NIDW - NOTICE OF INTENT TO DRILL A WELL

Victoria County Groundwater Conservation District

Mail: P.O. Box 69, Victoria, Texas 77902 | Phone: (361)579-6863
Email: admin@vcgcd.org | Website: www.vcgcd.org

NOTICE OF INTENT TO DRILL A WELL

Submit this notice to the district at least 2 hours before commencing drilling activities.

Is this notice associated with a well to be located within Victoria County, Texas?*

YESNO

Error: This form should only be used to provide notice of intent to drill a well located in Victoria County, Texas.

Item 1: Specify the name and address of the person drilling the well:*

Item 1a: Well Driller License:*

Item 2: Specify name and address of the person that will own the subject well:*

Item 3: Specify the geographic coordinate of the subject well:

Latitude:*

example: 28° 50′ 7.42″ N

Longitude:*

example: 96° 59′ 24.69″ W

Item 4: Specify the date the well drilling activities will commence.*

Item 5: Required Statement and Signature of the Person Drilling the Well:

I certify, under penalty of law, that the person that will own the subject well was notified of the of the existence of rules and regulations established by the district related to well spacing, limitations for producing groundwater for non-exempt-use purposes, registration of non-grandfathered and replacement wells, and permitting of groundwater production for non-exempt-use purposes.

Signature of the Person Drilling the Well:*

Date*

Printed Name of the Signee:*

First NameLast Name

Email Address (optional; used forward a copy of the form to the applicant upon submittal.)

example: john.doe@MyDomain.com

Item 6: Required Signature of Well Owner:

Signature of Well Owner or Authorized Agent:*

Date*

Printed Name of the Signee:*

First NameLast Name