THE PRIVATE WATER SUPPLIES (ENGLAND) REGULATIONS 2016 THE PRIVATE

ENTER DISTRICT NAME HERE SERVICES PLAN FOR PRIVATE SCHOOL
0 MOBILIZING PRIVATE FINANCE WITH IBRDIDA GUARANTEES
2 DIRECTORATE ANIMAL PRODUCTION PRIVATE BAG X138

APPLICATION FOR APPROVAL FOR USE OF A PRIVATE
PRIVATE AND CONFIDENTIAL THINK AHEAD APPLICATION FORM
SUBJECT PRIVATE DRINKING WATER WELL PROGRAM PAGE 1

THE PRIVATE WATER SUPPLIES REGULATIONS 1991

THE PRIVATE WATER SUPPLIES (England) REGULATIONS 2016

The Private Water Supplies (England) (Amendment) Regulations 2018

To the owners and/or occupiers of premises using water from a private water supply or private distribution system.

Personal Details

NAME: ……………………………………………………………………………..

ADDRESS: …………………………………………………………………………

…………………………………………………………………………………………..

TELEPHONE NO: …………………………………………………………………

EMAIL: …………………………………………………………………………….

Property Details

Please complete the box where appropriate

No. of people living in the property:

If the property is used to accommodate paying guests (e.g. Bed and Breakfast) as well as those normally resident, please state the maximum number of guests accommodated on any day:

Purpose for which water from private supply is used on your premises. Please tick appropriate box

Domestic use (Drinking, washing and cooking)

Producing food or drink for sale. Please give details…………………………...

Dairy Farming. Please give details……………………………………………...

Other. Please give details……………………………………………………….

Is the water supply to your property provided by another person?

YES No

If yes, please give the name and address of the person providing you with the water:

Name: …………………………………………………………………………………..

Address: ………………………………………………………………………………...

…………………………………………………………………………………………..

Telephone number: ……………………………………………………………………..

If you answered ‘Yes’ to question 7. Do you pay a charge for your water supply?

YES NO

If ‘Yes’, do you have a legal agreement, contract or licence concerning the supply of water?

YES NO

If Yes, please give details………………………………………………………….

…………………………………………………………………………………………..

If you answered ‘No’ to question 7, is the water supply to your property also used by other properties?

YES NO

If yes, please provide a list of other properties concerned:

………………………………………………………………………………………….

If you answered ‘Yes’ to question 9, do you receive a payment from the owners or occupiers of the other properties concerned for the supply of water?

YES NO

If ‘Yes’ please give details……………………………………………………………...

…………………………………………………………………………………………..

Details of Supply

Please indicate the nature of the supply e.g. Surface water, ground water, stream-abstraction, run- off, Borehole

…………………………………………………………………………………………..

12. Is the upper section of the borehole shaft lined?

YES NO UNKNOWN

If ‘Yes ‘What is the shaft lining material? ……………………………………………..

…………………………………………………………………………………………..

Does this lining extend above ground level?

YES NO UNKNOWN

13. Is the borehole classified as a shallow or a deep borehole?

SHALLOW DEEP UNKNOWN

Please specify the depth ……………………………………………………………….

14. Is the borehole covered by a water-tight chamber with a lockable cover?

YES NO UNKNOWN

15. Is a pump connected to the supply?

YES NO UNKNOWN

If ‘Yes please specify the type

…………………………………………………………………………………………..

Where is the pump situated? …………………………………………………………..

…………………………………………………………………………………………..

16. What is the distance of the borehole from the house? ……………………………...

17. What is the distance of the borehole from any cesspool, septic tanks, sewer pipes, reed bed, manure heaps?

…………………………………………………………………………………………..

18. Please indicate the usual sampling point

………………………………………….……………………………………………….

19. If known, please indicate the volume of water supplied or used in the previous calendar year (January-December)

…………………………………………………………………………………………..

20. Please indicate whether your water passes through a water softener

YES NO UNKNOWN

21. Do you have any other supply of water?

YES NO

If ‘Yes’, please state source (Mains, Private, Other).…………………………………..

Storage Tank

22. Please indicate whether there is a storage tank

YES NO

If ‘Yes’, please indicate the construction (Brick, plastic etc)…………………………

………………………………………………………………………………………….

23. Is the storage tank insulated?

YES NO UNKNOWN

24. Does the storage tank have a well fitting lid?

YES NO UNKNOWN

25. Are any openings protected with a fine mesh?

26. How often do you inspect your storage tank for silt accumulation?

…………………………………………………………………………………………..

27. Are you aware of action to take if silt is found to have accumulated?

YES NO

Please give details

…………………………………………………………………………………………..

Water Treatment

28. Please indicate the nature of any treatment given to the water (Ultra-violet, chlorination etc)

…………………………………………………………………………………………..

29. Is the treatment equipment regularly serviced?

YES NO

Water Analysis

30. Do you have your water supply analysed to determine the bacterial/ chemical quality?

YES NO

If ‘Yes, how frequently do you have the water tested? ………………………………

Please specify date of the latest water test…………………………………………….

31. Do you require the local authority to sample your supply?

(Please contact for current charges)

YES NO

If yes, how frequently do you wish your supply to be sampled? ...................................

Please use the space below to make any additional comments

…………………………………………………………………………………………

………………………………………………………………………………………….

…………………………………………………………………………………………..

(FOR PRIVATE CANDIDATE ONLY) MAI PERSIAN (SEMESTERIST) SESSION 201516
0115 951 NOTTINGHAMACUK PRIVATE AND CONFIDENTIAL NAME ADDRESS 1
07142011 095825 [PRIVATE MESSAGE TO ALL PRESENTERS] STEVE

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