Date: (dd/mm/yy)


Fee Paid:


Permit #:

Application must be submitted and permit number issued before drilling operations starts.


Name:


Address of Property: 


Phone #:


Applicant's E-Mail Address:


Accurate location of ground where well will be drilled:


Water to be used for:

Quantity required:


Gallons Per Month/Day: (Please Check One)
GPM
GPD

Diameter of Well:


Drilling Method:


Method of Storage Proposed:


Treatment Method:


Describe any existing wells on property:

In accepting a permit, owner/ well driller agree to abide by the following conditions:

A. The well driller's operation must be in accordance with the rules and regulations as established by Warrington Township Water & Sewer Department under the terms of Ordinance 3-61.

B. Issuance of a permit does not convey any right to divert water.

C. The well will not be used for the disposal of wastes or contaminated water.

D. In the event that this well is abandoned, owner will assume responsibility for plugging or sealing the well in a manner acceptable to the Board.

E. Well driller's report form will be filled in and returned to WTWSD upon completion of drilling operations.

F. Permits to drill wells are valid for one year from the date of issuance.

G. Annually, the owner must submit to WTWSD, a copy of a well water test performed by a qualified laboratory.


NOTE: The issuance of a permit to drill a well or a Certificate of Compliance shall not be construed as a guarantee that the systems will function satisfactorily, nor shall it in any way restrict the powers or responsibilities of the State, County or Municipality in the enforcement of any law or ordinance relation of Public Health.