HICKORY UNDERGROUND WATER CONSERVATION DISTRICT NO. 1

HICKORY UNDERGROUND WATER CONSERVATION DISTRICT NO. 1
P.O. Box 1214 111 East Main Street
Brady, Texas 76825
Phone (325) 597-2785
Email: hickoryuwcd@yahoo.com Website: http://www.hickoryuwcd.org
REGISTRATION OF WATER PRODUCTION FACILITIES
Purpose: This form is to be used to gather information on wells that are exempted from obtaining a permit according the Section 36.117 of the Texas Water Code, which are: a well used solely for domestic use for providing water for livestock or poultry on a tract of land larger than 10 acres that is either drilled, completed, or equipped so that it is incapable of producing more than 25,000 gallons of groundwater a day; the drilling of a water well used solely to supply water for a rig that is actively engaged in drilling or exploration operations for an oil or gas well permitted by the Railroad Commission of Texas provided that the person holding the permit is responsible for drilling and operating the water well and the well is located on the same lease or field associated with the drilling rig; or the drilling of a water well authorized under a permit issued by the Railroad Commission of Texas under Chapter 134, Natural Resources Code, or for production from such a well to the extent the withdrawals are required for mining activities regardless of any subsequent use of the water. A separate registration must be completed for each well.
Registration/Well Number:
Date Received:
I. Applicant Data
A. Name of Applicant
B. Mailing Address
C. Telephone
Format: (000) 000-0000.
E-mail:
example@example.com
D. Relation of the subscriber to this registration is that of (Owner, tenant, agent or otherwise) and he is authorized to make this application in behalf of the interest affected.
II. Nature and Extent of Use
A. The quantity of water used from the well listed in this registration is in the amount of acre feet per calendar year. (One acre foot = 325,851 gallons)
B. The water is diverted at a maximum rate of gpm.
C. Date well was/will be completed

MonthDayYear
Date
D. Driller:
E. The water has been/will be used for: (check use or uses)
III. Location Information
A. A general description of the location of the well is:
County:
IV. Completion Information
If well is already completed, provide the following information for the well.
1. Total depth of well (feet)
2. Depth of casing (feet)
3. Inside diameter of casing
4. Static water level
5. Depth of pump setting (feet)
6. If available, attach a copy of drillers log or water well report.
I hereby certify that the information provided herein is, to the best of my knowledge, true and correct.
Signed:
Printed Name:
Date:

MonthDayYear
Date
Should be Empty:

HICKORY UNDERGROUND WATER CONSERVATION DISTRICT NO. 1

REGISTRATION OF WATER PRODUCTION FACILITIES

I. Applicant Data

II. Nature and Extent of Use

III. Location Information

IV. Completion Information