Nj Dep Well Search Form PDF Details

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!

QuestionAnswer
Form NameNj Dep Well Search Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnjdep well search form, nj questionnaire pdf, well questionnaire, njdep well search questionnaire

Form Preview Example

State of New Jersey

Department of Environmental Protection

Div. of Water Supply and Geoscience

Bur. Of Water Allocation and Well Permitting

Mail Code 401-03

401 East State Street – P.O. Box 420 Trenton, NJ 08625-0420

E-Mail: Wellpermitting@dep.state.nj.us FAX# (609) 633-1231

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 #:

 

 

E-MAIL ADDRESS:

 

 

 

 

 

 

 

 

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 #:

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