Title Page

  • Conducted on

  • Prepared by

  • Location

Part 1: Well Location and Condition

  • 1. According to the well log, is the well a drilled well?

  • 2. If the well is NOT a drilled well, has it been brought up to current standard or code, according to well records?

  • 3. How old is the well, according to the well log?

  • 4. How deep is the well, according to the well log? (feet)

  • 5. Are well records available? Check all that are available and attach a copy with the report.

  • 6. According to well maintenance records, how often has the well been inspected?

  • 7. According to well maintenance records, how often were water tests performed on the well?

  • 8. Where is the well located on the property?

  • 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?

  • 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?

  • 11. Is the wellhead visible and above ground?

  • 12. Are any permanent structures located within 10 feet of the wellhead?

  • 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?

  • 14. According to well records, are there any abandoned wells on the property?

Part 2: Well Components

  • 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.

  • if no, indicate height of casing

  • 16. Are there any visible holes or cracks in the well casing?

  • if yes, please describe

  • 17. According to the well log, does the casing depth meet state and local codes?

  • if no, please describe

  • 18. Is the well cap vermin-proof, watertight and securely attached to the well casing?

  • if no, please describe

  • 19. Is there any corrosion visible at the plumbing fittings and/or the pressure/storage tank?

  • if yes, describe

  • 20. According to the well log, is pitless equipment used?

  • 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/.)

  • 21. Pressure Tank

  • What is the pump cut-in pressure?

  • What is the pump cut-out pressure?

  • What is the pressure differential?

  • 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?

  • 23. Does the home have any water treatment devices?

  • if yes, list

  • 24. Have water treatment systems been regularly maintained, according to well maintenance records?

  • if no, please explain:

Part 3: Water Testing

  • 25. Is a water sample needed?

  • What Types

  • Please List

Part 4: Well Yield/Flow

  • 26. Well Flow Test Results (gallons per minute (GPM))

  • 27. Is a more extensive test needed to evaluate well yield?

  • 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

  • Completed by (Name and Signature)

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