Water Well Application
PLEASE NOTE: Any application that is incomplete will not be deemed administratively complete and processed by PCGCD until all required information is provided. Water wells that are drilled, altered, completed and/or operated without PCGCD approval can be forcibly plugged by PCGCD, and civil penalties up to $10,000 per day per violation can be charged to the water well owner, water well driller, or both. All administratively incomplete applications will expire if not completed in 90 days from the day the District requests information or clarification or upon conclusion of an extension granted by the General Manager of the District.

FOR PERMIT APPLICANTS: In accordance with District Rule 3.7(e), the information provided by the permit applicant in the spaces below will be incorporated into the permit if a permit is issued by the District. The permit will be granted on a two (2) year basis or five (5) year basis for grandfathered permits and is contingent upon the accuracy of the information supplied in this application. A finding that false information has been supplied is grounds to refuse or deny the application or for immediate revocation of the permit.

METERING REQUIREMENTS: As required by District Rule 6.1(a) (1-3) the following wells shall be equipped with a meter or a flow measurement device: (1) All new, non-exempt wells; (2) existing wells that have been substantially altered to become non-exempt; (3) a well which produces water that is sold or leased to another person or entity; (4) a well used to supply water for active oil & gas drilling or exploration operations; (5) a well authorized under permit issued by the Railroad Commission of Texas under Chapter 134 for mining activities; (6) monitor wells; (7) remediation wells and (8) aquifer storage and recovery wells. The meter shall operate on the well to measure the flow rate and cumulative amount of groundwater withdrawn from the well to be submitted quarterly to PCGCD.

PLUGGING REQUIREMENTS: No water well plugging can commence until the application has been processed and written approval has been provided. Once approval is provided, the District must be notified at least 24 hours prior to initiation of the plugging operation by phone, email, regular mail, fax, or in person.

Applicant/Well Owner

First Name
MI
Last Name

WELL DRILLER AND PUMP INSTALLER

First
MI
Last

WATER WELL LOCATION

(Please provide specific directions to water well site and a physical address where water well is located. Attach a copy of the property plat or some type of map with the well site accurately located. Deed or other proof of ownership may be required.)
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According to Rule 3.4(d) of the District Rules, all new wells must be drilled within 30 feet (10 yards) of the location specified in the registration or permit application.

WATER WELL SPECIFICS: (Check Yes or No)

If yes, please list below:

Well Data:

Please specify other method:
*Note that wells equipped to produce 150 gallons per minute or more must provide a Hydrogeological Report meeting the requirements of District Rule 3.9(c). Applicants required to complete a Hydrogeological Report must publish notice in the newspaper in accordance with District Rule 3.9(d).

WELL USE: (Please check all that apply) Exempt

If you chose #9 above, complete the remaining questions on the form. If not, go to the end of the form and sign.

WELL USE DATA:

PLUGGING METHOD:

FEES: For all Drilling and Plugging Applications a $100.00 report deposit is required from the driller at the time of
submittal. If the well report or plugging report is timely submitted to the District, the District will return the report deposit in full.
I certify that, as the Applicant, I am the owner of the well which is the subject of this Application, or the Authorized Agent of the well owner. Additionally, I certify that each and all of the statements and information contained herein are true and correct to the best of my knowledge and belief. Moreover, I agree to fully comply with the terms of the Panola County Groundwater Conservation District’s enabling legislation, the rules of the District, and any water well plugging application requirement that may be requested pursuant to this Application. I understand that failure to comply with the rules of the District and failure to properly plug the water well that is the subject of this Application can result in enforcement by the District.
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