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Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
www.tooelehealth.org
eh@tooelehealth.org
Recertification For Well / Septic
Please put N/A for any fields that are not applicable
For a well re-certification proof of water rights is needed.
For a septic re-certification evidence that the septic tank has been pumped within the last five years is needed
Click here to upload additional documents if needed.
Date
Home Owner's Name
Location of Home
Contact Phone Number
Contact Person if different than owner
Approval letter to go to the following:
Establishment Information
Organization Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Septic Recertification:
$50.00
Select:
Item Subtotal:
$0.00
Well Recertification/Bacterial Sample Only:
$125.00
Select:
Item Subtotal:
$0.00
Well Recertification/Full Chemical Analysis:
$335.00
Select:
Item Subtotal:
$0.00
Total:
$0.00
Payment Information:
Method of Payment:
Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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