​REQUEST SEPTIC AND WELL RECORDS
If you need copies of a property's current septic and well records, please complete the form below. For record look-ups, the following information is required: Subdivision and lot number. If the property is not located in a subdivision, provide the septic/well permit holder's full name. **Record look-ups cannot be completed without this correct information.**   A $25.00 record search fee is required prior to the look-up.

Please allow 2-3 business days for record look-up. Records will be emailed to the address provided in the form. You may also request records by fax 304-496-9650.



Fees for Permits Revision
Posted March 20, 2024
Please take notice that the Hampshire County Board of Health, during the March 12, 2024 Board of Health Meeting, approved a revision of the Fees for Permit Schedule to be effective July 1, 2024 contingent upon West Virginia Legislative Rule 64CRS30 being repealed.   The fees are to be used for the purpose of conducting public health programs for which the fees are collected and no portion of these fees will be used for any purpose outside the authority of the Hampshire County Board of Health.  There will be a (30) day comment period beginning March 20, 2024 and ending April 20, 2024.  Copies of the regulation can be obtained at the Hampshire County Health Department during normal business hours Monday thru Friday 8:00am. to 4:00pm.  This notice is required by law to be in the form of a legal notice.


Applications and Forms

All Applications and Forms are in PDF format and require that your computer be running Adobe® Acrobat Reader software.

Please Note:If you experience difficulty in downloading or printing forms, please refer to the Adobe Web Site for troubleshooting and support guidelines.

If you have any questions or concerns, please contact us for further assistance.


Animal Encounter:
SG-58 Animal Encounter Report Form

  • For Healthcare Provider/Facility Attending to Animal Bite Patient


Body Piercing/Tattoo Studios:
SG-49 Application for Permit to Operate
SG-86 Piercing Studio Plan Review
SG-88 Piercing Technician Certification Application
SG-89 Information & Notification
SG-90 Hepatitis B Declination
64-80A Body Piercing Studio Rule Public Notice

Child Care Centers:
SG-49 Application for Permit to Operate
SG-99 Plan Review Information for Child Care Centers (New or Remodeled)

Complaint:
If you have a concern dealing with Environmental Health, please fill out the online Complaint Form  

Food Sanitation:
SF-4 Guidelines for Operating a Temporary Food Service Concession

SF-5 Food Establishment Permit Application

SF-5B Temporary Food Establishment Permit Application 

  • Must be received within 5 days of the event.

SF-7E Inspection Guide - 2013 FDA Food Code 
SF-35 Plan Review for New or Remodeled Food Establishments
Form 1-A Applicant Food Employee Interview
Form 1-B Food Employee Reporting Agreement
Form 1-C Applicant and Food Employee Medical Referral
PHSD Retail Food Emergency Flip Chart

General Sanitation:
SG-49 General Sanitation Permit Application


Manufactured Home Community:
SG-49 Application for Permit to Operate
EG-1 Manufactured Home Community Specification and Plan Review Summary Form
EG-2 Application for a permit to Construct, Install, Alter, or Extend a Manufactured Home Community
EG-4 Sewage System Information and Design Data Sheet
EG-5 Water System Design Information and Data Sheet​

Recreational Water Facilities:
SG-49 Application for Permit to Operate
ER-32 Recreational Water Facility Weekly Report
SR-153 Recreation Water Facilities Tables

Sewage:
SS-182A Application to Install or Modify a Small Sewage Disposal System    see info below

                                           Make checks payable to Hampshire County Health Department
ES-57 Affidavit


     Subdivision Forms:
     ES-76 Subdivision Application
  
     Septic Tank Cleaner Forms:
     SS-181 Application For Sewage Tank Cleaning Permit
 
     For Installers Only:
     SS-192 Installer Certification Renewal Application

Water:
SW-252c Springs
SW-252d Cisterns
SW-252e Installing a Hand Pump
SW-252g Pit-less Units
SW-253 Request for Water Analysis
SW-256 Water Well Application   Make checks payable to Hampshire County Health Department
SW-258 Water Well Completion Report

SW-259: Water Well Violation Report

SW-260 Water Well Variance Request
SW-261 Water Well Abandonment Report
SW-262 Water Well Pump Installation Report

Listing of West Virginia Certified Drinking Water Laboratories 
Private Water Well Owners–What to Do Before Drilling the Well
Private Water Well Owners–Water Well Pumping Systems    
Private Well Owners-Four Steps to Water Well Safety
How to Disinfect a Private Water Well

Environmental Services