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Permit Forms

Forms needed to obtain a construction, alteration, sealing, or conversion permit for a private water system.  Persons working on a private water system must be registered with the Ohio Department of Health prior to working on a private water system.

A permit application is required to be submitted, with fees, to the Local Health District prior to the construction, alteration, or sealing of any private water system.  Please contact the Local Health District in which the property is located to obtain information about the permitting process and the required fees. 

The following forms may be completed online and printed or printed and filled out by hand.  All permit applications must be complete and include a site plan.

Application for Permit and Site Plan

Required Prior to Constructing, Altering, or Sealing Private Water Systems.

Plans in Addition to the Site Plan

If you are supplying water to a building, a small business, or multiple dwellings, you must also supply additional plans as required in Ohio Administrative Code rules 3701-28-03 (E) and (F).  Additional plans are also required for the construction of a pond, spring, or cistern to supply water as a private water system.

  • Additional Plans Forms (print-only forms)
  • Required under Ohio Administrative Code rule 3701-28-03(E) and (F);

  • If you are a small business that supplies water to more than 25 people, more than 60 days out of the year, please contact the Ohio Environmental Protection Agency (OEPA) District Office Drinking and Ground Waters prior to obtaining a permit from the local health district.  The OEPA will determine if you meet the requirements as a public water system.  If not, contact your Local Health District to obtain a permit to construct, alter, or seal a private water system.  

Non-potable Water Systems

private water systems permit is not currently required for non-potable wells (such as: agricultural, irrigation, geothermal, and monitoring wells), ponds, springs, cisterns, and hauled water storage tanks that were not constructed as a private water system as defined in Ohio Administrative Code rule 3701-28-01(PPP).  Non-potable wells must be reviewed by the Local Health District prior to obtaining a permit to be converted to a private water system.

Local Health District Forms

Private Water Systems Contractor Forms

Registration to work on a Private Water System

Registration forms for persons planning to construct, alter, or seal a private water systems.  Property owners must contact their local health district or private water systems program staff to obtain the needed forms. 

OEPA District Offices

If you are working on water system for a water system with more than 15 service connections, or that serves more than 25 people more than 60 days out of the year, please contact the Ohio Environmental Protection Agency (Ohio EPA) District Office of Drinking and Ground Waters prior to obtaining a permit from the local health district. The Ohio EPA will determine if you meet the requirements as a public water system. If not, contact your Local Health District to obtain a permit to construct, alter, or seal a private water system.

Well Log and Sealing Report Filing

Ohio Department of Natural Resources website where you can file well logs and sealing reports for work performed on wells in the State of Ohio.

Problem finding the form.

If you are unable to locate a specific form, please contact the ODH Private Water System’s staff at (614) 644-7558.