, Lucas, and Monroe Counties.

Completed Forms

Once your forms are completed, please use our contact page to send the form directly to us. Once your form has been sent, please call us at (641) 724-3511 to make your payment by credit or debit card.

This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or any USDA office, or call (866) 632-9992 to request the form.

You may also write a letter containing all of the information requested in the form. Send your completed complaint form or message to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue S.W., Washington, D.C. 20250-9410, by fax at (202) 690-7442, or email at program.intake@usda.gov.
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This page was printed from the ADLM Counties Environmental Public Health website (https://www.adlmenv.com) on September 24, 2022