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Permit Forms – Forms needed to obtain a construction, alteration, sealing, or conversion permit for a private water system.  Persons working on a private water system must be registered with the Ohio Department of Health prior to working on a private water system;

  • Permit Application with Site Plan
  • Additional Plans

Local Health District Forms - Additional forms needed by the local health district to administer the private water systems program, such as:

  • Administrative Summary
  • Transmittal Forms
  • Literature Request Form
  • Contractor Inspection Forms
  • Down-Hole Camera Request Form

Private Water Systems Contractor Forms - Forms required for the construction, alteration, or sealing or a private water systems, such as:

  • Well Logs
  • Sealing Reports
  • Job Status/Completion Forms
  • Filter Labels

Registration to work on a Private Water Systems – Registration forms for persons planning to conduct work on private water systems as part of a business, property owners must contact their local health district or private water systems program staff to obtain the needed forms.

  • Private Water Systems Contractor Registration
  • Homeowners/Property Owners Registration
  • Water Hauler Registration
  • Contractor Lists

Well Log and Sealing Report Search - Ohio Department of Natural Resources website where you can locate well logs and sealing reports of previously constructed wells in the State of Ohio.

  • Well Log Search
  • Sealing Report Search


If you are unable to locate a specific form, please contact the ODH Private Water System’s staff at (614) 644-7558.

Page updated: 11/25/2015