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2017 Private Water Systems Contractor Registration Forms

If you wish to register as a private water systems contractor, please follow the instructions below then complete the required forms prior to submitting. Instructions are provided for both the Application and Bond Forms.

*Please note that documents may take several seconds to open after clicking the link.

How to Register as a Private Water Systems Contractor for 2017

***Please Note: If you intend to perform work on a system BEFORE Dec. 31, 2016 you must use the 2016 registration packet at this link***

  1. Read the Cover Letter;
  2. Complete the current Private Water Systems Contractor Registration Application Form;
    • Application **Please Note: the 2017 application requests some new information, please fill it out in full.  Contact program staff at 614-644-7558 with any questions.**
    • Application Instructions 
  3. Complete the current Private Water Systems Contractor Bond Form;
    • Bond 
      • THE REGISTRATION BOND MUST BE FOR THE AMOUNT OF $10,000.00 for each registration year for a renewing contractor. New contractors are required to submit a registration bond of $20,000 for the first three years of registration. Contractors who have had their registration suspended will also be required to submit a $20,000 bond for three years.
    • Bond Instructions
  4. Provide proof of at least $500,000 of general liability insurance.
    • Since April 1, 2011, the Private Water Systems Rules pertaining to registration requires registration applicants to provide proof that they have a minimum of $500,000 general business liability insurance. Typically, insurance providers will generate an ACORD 25, Certificate of Liability Insurance form produced by ACORD Corporation for their clients to submit to the Ohio Department of Health. The applicant may also submit a copy of their liability insurance policy as long as it shows the amount of their general business liability coverage.
  5. Review the checklist to make sure you have completed all the information needed.
  6. Read the Private Water System Rules (Ohio Administrative Code Chapter 3701-28).
  7. Mail the Application Form, Bond Form (includes the Power of Attorney), Certificate of Liability Insurance and check made payable to Treasurer, State of Ohio for $250.00 to:

Ohio Department of Health
BEHRP Private Water Systems
P.O. Box 15278
Columbus, OH 43215-0278

*If you are a private water systems contractor and have questions about private water systems contractor registration contact the ODH Private Water Systems Program staff at (614) 644-7558 or send an email to

Page updated: 7/27/2017