Get Express Well Permit Application (pdf) - Virginia Department Of Health - Vdh State Va

Filling out the Express Well Permit Application is an essential step for individuals seeking to construct a well in Virginia. This guide will walk you through the process of completing the application form online, ensuring that all necessary information is accurately provided.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Indicate the type of Class IV well you are applying for by selecting one of the options: New, Replacement, or Emergency.
3. Describe the proposed use of the well in the designated space provided.
4. Respond to the question regarding adjacent agricultural operations by selecting 'Yes' or 'No'.
5. Provide the address location of the well, including the city (Portsmouth), state (VA), and zip code.
6. Fill in the details of the subdivision, section, block, and lot, if applicable.
7. Offer clear directions to the property where the well will be located.
8. Enter the owner's printed name along with the mailing address and phone number.
9. Acknowledge the permit conditions by reading the terms carefully, including the responsibilities regarding site compliance. Sign and date where required.
10. Fill in the well driller's information, including their name, address, fax number, and license number.
11. The well driller should sign and date the application, confirming their role in the installation process.
12. Once completed, save your changes. You may then download, print, or share the application form as needed.

Take the first step towards your well construction by completing the Express Well Permit Application online today.