Groundwater Withdrawal Permitting: Forms and Fact Sheets

Forms for Groundwater Withdrawal Permitting:

 Description Effective Date 
Application Form for a Groundwater Withdrawal Permit  December, 2016 
Application Instructions for Completing a Groundwater Withdrawal Permit Application  December, 2015
Aquifer Test Plan Technical Advisory for Preparing an Aquifer Test Plan October, 2016 
Aquifer Test Data Summary Template  October, 2016 
Aquifer Test Well Summary Template October, 2016
Local Government Ordinance Form December, 2016
Mitigation Plan Template March, 2016
Pre-Application Meeting Form for a Groundwater Withdrawal Permit Application March 15, 2016
Quarterly Groundwater Withdrawal Report Form December, 2016 
Transfer of Groundwater Withdrawal Permit Form September 30, 2014 
Uncontested Termination Agreement Form November 18, 2013
Uniform Water Well Completion Report (GW-2) Form August 19, 2016
Uniform Water Well Completion Report Guidance Document  August 4, 2016 
Water Permit Application Fee Form:  PDF (non-fillable) format September, 2017 
Water Permit Application Fee Form:  Word (fillable) format  September, 2017 
Water Permit Fee Program Procedures August 1, 2006 
Well Abandonment Form (for use when original well completion report is unavailable)  August 1, 2016 


Ground Water Withdrawal Fact Sheets:

The Groundwater Withdrawal Permit Fact Sheet summarizes groundwater withdrawal permitting requirements and the expansion of the Eastern Virginia Groundwater Management Area.

Informational Fact Sheets:

Description  Effective Date 
Compliance Staff Territory Map September, 2016
Compliance Assistance Framework Fact Sheet February, 2017
Groundwater Withdrawal Permitting Fact Sheet  April, 2016 
Groundwater Withdrawal Permitting Staff Contact and Territories Map February, 2017
Map of Virginia's Groundwater Management Areas  January 1, 2014 
Meter Reading Tips Fact Sheet February, 2017 
Well Abandonment Fact Sheet  February, 2017 
Well Construction Fact Sheet  February, 2017 


Documents Currently Under Revision:

Description  Effective Date of current document 
 Groundwater Withdrawal Permitting Procedures Manual May 25, 2006 



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Virginia Department of
Environmental Quality
P.O. Box 1105
Richmond, VA 23218
(804) 698-4000

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