Information Request Form

Well & Septic Information Requests - Requested information will be returned to you within a minimum of 10 business days of receipt.  Percolation verification and other technical requests may take up to 30 business days.

Printable version of the Information Request Form is available here.

Information Research Request Form

  1. Frederick County Health Department - Environmental Health Services
    350 Montevue Lane, Frederick, MD 21702-8245
  2. 301-600-1726 (information) 301-600-3180 (fax)
  3. This document serves as a formal request for information on the property located at:
  4. (tag should be attached to well casing)

  5. ***ALL INFORMATION MUST BE PROVIDED OR REQUEST WILL NOT BE PROCESSED*** 
    Name of property owner at the time of well and/or septic installation, or at the time of repair or replacement. It is the requester's responsibility to provide the necessary information for our staff to complete the research. A deed search may be required prior to form submission in order to locate information requested.

  6. Real Property Search
  7. Maryland Deed Search

  8. AND

  9. ***This information must be provided or request will NOT be processed***

  10. Provide the following information:
  11. EXISTING PROPERTY WITH DWELLING
  12. NEW PROPERTY WITH NO DWELLING
  13. (be specific)
  14. Information to be
  15. Note

    Requested information will be returned to you within a minimum of ten (10) working days of receipt. Percolation verification and other technical requests may take up to 30 business days.

  16. Note:
    INCOMPLETE REQUEST FORMS WILL NOT BE PROCESSED.
  17. Leave This Blank:

  18. This field is not part of the form submission.