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Well Permitting and Notice of Intention Forms

***ATTENTION - FORM UPDATES AND REQUIRED INFORMATION***

ADWR forms are periodically updated to include new information needed to issue a well permit or authorization to drill a well.  Please bookmark this webpage and use it to download the latest version of each form as needed.  Please do not reduce the size of the forms.  Do not alter any form.  Effective immediately, only new forms will be accepted.

 

Fillable Forms

Drillers and Well Applicants! ADWR is converting its forms to fillable PDFs, The fillable forms are being uploaded to this webpage as they become available. You can open a form online, complete it, print it on your printer, and send it by US mail to ADWR with the appropriate fees, if applicable. You can also download the form and complete it offline or print a blank fillable form to complete manually. Required field on the forms are outlined in RED.

Reset buttons in the fillable form clears entries in the entire form or portions of the forms. At the top and bottom of each form is a “RESET” button that clears ALL entries in the document. ADWR suggests that you click on the RESET buttons before starting a new application to clear any extraneous information in the form. You can also save the completed form as a PDF for your records.

 

Location of Groundwater Withdrawals

Driller and Well Applicants! The ADWR form Notice of Intent (NOI) to Drill, Deepen, Replace or Modify a Well (DWR 55-40) has been modified to require drillers and applicants to indicate whether the water to be withdrawn from the proposed well will be used in the same groundwater basin where the well is to be located.

To assist NOI applicants and drillers in locating groundwater basin and sub-basin boundaries, the Department’s Basin and Sub-Basin Designations—June 1984 has been added to the website.  This document describes the official boundaries of each of the 46 groundwater basins and 27 sub-basins of the state not included in the five initial Active Management Area (AMA) basins in narrative and map form.  Click here to download the official basin/sub-basin boundaries outside AMAs. 

To more easily determine what basin and sub-basin a proposed well may be located, ADWR recommends referring to the Statewide Map of Groundwater Basins and Sub-Basins showing all the basins and sub-basins of the state before refining your search of the official 1984 boundaries document. Click here to download the Statewide Map of Groundwater Basins and Sub-Basins. 

Individual AMA boundary maps are available here to download. Click here to download individual AMA Maps.

 

Geographic Location Requirements

Drillers! The Well Driller Report and Log (form DWR55-55) and the Well Abandonment Completion Report (form DWR55-58) now REQUIRE Latitude and Longitude measured by GPS or other methods as listed on the application.  Please provide these actual coordinates on ALL reports.  Measurements should be reported in the preferred NAD83 datum and in degrees, minutes, decimal seconds (ddd°mm’ss.ss”).  Please clearly identify any other datum used to measure the location of a well.  The USGS Quad Map is no longer an acceptable method for determining and reporting geographic locations.

 

Landowner Authorizations

Drillers and Well Applicants! The landowner on which any well is drilled, modified, or abandoned must approve the actions to be taken on their property.  All NOIs have signature blocks for these authorizations.  If you are filing the NOI electronically, or the landowner is not available to sign the original NOI, the form DWR 55-72 “Landowner Authorization to Drill or Abandon a Well on Landowner’s Parcel” can be used in place of a signature on the NOI.  Download the form below.

Well Owners!  If a party wishes to change the well registry to list the party as the registered owner of a well, and they are NOT the landowner, the landowner must authorize the change.  The landowner must sign the Request to Change Well Information (DWR form 55-71A) or form 55-73 Third Party Change of Registered Owner Authorization must be attached to form 55-71A and submitted to DWR with the applicable fees.

 

** Please note: The following pdf documents are best viewed using Adobe Reader XI

Permits, Forms and Applications

If you are drilling a NON-EXEMPT WELL within an Active Manaagement Area (AMA), please use the following list:
Reference Application Form Instructions Checklist
55-0001 Application for a Permit to Drill or Operate a Non-Exempt Well Within an AMA Pursuant to A.R.S. 45-599   
55-41 Notice of Intention to Deepen, Replace or Modify a Non-Exempt Well   
55-41A Notice of Intention to Drill a Non-Exempt Well pursuant to a Non-General Industrial Use Permit   
55-90 Well Construction Supplement      
55-95 Non-Exempt Well Impact Waiver - 10 feet of Additional Drawdown      

 

 

If you are drilling any other type of well (inside or outside an AMA), please use the following list:
Reference Application Form Instructions Checklist
55-38 Notice of Intent to Abandon a Well
55-40

Notice of Intention to Drill, Deepen, Replace or Modify a Well

 

Exempt Well Certification of Compliance with A.R.S. § 45-454(C) or Request for Exemption Pursuant to A.R.S. § 45-454(D) (exempt well within 100 feet from a water provider with an assured water supply)

   
 

Supplemental to the Notice of Intention to Drill a Second Exempt Well for the Same Non-irrigation Use, At the Same Location, in an AMA Pursuant to § 45-454(I)

   
 

Certification to the Notice of Intention to Drill an Exempt Well for Domestic Use Pursuant to § 45-596(F) & (G) (self-certification for septic tanks and sewer systems)

   
55-43B

Notice of Intention to Drill and Abandon an Exploration/Specialty Well

55-44A

Notice of Intention to Drill, Deepen, or Modify a Monitor/Piezometer/Environmental Well

 

Remediation Well Certification of Compliance with A.R.S. § 45-454(C) or Request for Exemption Pursuant to A.R.S. § 45-454(F)  (exempt well within 100 feet of a water provider with an assured water supply)

   
55-75 eNOI Password/eMail Request    

 

 

Miscellaneous forms:
Reference Application Form Instructions Checklist
55-36 Well Owner’s Notification of Abandonment  
55-39 Notice of Well Capping  
55-55 Well Driller Report and Well Log  
55-56 Pump Installation Completion Report  
55-57 Project Completion Report for Mineral Exploration Drilling  
55-58 Well Abandonment Completion Report  
55-65

Late Registration of a Well (if well was drilled prior to June 12, 1980)

 
55-71A

Request to Change Well Information (change of registered owners, change of drilling contractor, change of address, update of well construction information)

 
  Online Change of Well Ownership      
55-72

Landowner Authorization to Drill or Abandon a Well on Landowner's Parcel (to be used in lieu of landowner’s signature on a NOI)

   
55-73

Third Party Change of Registered Owner Authorization (to be used with 55-71A in lieu of landowner signature on 55-71A.)

   
  Request for an Extension of Time to Submit Information for an Application      
         
         
Well Related Information (???)      
  Public Land Survey: Understanding Cadastral Location/Legal Description (tri-fold brochure)    
  Legal Requirements for Septic Setbacks 45-596 F & G and R12-15-818 (move to instructions for 55-40supp3)