Title Page
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Conducted on
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Prepared by
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Location
Part 1: Well Location and Condition
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1. According to the well log, is the well a drilled well?
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2. If the well is NOT a drilled well, has it been brought up to current standard or code, according to well records?
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3. How old is the well, according to the well log?
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4. How deep is the well, according to the well log? (feet)
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5. Are well records available? Check all that are available and attach a copy with the report.
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6. According to well maintenance records, how often has the well been inspected?
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7. According to well maintenance records, how often were water tests performed on the well?
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8. Where is the well located on the property?
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9. Is the soil around the well burmed to prevent puddling around the wellhead and to divert any runoff water from going to the wellhead?
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10. Are there any voids in the soil around the top of the wellhead which could allow runoff to travel down the borehole to the aquifer?
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11. Is the wellhead visible and above ground?
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12. Are any permanent structures located within 10 feet of the wellhead?
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13. Is it apparent from a site inspection that the well location meets the minimum distance from contamination sources as outlined by state or local regulation?
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14. According to well records, are there any abandoned wells on the property?
Part 2: Well Components
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15. Is the lining of the well (the casing) 12 or more inches above the land surface? Note: In flood prone areas, the casing should be 1 to 2 feet above the highest recorded flood level.
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if no, indicate height of casing
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16. Are there any visible holes or cracks in the well casing?
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if yes, please describe
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17. According to the well log, does the casing depth meet state and local codes?
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if no, please describe
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18. Is the well cap vermin-proof, watertight and securely attached to the well casing?
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if no, please describe
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19. Is there any corrosion visible at the plumbing fittings and/or the pressure/storage tank?
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if yes, describe
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20. According to the well log, is pitless equipment used?
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if yes, what type? Is this listed as approved under industry standard PAS-97(2017)? (The most current standard and product list is available at https://www.watersystemscouncil.org/resources/well-standards/.)
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21. Pressure Tank
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What is the pump cut-in pressure?
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What is the pump cut-out pressure?
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What is the pressure differential?
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22. How long does it take for the pump to go from the cut-in to the cut-out with no water running in the house?
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23. Does the home have any water treatment devices?
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if yes, list
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24. Have water treatment systems been regularly maintained, according to well maintenance records?
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if no, please explain:
Part 3: Water Testing
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25. Is a water sample needed?
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What Types
- Bacteria
- Nitrate/Nitrite
- Lead
- Arsenic
- Radon
- Other
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Please List
Part 4: Well Yield/Flow
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26. Well Flow Test Results (gallons per minute (GPM))
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27. Is a more extensive test needed to evaluate well yield?
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If the well falls short of ideal conditions, the home inspector should recommend that the homeowner contact a licensed well contractor about further well inspection, water testing and/or the need for well repair or replacement
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Completed by (Name and Signature)
