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13 <br />NO FAULT WELL REPAIR FUND APPLICATION <br />APPLICANT INFORMATION: <br />Owner: <br />Address: <br />City/ St/Zip: <br />Phone: <br />Directions To Property: <br />OCHD USE ONLY: <br />TMBL: <br />DATE RECEIVED: <br />DATE ASC NOTIFIED: <br /> <br />RS: <br />DESCRIPTION OF PROBLEMS: <br />1. When did the problems begin (if known): <br />2. Water Quality (please describe any problems with taste, stains, cloudiness, <br />etc.): <br />3. Water Quantity (please describe any problems such as loss of pressure, well i <br />running dry, etc.): <br />4. Is there any type of treatment system for the well water (filters, softeners, <br />etc.): YES NO <br />If yes, what type of treatment: <br />WELL INFORMATION: <br />Please give any of the following information that you know. Leave the space blank if <br />you do not know the information: <br />1. Well Depth: Ft. 2. Casing Depth: Ft. <br />3. Amount of Water: Gallons per Minute (GPM) • <br />