Dry Well Reporting Form

If you have experienced problems with the water-level in your well dropping below your pump or your well going completely dry, please complete as much the form below as you are comfortable filling in to assist us in gathering information regarding water levels changes within the area. Information you submit may be subject to public information requests, so only submit as much info as you are comfortable with the public potentially seeing. This info is extremely important to the HTGCD in obtaining a better understanding of what is going on around the District. Thank you for helping us understand the aquifer better.

Reported Date:
Your Name:	Last: First:
Your Address: -- OR -- Cross Streets
Your Phone:
Your Email:
Date Well was Orginially Drilled:		Initial Water Level:
Well Information When Dry:	Well Depth: Pump Depth:	Date went Dry:
Action Taken:		Date of Action:
Well Information After Action:	Well Depth: Pump Depth:
Who provided Well Service?	May we Contact for Additional Information ?
Historical Well Information: (Well Depth, Water Level and Pump Depth by Date. Note whether actual or estimated)
Other People in area with similiar well problems:
Other Comments:
* denotes a required field