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Environmental Health Programs
Septic Systems
Food Service Establishments
Private Water Supplies - Wells
Public Swimming Pools
Swimming Areas
Day Care Centers
Building Additions
Other Environmental Issues

Community Health Programs Airborne Disease Prevention
Tuberculosis Screening

Bloodborne Disease Prevention
Blood Pressure Services

Community Immunizations
Lyme Disease
Diabetes Self-care Program
Skin Cancer Screening
Cholesterol Control Program
Baby-sitting Training Class

West Nile Virus
Rabies
Reportable Disease Investigation
Volunteers

Other Community Issues

Public Health Statistics
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Forms & Applications
 

We have made the most frequently requested forms and applications available to you online. These forms are in PDF format and require the freely available Adobe Acrobat® Reader, click on the icon below to find out more about this file format and to download the reader.

If you already have the reader then just click on the form listed below. Once you have downloaded the form, it can be printed out, filled in and returned to Pomperaug District Department of Health with the necessary fees.

 

Forms/Regulations


Click on a form title below to open the form in a new browser window, once finished printing, close the window to return to the website.

Pomperaug Health District Forms and Applications

Fee Schedule 2008-2009 (20k)

Septic Permit Application (72k)
Septic As Built (4k)
Septic Plan Review Application (39k)
Soil Test Application (39k)
Pump Installation Permit (59k)
Change of Use/Conversion Commercial and Residential Application (53k)
Subdivision Review Application (57k)
Building Addition Application (245k)
Connecticut Food Inspection Report (22k)
Food Service Plan Review - Application (10k)
Food Service Plan - Requirements (4k)
Temporary Food Service License (845k)
Day Care Facility Application (6k)
Swimming Pool Inspection Form (10k)
Ground Water Monitoring (38k)
Lot Line Revision (51k)

Regulations

Septic System Design Manual (674k)
General Conditions for Septic Plan Approval (5k)
Connecticut Regulations and Technical Standards for Subsurface Sewage Disposal Systems (375k)
Review List for Engineered Septic System Plans (35k)
Review List for Non-Engineered Septic System Plans (9k)
Connecticut Food Regulations 19-13-B42 (38k)
Public Swimming Pool Regulations
Public Swimming Pool Code
Building Conversion, Changes in Use, Additions 19-13-B100a (7k)

 
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