State of California
Dry Well Reporting System
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What is this form?
General Information and Instructions
How is this information going to be used?
This information is intended to inform state, county and local agencies on drought impacts on household water supplies and should not be construed as an application for local, state or federal assistance. Individuals interested in assistance can access available local and state resources on the
Resources page
. Information submitted through this application can be viewed by the public and/or provided to local agencies.
Form Components:
Contact Information (Who is having the problem?)
Water Problem Information (What is the problem?)
Water Problem Location (Where is the problem?)
Available Financial Resources (Information to share, if interested.)
Well Log Data (If known)
Agency/Local Government Information (Required for Agency users only)
Thank you in advance for your time.
*
Required
Who do you represent?
What is this?
To better serve and address you, please help us identify who you represent.
Please choose the appropriate option to identify who you are representing.
*
Owner or renter of the property
Member of local agency organization
Contact Information:
What is this form?
Please enter the name, phone number (required), and email address for the owner or renter of the property experiencing a disruption in water supply. By leaving a name and contact information, someone may be able to follow up if and when new resources become available.
Name
Phone Number
*
Email
— email information is useful to connect you to your local entities that may have assistance
Water Problem Information:
[Required section]:
Please make every effort to share information about the water supply issue so the State can track the different types of problems that are occurring. *The most important information in this form is the location of the water problem in the next section*.
What type of water shortage are you facing?
*
Dry well (groundwater)
Low creek, stream, spring, or other surface water source — for surface water related outages contact your local water agency (County Public Health or Office of Emergency Services)
Other:
Please describe the water issue
*
Well is dry (no longer producing water)
Reduction in water pressure, lower flows.
Well is pumping sand, muddy water.
Well is catching air, have to wait to be able to pump.
Reduction in water quality
Other:
What is the primary use of this well or creek?
*
Household
Ag/Irrigation
Combination of Household/Agriculture
Other:
If household use, what kind of household is the well supporting?
(skip if this if well is primarily used for Agriculture/Irrigation)
owner-occupied
renter-occupied
Other:
How many people are in the household?
(A number from 1 to 999)
Approx. date problem started
*
Additional notes about water problem
Water Problem Location Information
[Required section]:
[Required section] Please provide location information about the water issue.
County
*
Choose County
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Klamath
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
State Level Sites
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
Provide at least one physical well location by: Full Address, Parcel Number (APN), Nearest Street Intersection, Latitude & Longitude. Location information is useful to connect you to your local entities that may have assistance.
Require at least one
Full Address
Street Address
City
Zip Code
Latitude & Longitude
Use map to pinpoint your latitude and longitude coordinates.
Parcel Number (APN)
Parcel on which well is located; please do not include dashes.
Nearest Street Intersection
If APN or physical address is unknown, use either crossroads or Lat/Long point.
▼
Map
Click on the map to enable interactive map
Was the problem resolved?
Please choose the answer which describes how
Yes, lowered the pump bowl
Yes, deepened the well
Yes, drilled replacement well
No, trucking in water
No, getting water from our neighbors with a hose
No, on drilling wait list
No, cannot afford to finance solutions
Other:
If you tried a different solution and were not successful, please describe the steps you took below
If your well was fixed, please note the approximate cost of repairs
Additional Information
Well Information (if known):
[Optional section]:
This section provides information about the construction of groundwater well that is used for water supply. Well logs are also known as well completion reports. These are typically completed by the well driller at the time the well is installed. It provides information about the construction (depth, screening, etc) of a well. If you do not have it, it can be requested from your county Depart. of Environmental Health, other well-permitting entity or from the Department of Water Resources. (
https://water.ca.gov/Programs/Groundwater-Management/Wells/Well-Completion-Reports
)
What is the total depth of your well?
Do you have a well log or well completion report?
Yes
No
What is the depth to water in the well?
In feet, if known:
Date Measured
Was the measurement taken with the pump was running or running within the last 15 minutes?
i.e. not during or just after the well was being pumped
Yes
No
Pumping Information
At what rate does the well normally produce water? (In gallons per minute, or indicate units)
Has the pumping rate been reduced? If yes, about how much?
(Please indicate the percentage of change in gallons per minute produced)
No, it's pumping at the same rate
Yes, about a 10% reduction
Yes, about a 20-30% reduction
Yes, about a 30-40% reduction
Not sure
It's no longer producing any water
Other:
Local Well ID (if known)
Site ID (if known)
Station Number (if known)
Helpful Resources for Homeowners:
Contact your County's
Office of Emergency Services
They will work with you to determine what help is available and how to get it.?
Find a well drilling/maintenance contractor
Well drillers can help lower well pumps, drill wells, clean well screens, and assess casings to allow for optimal well flow
Website to find well contractors
Find the local agency that will issue a permit for well rehabilitation or drilling a new well
To refurbish, replace or construct a well,
apply for a well permit from your local county
Contact your local groundwater sustainability agency
To learn more about groundwater management in your region, find your
Groundwater Sustainability Agency
Reported by Agency/Local Government/Housing Assistance Organization:
[Required section]:
This section is only to be completed by a local agency official when preparing this form on behalf of a member of the public
Report Date
*
Agency or Organization
*
e.g. USDA, DWR, OES, CDPH, HCD, Self Help Enterprises etc.
Name
*
Phone Number
*
Email
*
Additional Notes
Use this space if there are planned actions or follow up steps to be taken with the caller.