Module 4 — Water Well Drilling Agreements
Water Well Drilling Agreement Form
Identification
1.
Well owner_ ______________________________________________________________________________________________________________________
Address_ _________________________________________________________________________________________________________________________
2
Licensed water well contractor ____________________________________________________________________________________________________
Address_ _________________________________________________________________________________________________________________________
Licensed water well contractor approval no.___________
3.
Land location of well: Qtr_______ Sec_______ Twp_______ Rge_______ W of_____Meridian Lot_______ Block_______ Plan_______
4.
Proposed starting date_____________________________________________________________________________________________________________
Proposed completion date __________________________________________________________________________________________________________
Water Requirements
5.
Proposed well use: Household______________ Livestock_____________ Irrigation______________
6.
Desired water quality On-site tests:
total dissolved solids_______________________parts/million
iron______________________________________parts/million
hardness_________________________________parts/million
pH_______________________________________parts/million
7.
Desired yield_____________L/s (gpm) Min. acceptable yield_____________L/s (gpm)
8.
Groundwater supply options based on existing records________________________________________________________________________________
Well Construction
9.
Maximum desired depth_______________ m (ft.)
10.
Type of drilling____________________________________________________________________________________________________________________
11.
Diameter of hole___________________________________________________________________________________________________________________
12.
Flowing well control_ ______________________________________________________________________________________________________________
13.
Well connection_ __________________________________________________________________________________________________________________
14.
Formation logging procedure_ ______________________________________________________________________________________________________
15.
Annulus or casing seal_____________________________________________________________________________________________________________