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GENERAL INSTRUCTIONS

1. Complete this form and mail to P.O. Box 36020 Phoenix, Arizona 85067-6020 or hand deliver to 3550 North Central

Ave, Phoenix, Arizona 85012. Pursuant to A.R.S § 45-596 and A.A.C. R12-15-104, the fee for this Notice is $150.00

Please include a completed Well Construction Supplement DWR Form 55-90, which is enclosed as part of your

application. Completion of this form requires attachment of a detailed construction diagram. The diagram should verify

consistency with minimum construction requirements specified in the Department’s well construction rules found in

Arizona Administrative Code (A.A.C.) R12-15-801, et seq. Specifically, the diagram should include an indication of

perforated interval location(s) in relationship to the expected water level, depth and thickness of the surface seal,

proposed grouting materials, whether or not the surface or conductor casing will extend above grade and vault details, if

specified.

2. State the registration number of the original well and legal basis of entitlement to withdraw water.

3. Construction standards for replacement wells and deepening, modification, and abandonment of existing wells shall be in

accordance with the Department Rules.

4. A.R.S. § 45-596(D) provides that the Director shall determine whether all information required on form has been submitted.

If not, the person filing will be notified, and the drilling, deepening, or modification of the well may not proceed.

SPECIFIC INSTRUCTIONS, LIMITATIONS AND CONDITIONS APPLICABLE TO REPLACEMENT WELLS

IN APPROXIMATELY THE SAME LOCATION

Upon the return of this completed notice, the owner will be provided with specific instructions relating to site verification

requirements.

“Original well” means the well replaced by a replacement well in approximately the same location, except that if the

replacement well is the latest in a succession of two or more wells drilled as replacement wells in approximately the same

location, “original well” means the well replaced by the first replacement well in approximately the same location.

A replacement well in approximately the same location must be drilled within 660 of the original well. The replacement

well must not annually withdraw an amount of water in excess of the maximum annual capacity of the original well. The

Director will determine the maximum annual capacity of the original well by multiplying the maximum pump capacity of

the original well in gallons per minute by 525,600, and then converting the result into acre-feet by dividing the result by

325,851 gallons. The Director shall presume that the maximum pump capacity of the original well is the maximum

pump capacity of the well in gallons per minute as shown in the Department’s well registry records unless: (1) The

Director has reason to believe that the maximum pump capacity as shown in the Department’s well registry records is

inaccurate or; (2) The applicant submits evidence demonstrating that the maximum pump capacity as shown in the

Department’s well registry records is inaccurate.

If a well permit was issued for the original well under A.R.S. § 45-599, the replacement well must not annually withdraw

an amount of groundwater in excess of the maximum annual volume set forth in the well permit.

If a recovery well permit was issued for the well to be replaced pursuant to A.R.S. § 45-834.01(B) and the permit sets

forth a maximum annual volume of stored water that may be recovered from the well, the proposed well will not annually

recover an amount of stored water in excess of the maximum annual volume set forth in the recovery well permit.

If the well to be replaced has been physically abandoned in accordance with R12-15-816, a notice of intention to drill the

proposed well is filed no later than 90 days after the well to be replaced was physically abandoned.

After a replacement well in approximately the same location is drilled, the replacement well may be operated in

conjunction with the original well and any other wells that replaced the original well if the total annual withdrawals from

all wells do not exceed the maximum amount allowed.

Revised 3/1/2016

DWR 55-41

Form Dwr 55-41 - Notice Of Intention To Deepen Or Modify An Existing Non-Exempt Well Or Construct A Replacement Non-Exempt Well At Approximately The Same Location In An Active Management Area - 2016 Page 3