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Required entries are indicated by *

  • Tenant(s)*:  et al (and all others)
  • Address*:  Unit: 
  • City*:  , OREGON Zip*: 

  • The leased property uses a residential well to provide water for drinking, washing and waste removal.
  • For a property to be sold in Oregon, the well must be capable of producing a minimum of five gallons per minute under normal conditions. This amount can vary depending on season, so if Tenant(s) experiences some slowing of water flow, usage should be adjusted and care taken to not run the well dry by performing only one water task at a time. If the water level drops below the level of the pump, the pump will continue to run, will suck air instead of water, and may burn out requiring replacement.
  • Tenants are responsible for monitoring water usage to ensure this doesn't happen. Should water flow become measurably reduced at any time, Tenant(s) must stop water usage, and notify Owner/Agent immediately.

In freezing conditions, Tenant(s) agrees to protect pipes from freezing by leaving light on in well house, or using space heater in well house as needed.

Well water has been tested for contaminants as follows:
[ ] Nitrates
[ ] Fecal Coliform
[ ] Arsenic
[ ] Other

Date of last testing: _________________

If Tenant(s) notice odd odor or color to water, Tenant(s) agree to stop using system and notify Owner/Agent immediately.

Well Operation

  • Tenant(s) agrees to accept responsibility for damage caused to well system due to failure to abide by these instructions.
  • Tenant_______________________________ Date_________ Tenant_______________________________ Date_________
  • Tenant_______________________________ Date_________ Tenant_______________________________ Date_________
  • Owner/Agent_______________________________________ Date__________________________


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1462 Commercial St. NE, Salem, OR 97301
Phone: 503-364-5468 | Fax: 503-585-8119

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