Well Registration eForm

*Parcel Number This field is required.

Lattitude This field is required.

Longitude This field is required.

Township

6S 7S 8S 9S 10S 11S 12S 19S

Range

10E 11E 17E 18E 19E 20E 21E 22E

Section This field is required.

Proposed Starting Date Required

Proposed Starting Date Required Field Date

You must specify a value for this required field.

Property Owner/Agent Name This field is required.

Mailing Address This field is required

Phone Number This field is required.

*Well Location Street Address This field is required.

City Required

Alachua Archer Gainesville Hawthorne High Springs Island Grove Lacrossee Micanopy Melrose Newberry Waldo
This field is required

*State This field is required.

Zip Code Required

32601 32603 32605 32606 32607 32608 32609 32611 32615 32618 32622 32631 32640 32641 32643 32653 32654 32666 32667 32669 32694
This field is required

*Well Contractor Name This field is required.

Well Contractor License Required

This field is required

Proposed Casing Diameter Required

This field is required

Proposed Casing Depth Required

This field is required

Proposed Total Depth Required

This field is required

Aquifer Required

Floridan Intermediate Surficial Unknown
This field is required

Casing Type Required

Black Iron

Galvanized

PVC

Other (Please Specify)

Specify your own value:

This field is required

Category Required

New Construction

Modification

Abandonment

Existing

This field is required

Construction Method Required

Cable Tool

Rotary

Jetted

Auger

Other (Please Specify)

Specify your own value:

This field is required

Intended Well Use Required

Private Well

Public Supply

Irrigation

Industrial

Monitor

Other (Please Specify)

Specify your own value:

This field is required

Additional Comments This field is required

*Signatures This field is required.

A well registration form can also be printed, filled out and mailed to ACEPD.

If you are submitting well registrations for multiple wells on one parcel please fill out the form for one well and submit the details of the other wells in the comments field or email them along with a location map to Betty Rosenblatt.

I do hereby agree to comply with the provisions of the Alachua County Unified Land Development Code Chapter 406 Article 11 and the Murphree Wellfield Code (Alachua County Code Chapter 355).

Questions can be directed to Betty Rosenblatt, at (352) 264-6814.

A well completion report must be submitted to ACEPD upon completion of the well. They can be emailed to Betty Rosenblatt or mailed to ACEPD at 408 W University Ave. Suite 106, Gainesville, FL 32601.  The well completion reports must also be submitted to the St. Johns River Water Management District.

The well completion report can be obtained from the well contractor. Existing well owners can submit the well completion report with this form.