Get $100 Fee

Filling out the $100 FEE form is essential for obtaining permission to drill, deepen, replace, or modify a well. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete your $100 FEE form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by reviewing the instructions carefully to ensure you understand the requirements for completing the form. Use black or blue ink when manually filling it out if necessary.
3. In Section 1, if applicable, indicate whether you have obtained approval from your local health authority by checking the appropriate box and providing their details.
4. Proceed to Section 2 to complete your registry information, including the well type, proposed action, and exact location details of the well. Ensure that you provide accurate township, range, and section information.
5. In Section 3, provide the owner's information. If the well owner and land owner are the same, indicate this by checking the respective box.
6. Section 4 presents several questions regarding the well site. Answer all questions accurately, marking 'Yes' or 'No' as applicable, and follow any additional instructions if necessary.
7. Complete Section 5 with the drilling firm's information, including their name and contact details.
8. In Section 6, detail the principal and other uses of water intended for the well. Be specific about any irrigation or industrial uses.
9. Proceed to Section 7 for pro forma well construction design details. Attach separate sheets if necessary and ensure all specifications for casing and borehole are included.
10. If required, check the box in Section 8 to grant permission for the agency to access your property for water level measurements.
11. Draw your well site plan as instructed in Section 9, ensuring all required elements such as property boundaries and locations of existing systems are included.
12. Finally, in Section 10, sign and date the form, ensuring all information provided is complete and accurate. Review your form thoroughly before submission.
13. After completing the form, choose to save changes, download a copy, print it, or share your completed form as needed.

Complete your $100 FEE form online today for swift processing!