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13 <br /> NO FAULT WELL REPAIR FUND APPLICATION <br /> APPLICANT INFORMATION: QCIID USE ONLY- <br /> Owner: TMEL: <br /> Address- <br /> City/St/Zip: <br /> DATE RECEIVED: <br /> Phone: <br /> Directions To Property: DATE ASC NGFIFIID: <br /> R5: <br /> DESCRIPTION OF PROBLEMS: <br /> 1. When did the problems begin (if lm awn): <br /> 2. Water Quality (please describe any problems with taste, stains, cloudiness, <br /> eta.(: <br /> 3. Water Quantity (please describe say problems such as loss of pressure, well <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 ves, what type of treatment- <br /> WELL INFORMATION: <br /> Please give say of the fallowing information that you know. Leave the space blank if <br /> you do not know the information: <br /> 1. Well Depth: Ft. 2. Casing Depth: R. <br /> 3. Amount of Water: Gallons per Minute (GPM) <br />