Brazoria County Groundwater Conservation District

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WellTrack

Application for Well Permit

Well Owner

Management Company

(For use only by Management Companies or their clients)

Organization Name Or Last Name of Owner*

First Name of Owner

Correspondent Last Name

Correspondent First Name

Mailing Address*

City *

State *

Zip *

Phone *

Ext.

Fax

Email *

NOTE: If owner doesn't have an email, please enter " ownernoemail@gmail.com "

Drilling Company

If this is an existing well and the drilling company is unknown, type Unknown into the Drilling Company Field.

Drilling Company *

Contact Last Name *

Contact First Name *

Phone *

Ext.

Fax

Email *

Well Data

Street Address of Well Site *

City *

State

Zip

Latitude *

Deg. Min. Sec.

Longitude *

Deg. Min. Sec.

Inside Diameter Casing *

(in.)

Total Depth *

(ft.)

Depth to First Screen *

(ft.)

Expected Production
During the Next Twelve Months *.

(gals.)

Amount of Surface Water
Purchased in Previous Twelve Months

(gals.) Leave empty for 0 gals.

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.

PWS Number
Submission of TCEQ Approval letter required for public water system.

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

Type of Business

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

Other Wells used for lake or pond maintenance, landscape irrigation, golf courses, parks, etc.

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 development, include construction start date.

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?

Status of the well as of current date.

Existing

Date Drilled

(If unknown, Enter the date you purchased the property)

Awaiting Permit to Begin

Is this permit for transport of water outside of the District?

Yes, this permit is intended for groundwater export.
* If yes, you need to request an Export Permit.

Is this an temporary permit?

Yes, an temporary need for groundwater exists.

A temporary permit may be requested if the applicant is unable to wait for approximately 60 days for the permit to be approved. A temporary permit authorizes drilling and completion of the well to proceed. A decision by the General Manager to issue a temporary permit is not binding on the Board of Directors and your decision to drill the well is at your own risk. Final approval of the permit is contingent upon the decision by the Board of Directors after a public hearing to be held at a scheduled meeting of the Board of Directors at a later date.

Reason for temporary (Why you cannot wait approximately 60 days for your permit to be processed) ($200.00 Temporary Fee is in addition to the $100.00 Application Fee)

Does owner have any other wells in the District?

Yes, the owner has other wells in the District.

If Yes, Please list:

Will the New Well replace an existing well?

Yes, this will replace an existing well.

If known, Please provide the District Well# of the replaced well:

Status of the replaced well: Plugged (Plugging report required)
Capped (Must be capped according to District rules)
In Use (Requires permit to be used for a non-exempt purpose)

BCAD Property ID

- Application Fee $100.00
- Temporary Permit Fee $200.00
- Fees are due within 7 days of submission of application. You will be sent an invoice by email. Mail check or money order to address on invoice. Cash or credit cards are not accepted.

ESX, Inc., 12727 Featherwood Dr., Suite 110, Houston, TX 77034
Voice: 281-822-6500, FAX: 281-822-1211, E-mail:info@esxinc.com