Dry Well Report 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.

To better serve and address you, please help us identify who you represent.

Please enter the name, phone number, 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.

Email information is useful to connect you to your local entities that may have assistance

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*.

Please provide location information about the water issue. 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.

Use the interactive map to pinpoint your latitude and longitude coordinates. If left blank, the latitude and longitude will be geocoded with other filled location information.

Open Interactive Map

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)

Helpful Resources for Homeowners:

Required fields Require at least one