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Private Water Systems Contractor Forms

Well Logs / Sealing Reports

In order to obtain paper well log forms or sealing report forms, contact the Ohio Department of Natural Resources (Ohio DNR) Soil and Water Resources Division at 614-265-6740.

File a well log or sealing report

Well log and sealing report searches may be done on the Ohio DNR Soil and Water Resources Division website or by calling 614-265-6740. 

Search for a well log or sealing report 

Job Status / Completion Form for Private Water Systems:

Form Requirements

The following must be submitted to the Local Health Department after work on the Private Water System has been completed.

  • Job Status portion requirements:
    • Must be completed and submitted to the Local Health District within ten (10) days of the completion of the work done.
    • Briefly explain what work was done;
    • Keep a copy for your records;
    • Use a copy to complete the Completion Form portion at a later date if you chose;
    • When submitting within ten days, the Completion Form portion may also be completed.
  •  Well Logs, Completion Forms, and Sealing Reports requirements:
    • Must be completed and submitted to the Local Health District within thirty (30) days of the completion of the work done.
    • Specific detail is required on this portion of the form;
    • If submitting within ten (10) of the completion of the work, the form will replace the Job Status submittal requirements.

Water Treatment and Filtration Label Templates

Use these templates with your company name on them to label the disinfection and filtration component of the private water system.

Registration forms for Private Water Systems Contractors are located at the Registration webpage.

OEPA District Offices
  • If you are working on water system for a water system with more than 15 service connections, or that serves more than 25 people more than 60 days out of the year, please contact the Ohio Environmental Protection Agency (Ohio EPA) District Office of Drinking and Ground Waters prior to obtaining a permit from the local health district. The Ohio EPA will determine if you meet the requirements as a public water system. If not, contact your Local Health District to obtain a permit to construct, alter, or seal a private water system.

 Updated 07/04/2016