Existing Well Registration

A. WELL OWNER INFORMATION

First Name:	*
Last Name:	*
Primary Phone:	*
Mailing Address:	*
City:	*
State & Zip:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *   *
Email: (For fastest response of confirmation)	*

B. WELL LOCATION Well Location Same as Section A Owner Address?

Physical Address:	*
City:	*
State & Zip:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *   *
Use the url link below to find your well's latitude & longitude. Click on the link, enter your physical address, click the 'Show Location' button. Zoom in on the map using the '+', select the satellite imagery and move the pin to the location of your well. Copy the coordinates and enter them below. www.maps.ie/coordinates.html
Latitude (i.e. 30.123400)
Longitude (i.e. -98.021234)

C. WELL USE (Check One)

Exempt: (Residential/Domestic, Agricultural, Geothermal) Non-Exempt: (Commercial/Business, Public Water Supply, Retail Water Supply)

D. WELL DETAIL (if known)

Date Drilled:
Driller
Well Depth (feet):

E. WELL RECORDS

If you have hardcopies of well records for your well (i.e. drillers log, State Well Report), please email them to staff3@haysgroundwater.com or mail to P.O. Box 1648, Dripping Springs, TX. 78620

F. PREPARED BY (if different than owner)

First Name:
Last Name:

G. COMMENTS

 

By pressing the "Submit Well Registration" button below, you certify the following:
I hereby register my water well with Hays Trinity Groundwater Conservation District for the purposes indicated on this form.
I certify that I am the property owner/grantor or lessee/grantee or an Authorized Agent, and that the information provided on this form is true and correct to best of my knowledge.
I will comply with HTGCD District Rules.