AppHealthCare Disinfection Assistance Request Form

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Please complete this form only if you need well or spring disinfection assistance. Once you complete the form, an AppHealthCare staff member will call you to gather additional information. We have teams available to assist in the disinfection process.

If you need water test kits or “do it yourself” disinfection kits, you do not need to complete this form. You can pick up test and disinfection kits from any of our Environmental Health offices (listed below) Monday through Friday, 8:00am to 4:45pm. These kits are offered at no cost.

Flooded or Submerged Wells/Springs:
All wells/springs that were flooded from Helene should be first disinfected and then tested. The disinfection process helps to eliminate any potential bacterial contamination that may have entered your well/spring from flooding. Once your well/spring has been disinfected, you can proceed with testing.

Wells/Springs that Were Not Flooded:
If your well/spring did not flood but you are concerned about bacterial contamination, you can get a testing kit from us at no cost.

Additional Information:
-Check out these “how to” videos for step-by-step instructions (include video links)
-Please note that we cannot offer testing for municipal, town or community water supplies. Contact your water provider for testing options.

If you have any questions or concerns, call us at (828) 795-1970 or email eh@apphealth.com.

AppHealthCare Environmental Health Offices:
Water testing/sampling kits and disinfection kits can be picked up at any of our Environmental Health Offices.

Watauga Environmental Health Office, 126 Poplar Grove Connector in Boone (second floor)
Ashe Environmental Health Office: 626 Ashe Central School Road in Jefferson
Alleghany Environmental Health Office: 157 Health Services Road in Sparta

Name *

Address *

City *

Zip Code *

County *

Alleghany

Ashe

Watauga

Phone Number *

Email *

Was there direct flooding of your well or spring? *

Yes - Please note that your well or spring must be disinfected first before water sampling. We can assist with disinfection or you can come pick up a "do it yourself" disinfection kit from our offices.

No - You do not need to complete this form. If you would like a testing kit, you can come by our offices (listed above) to pick up a water testing kit.

Unsure - An Environmental Health Specialist will contact you.

Are you aware of any damages to your well or spring? Please complete this well repair application. If possible, please also send us a picture of those damages to eh@apphealth.com with your address in the subject line. *

If there were damages and those have those been fixed already, water sampling may proceed.

If there were damages and well has not been fixed, you will need to first submit a well repair application to our Department and work with a well contractor. Please go to our AppHealthCare Environmental Health website. You can also email eh@apphealth.com.

If no damages and you only need a water sample bottle, please come by our offices to pick up a testing kit.

Not applicable

Do you need a disinfection kit & instructions for well or spring disinfection to do on your own? *

Yes

Do you have concerns about the need for testing contaminants other than bacteria? Please note that our capability is currently only for bacteria testing and that we are consulting with NC DHHS to learn if or when other sampling may be available at a later time. *

Name of person completing this form *

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