Well Permitting & Notice of Intention Forms
***ATTENTION - FORM UPDATES AND OTHER 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, or alter any form. Effective immediately only the most current forms will be accepted.
Location of Groundwater withdrawals
Attention Drillers 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has been modified to require drillers and applicants to indicate whether the water to be withdrawn from the proposed well will be used in the same groundwater basin where the well is to be located.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 basins and sub-basins designated by the Department have 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, which are not included in the five initial Active Management Area (AMA) basins, in narrative and map form.
To more easily determine in which 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.
Individual AMA boundary maps are available here to download.
Geographic Location Requirements
Attention Drillers:
The Well Driller Report and Log (form DWR 55-55) and the Well Abandonment Completion Report (form DWR 55-58) call for 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 determine 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.
Permits, Forms & Applications
Drilling A Non-Exempt Well Within An Active Management Area (AMA)
If you are drilling a NON-EXEMPT WELL within an Active Management Area (AMA), please use the following list:
| Reference | Form Name | Online Application | Application | Instructions |
|---|---|---|---|---|
| Well Impact Waiver | File
|
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| 55-0001 | 55-0001 Application for a Permit to Drill or Operate a Non-Exempt Well Within an AMA Pursuant to A.R.S. 45-599 |  |
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| 55-41 | 55-41 Notice of Intention to Deepen, Replace or Modify a Non-Exempt Well | |
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| 55-41A | 55-41A Notice of Intention to Drill a Non-Exempt Well pursuant to a Groundwater Withdrawal Permit (Other than a General Industrial Use) in an Active Management Area | |
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| 55-90 | 55-90 Well Construction Supplement | |
Drilling Any Other Type Of Well
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 fields on the forms are outlined in RED.
If you are drilling any other type of well (inside or outside an AMA), please use the following list:
List
| Reference | Form Name | Online Application | Application | Instructions | Checklist |
|---|---|---|---|---|---|
| 55-38 | 55-38 Notice of Intent to Abandon a Well | |
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| 55-40 | 55-40 Notice of Intention to Drill, Deepen, Replace or Modify a Well | |
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| 55-40A | 55-40A 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) | |
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| 55-40B | 45-454(I) 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) | |
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| 55-40C | 45-596(F)&(G) 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) | |
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| 55-40D | 55-40D Certification of Compliance to Replace an Exempt Well Within an Active Management Pursuant to § 45-454(I) | |
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| 55-43 | 55-43 Notice of Intention to Drill and Abandon an Exploration/Specialty Well | |
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| 55-44 | 55-44 Notice of Intention to Drill, Deepen, or Modify a Monitor/Piezometer/Environmental Well | |
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| 55-44A | 55-44A REMEDIATION Well Certification of Compliance with A.R.S. § 45-454(C) or Request for Exemption Pursuant to A.R.S. § 45-454(D) (EXEMPT REMEDIATION ONLY well within 100 feet from a water provider with an assured water supply) | |
File
|
Related Well Forms
| Reference | Form Name | Online Application | Application | Instructions |
|---|---|---|---|---|
| 55-36 | 55-36 Well Owner’s Notification of Abandonment | |
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| 55-39 | 55-39 Notice of Well Capping | |
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| 55-55 | 55-55 Well Driller Report and Well Log | |
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| 55-56 | 55-56 Pump Installation Completion Report | |
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| 55-57 | 55-57 Project Completion Report for Mineral Exploration Drilling | |
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| 55-58 | 55-58 Well Abandonment Completion Report | |
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| 55-65 | 55-65 Late Registration of a Well (if well was drilled prior to June 12th, 1980) | |
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| 55-71A | 55-71A Change of Well Information | |
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| 55-71B | 55-71B Change of Well Driller | |
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| 55-72 | 55-72 Landowner Authorization to Drill or Abandon a Well on Landowner's Parcel | |
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| 55-73 | 55-73 Third Party Change of Registered Owner Authorization (to be used with 55-71A in lieu of landowner signature on 55-71A) | |
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| NOI Site Plan | NOI Site Plan | File
|
Groundwater Withdrawal Permits
| Reference | Form Name | Online Application | Application | Instructions |
|---|---|---|---|---|
| 45-1041 | 45-1041 Application for Water Exchange Permit | |||
| 45-513 | 513 Application for Permit to Withdraw Groundwater for Dewatering Purposes in an AMA | |
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| 45-514 | 514 Application for Permit to Withdraw Groundwater for Mineral Extraction & Metallurgical Processing | |
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| 45-515 | 515 Application for Permit to Withdraw Groundwater for General Industrial Use | |
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| 45-516 | 45-516 Application for Permit to Withdraw Poor Quality Groundwater | |
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| 45-518 | 45-518 Application for Permit to Withdraw Groundwater for Temporary Dewatering Purposes | |
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| 45-519 | 519 Application for Permit to Withdraw Groundwater for Drainage Purposes | |
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| 45-519.01 | 519.01 Application for Permit to Withdraw Groundwater for Hydrologic Testing Purposes | |
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| 45-520 | 520 Notification of Change of Ownership of a Groundwater Withdrawal Permit | |
| Reference | Form Name | Application | Instructions |
|---|---|---|---|
| 55-40T | General Well Diagram Template | ||
| 55-44T | Monitor Well Diagram Template | ||
| 55-90T | Non-Exempt Well Diagram Template |