Follow the steps to successfully complete the questionnaire form.

1. Press the ‘Get Form’ button to access the questionnaire and open it in your preferred editing tool.
2. Begin by filling out the requester’s name, indicating whether you are the driller, property owner, environmental consultant, health officer, or another role.
3. Provide your address, including city, state, and zip code, along with your telephone number and email address for contact purposes.
4. State the reason for your well search request, selecting from options such as decommission well, environmental investigation/remediation, or other.
5. Indicate whether you are searching for well abandonment reports by selecting yes or no.
6. Select the intended use of the well, choosing from options like domestic/potable, monitoring/environmental, irrigation, industrial, or other.
7. If known, enter the well permit number. Include a list of all previous owners' names and builders, as applicable.
8. Provide the year the well was installed. If the exact year is unknown, an approximate year is acceptable.
9. Fill in the lot number and block number for both the current status and at the time of installation.
10. List the street address and the closest street intersection.
11. Specify the municipality and county in which the well is located.
12. Provide the well coordinates, including the easting and northing values.
13. Gather all relevant information about the well, such as its depth, diameter, casing material, length, and driller.
14. If applicable, include a well abandonment proposal, which must be submitted by a licensed well driller, along with the driller's name and registration number.
15. Finalize the form by reviewing all provided information for accuracy. You may then save, download, print, or share the completed form as needed.

Complete your Njdep Individual Well Search Questionnaire Form online today!