Report a Dry Well

The below form is provided for community members in Arizona to report any concerns or issues related to dry wells.

If you prefer to submit by mail, please download and print this form for submission.

Your Information

Name

Email

Phone

Address

Address 2

City/Town

State

ZIP Code

Dry Well Details

Well Registry Number (if known):

Legal Description of Well Location (if known):

Parcel Number Associated with Well (if known):

Approximate Date the Well Went Dry:

Has your well ever gone dry before? When?

As a result of your well going dry, did you drill a new well or deepen your existing well? How deep? How much did it cost? What company deepened your well?

Current Well Depth:

Is there anything else you would like us to know about your well issues? Attach additional information if necessary.

Attachment(s):

One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Landowner Name (if different from above):

Landowner Email (if different from above):

Landowner Phone (if different from above):