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2. First Name*
3. Last Name*
5. Email*
6. Requestor's Daytime Phone Number*
   Example: 317 823-2332
10. Nearest Major Intersection*
12. Location of Complaint
14. Description of Problem
16. Disclaimer
    Sewage Complaints will be assigned to the next available environmental health specialist. Please be prepared to be contacted and to answer questions, as more information is often needed to perform an investigation.
18. Destination
    Requests will be sent to the Government of Hamilton County Health Department. For questions or concerns, please email Environmental Health Specialist or call 317-776-8500.
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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