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NO FAULT WELL REPAIR FUND APPLICATION <br /> APPLICANT INFORMATION: OCHD USE ONLY: <br /> Owner: TMBL: <br /> Address: <br /> City/St/zip: <br /> DATE RECEIVED: <br /> Phone: <br /> Directions To Property: DATE ASC NOTIFIED: <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 <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 />