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WW6A7 (612)OPERATOR: WELL NO: PAD NAME: REVIEWED BY: SIGNATURE: WELL RESTRICTIONS CHECKLIST HORIZONTAL 6A Caldwell Restrictions At Least 100 Feet from Pad and LOD (including any E&S Control Feature)

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How to fill out well restrictions checklist

01

Start by obtaining a copy of the well restrictions checklist from a trusted source.

02

Carefully read through the checklist to familiarize yourself with the items and requirements.

03

Begin by filling out the information section at the top of the checklist, including the well owner's name, address, and contact details.

04

Proceed to the first section of the checklist, which typically focuses on the well construction. Provide the necessary information regarding the well's depth, casing material, and other relevant details.

05

Move on to the next section, which may deal with the well's location and setback requirements. Ensure that you accurately fill in the distances from various potential contamination sources, such as septic systems, underground storage tanks, and property boundaries.

06

Continue filling out the checklist by addressing the well's protection measures, such as the presence of a sanitary well cap, vermin-proof well seals, and protection from surface water runoff.

07

Pay attention to the section on water sampling and testing. Provide information about the frequency of testing, the parameters to be tested, and any recent test results.

08

If applicable, complete any sections related to well maintenance, such as regular inspections, cleaning, and disinfection procedures.

09

Finally, review and double-check all the information provided in the checklist. Ensure that everything is accurate, legible, and complete.

10

Once you are satisfied with the checklist, sign and date it to indicate your compliance and understanding of the well restrictions.

11

Keep a copy of the filled-out checklist for your records and submit the original to the relevant authority, as required.

Who needs well restrictions checklist?

01

Well restrictions checklists are typically needed by individuals who own or oversee private or public drinking water wells. This can include homeowners, property managers, municipalities, and government agencies responsible for monitoring and maintaining the safety of water supplies.

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What is well restrictions checklist?

The well restrictions checklist is a document used to identify any limitations or restrictions on a property related to well usage.

Who is required to file well restrictions checklist?

Property owners or well operators are required to file the well restrictions checklist.

How to fill out well restrictions checklist?

The well restrictions checklist can be filled out by providing information about any restrictions or limitations on well usage on a property.

What is the purpose of well restrictions checklist?

The purpose of the well restrictions checklist is to ensure that any limitations or restrictions related to well usage are properly documented and disclosed.

What information must be reported on well restrictions checklist?

The well restrictions checklist must report any restrictions or limitations on well usage, including any regulations or requirements that apply.

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