Non-Production Wells

REQUEST FOR NON-PRODUCTION WELL CONSTRUCTION

Fill out this form, and then click the button to generate the printable form, then print the Non-Production Well Construction form from the resulting .pdf file. If you would like to print a blank Non-Production Well Construction form, simply leave the form blank and click the button to generate the printable Non-Production Well Construction form.

- The Non-Production Well Form must be completed and signed by the project owner or authorized representative. The form shall not be signed by the licensed driller.

- See R655-4-9 of the Administrative Rules for Water Wells for information and requirements for the approval process for non-production wells.

- See R655-4-12 and R655-4-15 of the Administrative Rules for Water Wells for drilling and construction information and regulations for non-production wells.

This permit may not be the only authorization needed to drill a well. The applicant is responsible for obtaining other permits/authorizations from federal agencies, other state agencies, and/or local jurisdictions as applicable. Moreover, if the applicant is not the landowner, it is the applicant's responsibility to ensure that approvals/permissions have been obtained to trespass and drill a well(s) on the property. This permit does not give authorization to trespass on private property.

The Adobe reader is required to print the Non-Production Well Construction form. It can be acquired at the following link.

Well Type :

Test Monitor Cathodic Protection Closed Loop Heat Exchange

Piezometer Inclinometer Dewatering Other:

Applicant's Name :


Mailing Address :






Project Address :

Contact Person :	Phone :


Proposed Start Date :	Anticipated Completion Date :

Well Driller who will perform the work: (if known)	Proposed Number of Wells :

PROPOSE LOCATION OF WELLS:	County :	Water Right Area :

N/S	N/S	E/W	E/W	Section	Section	Township	Range	Base	Diameter	Depth	Property
Direction	Distance	Direction	Distance	Corner				Meridian	(inches)	(feet)	Parcel Number

Explanatory :

Su	Mo	Tu	We	Th	Fr	Sa