Well Construction Notification Application – Hays Trinity Groundwater Conservation District

This form provides notification to the District of intent to drill a well. This includes other aquifer penetration within the boundaries of the Hays Trinity Groundwater Conservation District.

A well is any artificial penetration, excavation, borehole or other man-made feature constructed for the purposes of exploring for or producing groundwater, or for injection, cathodic, monitoring, de-watering purposes or a leachate or remediation well. Also includes a closed loop well. (e.g. geothermal systems, etc.)

"*" indicates required fields

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Application Number

A. WELL OWNER INFORMATION

Any person who has the right to produce groundwater, either by ownership, contract, lease, easement, or any other estate in the land.

(*) denotes a required field

Business/Organization: (if applicable)

First Name:*

Last Name:*

Mailing Address:*

City:*

State:*

Zip:*

Phone:*

Alternate Phone:

Email: (Only used for confirmation and HTGCD communication about well)*

Transaction

Is this well being installed as part of a near term real estate transaction? If so, the new owner must register the ownership change within 60 days of the transaction.

B. WELL LOCATION

(*) denotes a required field

Well Location Same as Section A Owner Address?

Address*

City:*

State*

Zip:*

Hays County Property ID #*

Latitude (i.e. 30.123400)*

Longitude (i.e. -98.021234)*

Elevation (in feet): (Can use Google Earth or GPS device)

Provide specific directions to the location of the well on the property

C. WELL SPACING STANDARDS

(*) denotes a required field

How many feet is the well from the closest property line?*

How many feet is the well from an existing well?*

How many feet is the well from a concentrated source of potential contamination, such as livestock or poultry facilities?*

How many feet is the well from a septic system drain field or wastewater irrigation system?*

How many feet is the well from any septic tank?*

I understand that my well must be grouted 100' if my well does not meet the minimum spacing requirements. My well meets the minimum spacing requirements.*

Yes

Is the well located within 50 feet of or within the service area of a public water system?*

Yes

Which system? (Required)*

Which system? (Optional)

Is property within a groundwater management zone?*

Yes Jacob’s Well Groundwater Management Zone

Yes Regional Recharge Study Zone

(see map to check locations of zones)

D. WELL DRILLER'S INFORMATION

(*) denotes a required field

Company Contracted

If driller is not in list, please complete the following information.

Company:*

Address:*

City:*

State:*

Zip:*

License Number:*

Phone Number:*

Email:*

E. PUMP INSTALLER'S INFORMATION

(*) denotes a required field

Same as Section D. Driller?

Company Contracted

If driller is not in list, please complete the following information.

Company:*

Address:*

City:*

State:*

Zip:*

License Number:*

Phone Number:*

Email:*

F. GENERAL WELL INFORMATION

If this is a new well, please provide an estimate.

(*) denotes a required field

Borehole Diameter (inches):*

Casing Size (inches):*

Well Depth (feet):*

Pump Size (hp):*

Production Capability (gpm):*

Anticipated Start Date of Drilling/Alteration:

MM slash DD slash YYYY

Where will water from the well be used?*

G. PURPOSE OF WELL

Check one.

(*) denotes a required field

Exempt Purpose Types

See Hays Trinity Groundwater Conservation District Rules for full definitions.

Residential / Domestic Well

A well used solely for domestic use by a single private residential household incapable of producing more than 25,000 gallons per day. The use of groundwater by an individual or a household, including a home-based business, including water for use inside the home; for irrigation of lawns, or of a family garden and/or orchard; for watering of domestic animals; for swimming pool associated with a single residence, for stock watering pond of less than 1/4 acre extent with an average depth of less than 3-feet, lined with bentonite, geomembrane, or an equivalent sealing material as adjudged by the Distict.

Agricultural

The use of groundwater for: (A) Cultivating the soil to produce crops for human food, animal feed, or planting seed or for the production of fibers; (B) Practicing floriculture, viticulture, silviculture, and horticulture, including the cultivation of plants in containers or non-soil media, by a nursery grower; (C) Raising, feeding, or keeping animals for breeding purposes or for the production of food or fiber, leather, pelts, or other tangible products having a commercial value; (D) Planting cover crops, including cover crops cultivated for transplantation, or leaving land idle for the purpose of participating in any governmental program or normal crop or livestock rotation procedure; (E) Engaging in wildlife management as defined in Texas Tax Code Section 23.51(7); and, (F) Raising or keeping equine animals.

Texas Agricultural or Timber Registration Number

GeoExchange

Number of Wells

Non-Exempt Purpose Types

See Hays Trinity Groundwater Conservation District Rules for additional information.

Irrigation

Use of groundwater to supply water for application to plants or land in order to promote growth of plants, turf, or trees. Irrigation use for agricultural purposes and for residential purposes is exempt from obtaining an operating permit. All other irrigation use must obtain an operating permit.

Public Water System

A system as defined by 30 Texas Administrative Code Section 290.38 for providing water to the public for human consumption.

Community Water System

A system other than a public water system, that supplies groundwater to long term living units such as apartment complexes, town homes, or more than 4 dwellings

Retail Public Water Utility

As defined by 30 Texas Administrative Code Section 291.3, any person, corporation, public utility, water supply corporation, municipality, political subdivision or agency operating, maintaining, or controlling within the District facilities for providing potable water service for compensation.

Commercial

The use of groundwater to supply water to properties or establishments that are in business to build, supply or sell products, or provide goods, services or repairs and that use water in those processes, or to supply water to the business establishment primarily for employee and customer conveniences (i.e. flushing of toilets, sanitary purposes, or limited landscape watering).

De-watering Well

A well used for lowering the water table for construction purposes.

Industrial

Use of groundwater primarily in the building, production, manufacturing, or alteration of a product or goods, or to wash, cleanse, cool, or heat such goods or products.

Injection Well

A well used to inject water or other material into a subsurface formation or into pipe or tubing placed in the formation for the purpose of storage or disposal of the fluid.

Monitor Well

A well generally used for collecting water-quality and/or water -level data on an ongoing basis.

Aquifer Test Well / Observation Well

A well for observing water level changes during an aquifer test.

Aquifer Test Well / Pumping Well

The pumping well used during an aquifer test.

Remediation

A well used to pump or vent contaminated air, water, or fluids from the ground.

Other Purpose Type

Other

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H. FEE

New Well Construction Fee

Wells used solely for agricultural purposes are exempt from fees provided a copy of the 'Texas Agricultural or Timber Registration' is submitted to the district.

Select Payment Method*

Check / Money Order

New Well Construction Application Fees

Price: $1.00

Quantity:

Credit Card

Please check if you have activated a Stripe feed for your form.

NSF confirmation*

I understand that if my check is returned for NSF, I am responsible for the NSF fee charged by the bank.*

I. PREPARED BY

By signing this form, I declare that I have knowledge of the information provided in this form and that it is true and correct, to the best of my knowledge and belief. Furthermore, I am familiar with all pertinent requirements contained in the Hays Trinity Groundwater Conservation District Rules including the District's well construction standards. I understand that within 60 days after the completion of the well, the driller submits the State of Texas Well Report (Well Log) to the District.

Conditions*

I agree to the conditions.

Well Owner:*

First Last

Contact Information (if different from Section A):

Address:

City:

State:

Zip:

Phone Number:

J. COMMENTS

Comment

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Confirmation Message