Well Construction & Drilling Forms

Well Construction

• Application for Authorization to Abandon a Well
• Request for Domestic Drilling Permit when Casing Diameter Exceeds 6 Inches
• Enforcement Policy
• Well Driller's Report
• Notification of Seal Installation
• Drilling Permit Form 235-1
• Start Card

Low Temperature Geothermal Resource Wells

Note: Use Application for Drilling Permit under Well Permit Forms above for Low Temp Geo application.

• Low Temp Geo Resource Surety Bond
• Low Temp Geo Resource Well Cash Bond Pledge
• Request for Exemption of Low Temp Geo Use
• Application for Permit

Geothermal Resource Wells

The forms below have 2 variations to meet your needs. To modify and submit an electronic version, select the Word Document icon. To print the form and complete by hand, selct the PDF icon.

• Form 4003-1  
  Application for Permit to Drill for Geothermal Resources
• Form 4003-2    
  Application for Permit to Alter a Geothermal Well
• Form 4003-3    
  Application for Permit to Convert a well to a Geothermal Injection Well. (Also requires permitting through UIC Program)
• Form 4003-5    
  Geothermal Resources Surety Bond
• Form 4003-7    
  Notice of Intent to Abandon a Well
• Form 4003-9    
  Report of Abandonment of a Well

• Form 4010-1 - Monthly Injection Report for Geothermal Wells. (Other forms my be used with prior approval by the Department)
• Form 4010-2 - Monthly Energy Report for Geothermal Wells. (Other forms my be used with prior approval by the Department)

• Monthly Injection/Monthly Energy Report Spreadsheet

Injection Well Forms

Deep Injection Wells

• Injection Well Permit Application
• Low-flow (≤ 50 GPM) Ground Source Heat Pump (5A7)
• Notice of Completion of Construction for an Injection Well
• Notice of Change in Ownership or Operator for an Injection Well
• Application for Authorization to Decommission a Well
• Notice of Completion of Injection Well Decommission

Shallow Injection Wells

• Shallow Injection Well Inventory Form
• Application for Authorization to Decommission a Well
• Notice of Completion of Abandonment for an Injection Well