Northeast District Department of Health

      69 South Main Street, Unit 4, Brooklyn, CT 06234
       Phone: (860) 774-7350 / Fax (860) 774-1308 / www.nddh.org  

				

An Important Notice Regarding Your Permit

Permit Fee
$180.00

To: Outdoor Swimming Pool Owners
From: The Northeast District Department of Health
Date: February11, 2026
Subject: 2026 Swimming Pool Permit Renewal

The Swimming Pool permit issued to your establishment by the Northeast District Department of Health (NDDH) has expired and must be updated on a yearly basis. 

Please return the following to this office by Wednesday, April 15, 2026:

•	A completed Swimming Pool Application. You may access the application forms and can make payment online at www.nddh.org/formspermits. If you do not have computer access, you may complete the form at our office.
•	Pay the application fee https://nddh.org/formspermits/pay-online/.

We are eager to assist you in complying with the State of Connecticut public health regulations. Upon receipt of all completed documentation, a permit will be issued for your establishment. Please be sure to provide us with a valid e-mail address, as we will be sending permits electronically.

All completed documentation and fees must be  received or postmarked by Wednesday, April 15, 2026, or your application will be considered late. The cost of a late fee is $90 and will be added to your permit fee. In addition, a penalty fee of $12 per NDDH business day with a maximum of $120 shall be assessed for each day late from April 30th  through May 13th inclusive. Please make sure that NDDH receives your application and permit fee prior to opening for the season.

Annual inspections will be conducted throughout the year.  Please be aware a re-inspection fee of $150.00 will be charged for a failed inspection.

If you have any questions, please feel free to contact us. We look forward to working with you.

Sincerely,

Melissa Nichols
Finance Manager

Sanitarian Approved Initial:	 Date: 	
Emailed:	

Northeast District Department of Health
69 South Main Street, Unit 4,
Brooklyn, CT 06234
Phone – (860) 774-7350 / Fax - (860) 774-1308
www.nddh.org	email@nddh.org

SWIMMING POOL APPLICATION

SELECT STYLE:	 INDOOR	 OUTDOOR
OWNERS NAME: 	

BUSINESS NAME: 	
PHYSICAL LOCATION: 	

MAILING ADDRESS: 	
BUSINESS PHONE: 	BILLING EMAIL: 	

CONTACT PERSON: 	CONTACT PHONE: 	
WATER SUPPLY:	WELL 		MUNICIPAL 	

DIMENSIONS:	LENGTH 	WIDTH 	DEPTH	SLOPED DEPTH RANGE 	
RECIRCULATING INLETS: 	OUTLETS / MAIN DRAINS: 	

CIRCULATING PUMP: 	RATING: 	GPM
FLOW GUAGE: 	SCALE: 	TO 	GPM

HAIR CATCHER: 	FILTER: 	MODEL: 	
FILTER TYPE:	SAND	 D.E.	 CARTRIDGE		SIGHT GLASS:	YES	NO MAKE UP WATER PLACE OF INTRODUCTION: 						
CHEMICAL FEED:	MANUAL	 AUTO

CHLORINATOR: 	MODEL# 	CAPICITY:	GPD
TEST EQUIPMENT: 	

FILTER BACKWASH DISPOSAL: 	
COMPLIANCE DOCUMENTS PROVIDED TO NDDH REGARDING VIRGINIA GRAEME BAKER ACT: YES	NO SKETCH OF POOL:

SIGNATURE: 		DATE: 	

NDDH Use Only		
Date: 	Fee: 	Check # 		CC	E-Check	Cash	Receipt #		
Date: 	Fee: 	Check # 		CC	E-Check	Cash	Receipt #		
Rev. 111121

Northeast District Department of Health

69 South Main Street, Unit 4, Brooklyn, CT 06234
860-774-7350 / Fax 860-774-1308	www.nddh.org

***EMERGENCY CONTACT INFORMATION***

Water Interruption • Power Outage • Fire • Flood • Contamination • Natural and Man-made Disasters

There are a number of emergencies that can interrupt your establishment. To protect the public, the Northeast District Department of Health (NDDH) must be able to quickly contact decision-makers for your business/organization to provide appropriate guidance. Check our website for regular updates that impact your establishment at https://www.nddh.org.

NDDH will conduct periodic tests of our Emergency Notification Systems. You may receive messages by phone, text, fax, or email. Please complete the information below, being sure to fill all fields accurately with contact information other than the owner.

Today’s Date: ______________ 

Business/Org Name:  ____________________________________________________
Business Address:  ______________________________________________________
City:  _____________________________   State:  ___________   Zip:  ____________

Emergency Contact Name and Title:  ______________________________________
Cell Phone: ___________________________ Fax Number: ____________________

Work Phone:  _________________________ Home Phone: ____________________

Email Address: __________________________________________________________ 

Alternate Emergency Contact Name and Title:  ________________________________
Cell Phone: ___________________________ Fax Number: _____________________

Work Phone:  _________________________ Home Phone: _____________________

Email Address: __________________________________________________________

Is water for your business establishment/organization supplied by:

	____Well                      ____Community Water System 

Businesses with multiple locations: Please complete a separate form for each location.

NDDH USE ONLY:
 
Updated - EHS Database: ______________   Excel Data Sheet:     ______________ Initials: ___________

REVISED 10/27/2025