As New Jersey residents, there is an ever-present need to know what lies beneath the ground we live and work on. To meet this need, NJDEP requires a detailed Well Search Form to be filled out for any wells that are used for drinking water purposes in the state. With the form already established by NJDEP, it's important to understand exactly how to use it and what information is required when filling one out. In this blog post, we'll take a look at everything you need to know about using NJDEP’s Well Search Form and why having accurate information is essential when submitting it!
Question | Answer |
---|---|
Form Name | Nj Dep Well Search Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | njdep well search form, nj questionnaire pdf, well questionnaire, njdep well search questionnaire |
State of New Jersey
Department of Environmental Protection
Div. of Water Supply and Geoscience
Bur. Of Water Allocation and Well Permitting
Mail Code
401 East State Street – P.O. Box 420 Trenton, NJ
INCOMPLETE WELL SEARCH REQUESTS WILL BE RETURNED FOR MORE INFORMATION
Individual Well Search Questionnaire
REQUESTOR’S NAME:
DRILLER PROPERTY OWNER
ADDRESS/CITY/STATE/ZIP:
ENVIRONMENTAL CONSULTANT OTHER
HEALTH OFFICER
TELEPHONE #: |
|
|
|
|
|
FAX #: |
|
|
||
|
|
|
|
|
|
|
|
|||
REASON FOR WELL SEARCH REQUEST: |
|
|
|
|
||||||
DECOMMISSION WELL |
ENVIRONMENTAL INVESTIGATION/REMEDIATION |
|||||||||
OTHER: |
|
|
|
|
|
|
|
|
|
|
SEARCH FOR WELL ABANDONMENT REPORTS? |
|
YES |
NO |
|
||||||
WELL USE: |
DOMESTIC/POTABLE |
|
IRRIGATION |
AGRICULTURAL |
||||||
|
|
|
MONITORING/ENVIRONMENTAL |
|
INDUSTRIAL |
PUBLIC SUPPLY |
||||
|
|
|
OTHER |
|
|
|
|
|
|
WELL PERMIT NUMBER (if known): |
|
|
|
|
|
LOCAL ID (if applicable): |
|
|||||||||
LIST ALL PREVIOUS OWNERS NAMES, BUILDER, ETC.: |
||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
YEAR WELL WAS INSTALLED: |
|
|
|
|
|
|
|
|
(Approximate if not known) |
|||||||
LOT #: |
|
|
BLOCK #: |
|
|
|
|
|
(current and at time of installation) |
|||||||
STREET ADDRESS: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
CLOSEST STREET INTERSECTION: |
|
|
|
|
|
|
|
|
|
|||||||
MUNICIPALITY: |
|
|
|
|
|
|
|
|
COUNTY: |
|
||||||
WELL COORDINATES: |
Easting: |
|
|
Northing: |
||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ALL INFORMATION KNOWN ABOUT THE WELL (depth, diameter, casing material, length, driller, etc.)
WELL ABANDONMENT PROPOSAL (must be submitted by a licensed well driller)
DRILLER NAME: |
|
|
|
|
|
|
REGISTRATION #: |
|
||||||||
METHOD: |
|
|
|
|
|
|
|
|
|
|
|
|||||
NJDEP BWSWP USE ONLY |
|
|
|
|
|
|
|
|
|
|
||||||
DATE: |
|
|
SEARCH PERFORMED BY: |
|
|
|
|
|
|
|||||||
|
|
|
|
|
|
|
|
|
|
|||||||
WELL PERMIT |
|
|
WELL RECORD |
|
|
WELL DECOMMISSIONING |
||||||||||
|
|
|
|
|
|
|
|
|
|
|
||||||
COPY INCLUDED |
|
COPY INCLUDED |
|
|
COPY INCLUDED |
|
|
|||||||||
NOT ON FILE |
|
NOT ON FILE |
|
|
NOT ON FILE |
|
|
Approval to decommission the well will not be granted until a written proposal outlining the method of decommissioning has been submitted to the Bureau of Water Systems and Well Permitting. Proposal must include total depth, diameter, casing material and length.
Other:
APPROVAL TO ABANDON:
DATE: |
|
NAME: |
|
APPROVAL #: |
Individual Well Search Questionnaire