Submitting Real Estate Transaction Form
 
The information requested is part of a statewide effort to assess the status of groundwater in Oregon and help protect the health of people who rely on private wells for their household water.
 
Please fill in this form for all real estate transactions involving a well that supplies groundwater for domestic use* and, include a copy of the test results for ARSENIC, COLIFORM BACTERIA, and NITRATE. Fresh water springs do not need to be tested under the law (ORS 448.271).
 
*Domestic water use means the use of water for human consumption, household purposes, domestic animal consumption that is ancillary to residential use of the property or related accessory uses. (Chapter 690-300-0010(14))

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* 1. Property Address:

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* 2. Well Address: (if different from property address)

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* 3. Where was the water sample collected? (Ex. outside faucet, wellhead, kitchen sink)

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* 4. Was the buyer notified of test results?

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