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Water Well Sealing Plan For Homeowners


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    1. Livingston County Health Department
    2. This form must be submitted prior to a potable water well, boring, or monitoring well being sealed. All abandoned water wells must be sealed in accordance with the Illinois Water Well Construction Code. Approval must be obtained after receipt of this form and prior to sealing such wells. The Livingston County Health Department must be notified 48 hours in advance of any sealing activity.
    3. General Description
    4. Type of Well:
    5. Well to be sealed by homeowner?
    6. Well to be sealed by Licensed Water Well Constractor
    7. Well Sealing Details
    8. Casing
    9. Upper two feet of casing will be removed?
    10. Plugging Details (top to bottom)
    11. Material Needs by Volume or Weight
    12. Material Needs by Volume or Weight
    13. Material Needs by Volume or Weight