Form Sw 262 PDF Details

In the state of West Virginia, the importance of managing water resources efficiently and ensuring that water systems meet health and safety standards cannot be overstated. The SW-262 form plays a crucial role in this endeavor, serving as a comprehensive report that must be filed within 30 days after the completion of a water well pump installation. This document covers a range of vital details, including the date of pump installation, water well permit number, and specific data pertaining to the pump and well construction, such as type of pump, method of cutting hole in casing for pitless installations, well diameter, depth, static water level, and whether the well was disinfected. The form provides a structured way for owners and installers to document key information about the water system’s use—for instance, whether it's for potable public water supply, geothermal, industrial, commercial, irrigation, or other purposes. Additionally, the form captures details about the pumping equipment and storage tank, alongside the installer's certification that the installation complies with the state's rules, thus ensuring accuracy and completeness of the information. This meticulous documentation aids in maintaining the integrity and safety of West Virginia's water systems, reflecting the state's commitment to protecting public health and environmental resources.

QuestionAnswer
Form NameForm Sw 262
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesDriller, JOURNEYMAN, INSTALLER, Potable

Form Preview Example

Rev 3/08

 

 

 

 

 

DATE OF PUMP

STATE OF

 

 

 

 

FORM SW-262

 

 

 

 

 

 

INSTALLATION

 

 

 

THIS REPORT MUST BE

ST/CO USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEST VIRGINIA

 

SUBMITTED WITHIN 30 DAYS

DATE RECEIVED

 

MM

DD

YY

 

 

WATER WELL

 

 

AFTER INSTALLATION IS

 

 

 

 

 

 

___

___

___

 

 

MM DD

YY

 

 

 

 

 

PUMP

 

 

 

 

COMPLETED

___ ___

___

 

 

 

WATER WELL PERMIT

INSTALLATION

 

 

 

FILL IN THIS FORM

 

 

 

 

 

 

 

NO.

 

 

 

 

 

COMPLETELY

 

 

 

 

 

 

 

 

REPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE PRINT OR TYPE

 

 

 

 

 

 

DW-________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PUMP INSTALLATION LOCATION

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner: LAST NAME

 

 

 

 

FIRST NAME

 

 

 

 

 

 

 

STREET/ROAD

 

 

 

 

 

COUNTY

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AREA NAME/LOCATION:

 

 

 

 

WATER SYSTEM USE:

Potable

Public Water Supply

 

 

 

 

 

 

 

 

 

 

 

Geothermal

Industrial

Commercial

Dewatering

 

 

 

 

 

 

 

 

 

 

 

Irrigation Test/Exploratory Other ___________________

 

 

 

 

 

 

 

 

 

 

 

 

PUMPING EQUIPMENT

 

 

 

 

INSTALLATION DETAILS (CONT.)

Type Pump:

 

Submersible

Jet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other (specify)

 

 

 

 

 

 

Pitless: Pitless Adapter

Pitless Unit

 

 

Pump Manufacturer:

 

 

 

 

 

 

Pitless Manufacturer:

 

 

 

 

 

Pump Model:

 

 

 

 

 

 

Pitless Model:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Cutting Hole in Casing for

 

 

INSTALLATION DETAILS

 

 

 

Pitless:

 

 

 

 

 

 

 

 

Well Diameter ______________inches

 

 

 

Storage Tank Model:

 

 

 

 

 

 

Well Depth _______(Ft)

 

 

 

 

 

Check Valves Locations:

 

 

 

 

 

Static Water Level (from surface): ____________(Ft.)

 

 

Well Disinfected:

 

Yes

No

 

 

Depth of pump: ___________________________(Ft.)

 

 

By Whom:

 

 

 

 

 

 

 

 

Riser Pipe: Material________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Pressure Rating__________________(psi)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMENTS BY INSTALLER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby certify that this well has been constructed in accordance with state rules and that the information presented herein is accurate and complete to the best of my knowledge.

Pump Equipment Installed by :

Property Owner Name (Print)_________________________________________ Owner Signature _______________________________________

Pump Installation Test Passed on ________/_______/_______

Company Name ________________________ WV Contractor No. ____________________ Business Franchise Number_______________

Master Well Driller Certification No. _________________ or Pump Installer Certification No. _________________________________________

Master Well Driller (print) ________________________

Master Well Driller Signature _____________________________________________

Pump Installer ( print) ____________________________

Pump Installer Signature__________________________________________________

SITE SUPERVISOR (SIGNATURE OF DRILLER OR JOURNEYMAN RESPONSIBLE FOR SITEWORK IF DIFFERENT FROM MASTER DRILLER.

Journeyman Well Driller Certification No. _____________________________

Journeyman Well Driller (please print) ________________________________

Apprentice Name(s) __________________________________, __________________________________, __________________________________

How to Edit Form Sw 262 Online for Free

If you wish to fill out INSTALLER, you don't have to install any software - just try our PDF editor. To make our editor better and easier to use, we constantly work on new features, considering suggestions from our users. Starting is easy! Everything you need to do is stick to these easy steps directly below:

Step 1: Press the "Get Form" button above. It's going to open our tool so that you can begin completing your form.

Step 2: Using this advanced PDF tool, you'll be able to do more than just fill out blank fields. Edit away and make your documents appear professional with customized text put in, or modify the file's original input to excellence - all comes along with the capability to add any images and sign the PDF off.

If you want to fill out this PDF document, be certain to enter the required details in every blank:

1. Fill out the INSTALLER with a selection of necessary fields. Gather all of the necessary information and be sure absolutely nothing is left out!

Part no. 1 in filling out Driller

2. Once your current task is complete, take the next step – fill out all of these fields - INSTALLATION DETAILS Well Diameter, COMMENTS BY INSTALLER, INSTALLATION DETAILS CONT Pitless, I hereby certify that this well, and Pump Equipment Installed by with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage # 2 for submitting Driller

Concerning I hereby certify that this well and INSTALLATION DETAILS Well Diameter, be certain you don't make any mistakes in this section. The two of these are thought to be the key fields in the page.

3. Within this stage, check out Pump Equipment Installed by. Every one of these should be filled out with highest precision.

The right way to complete Driller part 3

Step 3: Right after taking one more look at your filled in blanks, hit "Done" and you're all set! Download your INSTALLER once you subscribe to a free trial. Conveniently view the document inside your FormsPal account, together with any edits and changes automatically kept! Whenever you work with FormsPal, you'll be able to fill out forms without worrying about database leaks or data entries being distributed. Our secure platform helps to ensure that your private data is stored safe.

Form Sw 262 isn’t the one you’re looking for?

Related Documents