Registration for New Well

Application for Well Registration

Brazoria County Ground Water
Conservation District
111 E. Locust St.
Building A-29, Suite 140
Angleton, TX 77515
Phone: (979) 864-1078
Fax: (979) 864-1079

Instructions: State of Texas Well Report is due within 90 days of drilling of new well.

Well Owner:

Correspondent:

Mailing Address:

City:   State:   Zip:

Attention:

Phone Number:       Ext.:

Fax:

Drilling Company:

Contact:

Phone:

Fax:

Proposed well size:

Street address of proposed site:

Select intended use:

Public Supply - Wells used for retail or wholesale water supply, or if well is used by at least 25 individuals at least 60 days out of the year, or combined systems serve 15 or greater.

Commercial - Wells used by commercial or business establishments for potable or sanitary needs.

Industrial - Wells used as part of an industrial process or in the manufacturing of a product.

Agricultural - Wells used in production of food or fiber commodities grown for resale or commercial purposes including wholesale nursery growers and wells used for livestock operations.

Other - Wells used for other non-exempt uses such as subdivision lake or pond maintenance, irrigation of golf courses, landscapes, parks, etc.

Single-Family Residential - Wells connected to one single-family dwelling and used for typical domestic and sanitary needs including lawn irrigation and maintenence of ponds for personal use.

Provide detailed description of intended use. If commercial or industrial, describe type of business, number of employees, type of product produced or sold, etc. If for new house or development, include construction start date. If agricultural, include crop type and acreage.

Describe any other water supply available at this location. For example, is there a municipal water line available for potable service or a canal or other raw water source for non-potable uses?

Does the "well owner" own any other well in Brazoria county?

Yes No

If yes, explain:

Is this well replacing an existing well?

Yes No

If yes, give well no. of well being replaced and length of time owned or leased:

If this well is a replacement well, what will be the status of the old well?

Not a Replacement Well Capped Plugged In Use

If status of old well is "In Use", explain:

Please enter your e-mail address:

Please re-enter your e-mail address:

Well Owner:
Correspondent:
Mailing Address:
City:	State: Zip:
Attention:
Phone Number:	Ext.:
Fax:
Drilling Company:
Contact:
Phone:
Fax:
Proposed well size:
Street address of proposed site:

Please enter your e-mail address:
Please re-enter your e-mail address: