Well Registration

Owner's Information

Name :*

Individual/Association/Company/Public Authority

Designation (If applicable):

Owner’s Address:

Telephone :

Mobile :

Fax :

Email

Postal Address :

(If different from above)

Well Location Information

(A) Is the address of the well same as above?

Yes
No

Address :

(If different from above)

(B) Property regime of land:

Lease hold
Transport
Title
Other

Please specify Property regime of land :

(C) Area of the land (in Hectares):

(D) Sketch / Drawing of Well location

Please attach with the registration form a sketch or drawing showing where the well is located on the property, relative to the boundaries, road or any other structures on the land.

National Grid Reference of point of water uptake:

Longitude

Latitude

Elevation

UTM Zone (NAD83)

Easting

Northing

Source of coordinates (check one):

GPS
Google Earth
Other

Please specify source of coordinates :

Well Information

Is the Well Construction Report available?

Yes
No

Well construction report (if available)

Type of water point:

Borehole
Dug well
Augured shallow well
Other

Please specify type of water point :

Water point ownership :

Private
Public
Institutional

Water point use :

Domestic
Irrigation
Livestock
Industrial
Other

Please Specify Water point use:

Contractor :

Method of construction :

Air Rotary
Augured
Cable Tool
Dug
Mud Rotary
Other

Please Specify method of construction:

Date of completion

YYYY

MM

DD

Date of Possession

YYYY

MM

DD

If completion date is unknown, provide the date you took possession of the property

Well Diameter (mm):

Completed well Depth (m):

Well Performance or Abstraction rate (m 3 per day / month) :

Other relevant technical information:

DECLARATION OF APPLICANT

I certify that the information provided in this form is correct to the best of my knowledge. I also agree that no decision will be made pursuant to this application until I receive a notification from the Hydrometeorological Services.

Name

This field is for validation purposes and should be left unchanged.

Registration of Existing Well

Owner's Information

Well Location Information

Well Information

DECLARATION OF APPLICANT