Form 300 – Well Registration and Completion

2. FORM 300

   Well Registration Application

6. SECTION I – APPLICANT
8. First Name*
9. Last Name*
11. Company (if applicable)
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Email Address*
24. SECTION II – EXEMPTION
26. Is the Applicant Requesting an Exemption Under Lost Pines Groundwater Conservation District Rule 3.1?*
    -- Select One --YesNo
28. If Yes to the question above, which type of exemption is being claimed?
    -- Select One --A well that is solely for domestic or livestock use that is incapable of producing more than 25,000 gallons per day (gpd).A well that uses less than 200 acre-feet/year solely for agricultural use.A well that is 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.A water well authorized under a permit issued by the Railroad Commission of Texas for mining activities.A water well drilled and completed solely for the purposed of aquifer testing.
32. SECTION III – WELL INFORMATION
34. State Well Report

    NOTE: A fully completed state well report can be uploaded here in lieu of filling in the information below in this section.

36. Location of the well:
38. Latitude
39. Longitude
41. Physical description of the well location (if GPS coordinates are not available):
43. County that the well is located in:
    -- Select One --BastropLee
45. What is the type of well?
    -- Select One --DomesticLivestockIrrigationMunicipal SupplyMiningRig SupplyTestOther
47. If answered Other to question above, please type what the primary use of the well will be.
49. What aquifer is water produced from (if known)?
51. Please upload copies of the following Schedules or Logs, if applicable:
53. State Well Report
54. Electric Log
55. Aquifer Test Results
57. Date Well Drilled:
    Date Well Drilled:
58. Driller:
59. Driller's License No:
61. Land surface elevation in feet:
63. Total well depth in feet:
65. Screened interval in feet:
67. Depth to water in feet:
69. Well diameter in feet:
71. Diameter of borehole in inches:
73. Pump set at in feet:
75. Pump type:
77. Pump size in horsepower:
79. Well capacity in gpm:
83. SECTION IV – AFFIRMATION
85. In signing this I certify that all statements and information in this application are true and correct.*

    Please type your first and last name as a digital signature.

86. Date*
    Date

    Please enters today's date.

Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit

* indicates a required field