Form 3300-221 at a glance
What it is: Form 3300-221 is the Property Transfer Well and Pressure System Inspection of the State of Wisconsin Department of Natural Resources.
Who signs: Signature of Licensed Water Well Driller or Licensed Pump Installer.
A filled-in Form 3300-221 example: an inspector completes the form for a sale
How to fill out Form 3300-221, box by box
Contact Information
Under Contact Information, enter Inspection Requested By, Telephone Number, Mailing Address, City, State and ZIP Code.
Enter Well Owner's Name, Telephone Number, Mailing Address, City, State and ZIP Code.
Property Location
Under Property Location, enter Fire Number and Street or Road, mark City, Town or Village, then enter County.
Well Data
Well Data is optional: Casing Diameter, Casing Depth, WUWN, Depth to Bedrock, Total Well Depth, Casing Height, Depth to Water, Date Drilled (if known) and Constructed by (if known).
Mark Drilled, Driven point, Jetted well, Unknown, Dug or Other.
Pump/Supply Line Data
Pump/Supply Line Data is optional. Pump Type (if known): Submersible, Single Pipe, Packer-Jet, Shallow Well, Hand Pump, Double Pipe, Deep Well, "Offset - Height Above Floor", Working Head, Other.
Well Discharge Piping (if known): "Above Ground", Non Pressurized Concentric piping, "Below Ground", Non Pressure Conduit Present, Pitless Adaptor, Overflow Pipe for Flowing Well, Pressurized Concentric Piping, Unprotected Buried Suction Line.
Pump Location (if known): In Well/Submersible, On Well, Pit, Building, Basement, Crawl Space, Pumphouse, Alcove, None.
Enter Pump Make/HP (if known) and Pressure Tank Type/Location.
Compliance Determination
Under Compliance Determination, check one: Complies with NR 812, Wis. Adm. Code; Does not Comply with NR 812, Wis. Adm. Code; or Complies with NR 812, Wis. Adm. Code, except that a more comprehensive search or additional research is needed to evaluate potential violations that may exist but are not fully identifiable as part of the basic visual inspection, such as: an unused well, floodway/floodplain, contamination source or other.
Comments
Comments: Evidence of Some Corrosion on Well Casing Pipe; Pre-1991 Driven Point Pipe Depth < 25 feet; Inaccessible or Difficult Location for Future Well Work; Well Construction Report Not on File or Unlocatable; Inaccessible or Difficult Location for Future Pump Work; Well Located in Special Well Casing Depth Area; Pre-1979 Two-Wire Submersible Pump; Non-Vermin-Proof Well Cap or Well Seal; Other.
Identified noncomplying features
Identified noncomplying features are noted with a check mark.
1. Unused Well - Unused or noncomplying well that needs to be filled and sealed, or a well that was improperly filled and sealed or sealed by an unlicensed person after June 1, 2008; 2. Well with Stovepipe or Thin-walled Casing; 3. Dug Well - Unsanitary or noncomplying; 4. Buried Suction Line - Noncomplying or unprotected; 5. Alcove (Subsurface Pumproom) or Pit; 6. "Non-Walkout Basement or Below-Grade Crawl Space Well"; 7. Poor Well Casing Pipe Condition - Corroded, cracked or damaged; 8. Contamination Source less than Minimum Separation Distance from the Well (As provided in ss. NR 812.08 and NR 812.42); 9. Well in Floodway or Flood Fringe; 10. Well at Risk of Localized Flooding - In low area or drainage swale; 11. Cross-Connection - Visible cross-connection with a sewer or a community water system; 12. Driven Point Well - <25 feet of Well Casing Pipe or Installed after 1-31-1991 with no well Construction Report.
13. Nonpressure Conduit - Horizontal or vertical; 14. Hand Pump; 15. "Offset Pump or Piping Height Above Basement Floor - <12 inches above a basement floor installed after October 1, 2014, or <6 inches above a basement floor installed prior to October 1, 2014"; 16. Yard Hydrant - Hydrant installed in or on a well, or installed upstream of the pressure tank after October 1, 2014; 17. Materials for Pump and Supply Piping; 18. Flowing Well Installation; 19. Check Valve in a Noncomplying Location; 20. Well Cap or Seal Missing or Noncomplying; 21. "Less than Minimum Casing Height above Grade or Floor"; 22. Electrical Wires at Wellhead Not Enclosed in Conduit; 23. Sample Faucet is Missing or Noncomplying - System lacks a sample faucet either upstream or on the tee of the pressure tank or is noncomplying; 24. Extreme Health/Safety Hazard Not Noted Elsewhere on This Form.
Licensed Water Well Driller or Licensed Pump Installer
Enter Printed Name of Licensed Water Well Driller or Licensed Pump Installer, Individual License # and Telephone Number; then Signature of Licensed Water Well Driller or Licensed Pump Installer and the Date.
More rules for Form 3300-221
This form lists the visible conditions of the well and pressure system on the property at the time of inspection and does not imply or give any guarantee.
Some features such as well cap, casing height or nonpressure conduit may comply for purposes of this inspection, but may require an upgrade the next time work is done on the well or pressure system.
Common questions about Form 3300-221
Where do I file it?
Pursuant to ch. 280, Wis. Stats., and ch. NR 812, Wis. Adm. Code, this form shall be used to document any well and pressure system inspection conducted as part of a property transfer. Inspections are voluntary, and well owners are not required to bring systems into compliance as a result of the inspection. Inspectors must provide the completed form to the requester of the inspection. Do not send forms to Department of Natural Resources (DNR) except in the case of a variance request.
Sources
[1] Form 3300-221 (R 04/2026), Property Transfer Well and Pressure System Inspection, State of Wisconsin Department of Natural Resources (the Official source link on this page).