Forms

PUBLIC WATER SYSTEMS

Operator Forms

• Form EW-102C (Application for Certification and Examination of WD & Class I-IV.)
• Form EW-102D (Application for Renewal of WD & Class I-IV)
• Form EW-102E (Application for Certification as an OIT)
• Form EW-102F (Application for 1D Certification, Examination, and Renewal)
• Form EW-74      (Resignation)
• Form EW-108   (Application for Certification Through Reciprocity)

 

System Forms

• Form EW-104 (Annual Personnel Status Change)
• Form EW-111 (Employment Status Change)
• Form EW-107 (Certified Operator Requirement Waiver Application )

 

WASTEWATER TREATMENT WORKS

Operator Forms

• Form ES-51 (Application for certification as an Operator-In-Training)
• Form ES-53 (Application for Certification as Wastewater Operator, or to schedule an examination.)
• Form ES-54 (Application for Class III and IV Operator Renewal.)
• Form ES-74 (Resignation)
• Form ES-55 (Application for Certification through Reciprocity)

 

WELL DRILLERS

• Form EW-125A (Application for Master Well Driller Certification)
• Form EW-125B (Application for Well Driller Journeyman Certification)
• Form EW-125C (Application for Pump Installer Certification)
• Form EW-125D (Application for Well Driller and Pump Installer Duplicate)
• Form EW-125E (Application for Well Driller and Pump InstallerInactivation/Reactivation)
• Form SW-256 (Application for a Permit to Construct, Modify or Abandon a Water Well)
• Form SW-258 (Water Well Completion Report)
• Form DW-22 (Water Well Violation Report)
• Form SW-260 (Request for Water Well Variance)
• Form SW-261 (Water Well Abandonment Report)
• Form SW-262 (Water Well Pump Installation Report)

Fact Sheets

• How to Disinfect a Private Water Well
• Potable water hauling information
• Water Well Pumping Systems - Private Well Owners
• What to Do Before Drilling the Well - Private Well Owners
• Four Steps to Water Well Safety - Private Well Owners

 

Click here for additional information on individual water supplies from Public Health Sanitation

 

MONITORING WELL DRILLERS

Monitoring Well Drillers Application Packet

CROSS-CONNECTION AND BACKFLOW PREVENTION

• Form EW-75 (Backflow Prevention Assembly Inspector/Tester)
• General Backflow Assembly Tester Inspection Form

Cross-Connection and Backflow Prevention Manual

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Last updated October 20, 2009.