âť– Review instructions prior to completing form in black or blue ink. âť– The registered well owner should file this report with the Department within 30 days.REGISTERED DESIGN PROFESSIONAL: Complete all information requested on this form. Indicate the ITEMS requiring Structural Observation. Fill in the registration number of the well in the box in the upper right-hand corner of the form. Review the Special Structural Inspections Program form for accuracy and ensure that it identifies all work requiring Special Inspections. Edit, sign, and share letter completion report online. No need to install software, just go to DocHub, and sign up instantly and for free. If the report is fully completed, signed, and uploaded in WebLGY prior to cancellation, the full fee for the appraisal shall be paid to the appraiser. Fill out, sign, and date VA Form 1010164 (Opt Out of Sharing Protected Health Information).