Form LC-25 Lower Colorado River Well Inventory

OMB Approval No. 1006-0014
Expiration Date:

Lower Colorado River Well Inventory

Site ID: ___________________________________ Date: ______________ Time (MST): __________ Agency: ____________ Collected by: _______________
Site Name: ________________________________ Land Net: _____ 1/4 _____ 1/4_____ 1/4

Section________Township________ Range_______ State: _____

Other identifier or markings: ______________________________________ GPS file name:________________________________ County: _________________
Data reliability:

C (field checked)

L (poor location) M (minimal data)

Outer casing ID: _______________ in.

U (unchecked)

Material: ____________________

Outer casing ht. above land surface (LS): ____________________________ ft

Agency use:

O

District code: 04

Inner casing ID: _______________ in.

Station type: _______

Material: _______________________

Distance between tops of inner and outer casings: ________________________ ft

Describe reference point for LS: __________________________________________________________________________________________________________
Condition of well: _____________________________________________________________________________________________________________________
Type of power: ________________________ Motor brand: _____________________________ Serial no.: ______________________________ HP: ____________
Power meter no.: _______________________________ Power company: _________________________________________________________________________
Type of pump: _________________ Diameter of discharge pipe: ________________ in.

Flow rate: ___________cfs / gpm

Method of meas: ______________

Photograph no. ____________________, view toward __________, showing _____________________________________________________________________
Photograph no. ____________________, view toward __________, showing _____________________________________________________________________
________ft _______ from power pole no._____________; _________ft _______ from stop sign; ________ ft ________from street sign; ________ft ____from canal
________ft _______ from __________________________________________; ________ft _______ from ______________________________________________
Additional location information: __________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Water level (WL) required outside flood plain above Laguna Dam
Tape Held: ____________________________________________________ ft

WL measurement method: ___________________________________________

WL Cut: ______________________________________________________ ft

Measuring point (MP) description: ____________________________________

WL below MP: ________________________________________________ ft

_________________________________________________________________

MP height above LS: ___________________________________________ ft

TD below MP: ___________________________________________________ ft

WL below LS: _________________________________________________ ft

TD below LS: ____________________________________________________ ft

Status of nearby fields, pumps, canals, etc.: _________________________________________________________________________________________________
Site status for WL: _______________________________________________
D (dry)
E (recently flowing)
F (flowing)

Source of WL other than measured: ____________________________________

G (nearby flowing)
J (injector site monitor) P (pumping)
H (nearby recently flowing) N (measurement discon.) R (recently pumped)
I (injector site)
O (obstruction)
S (nearby pumping)

T (nearby recently pumped) X (surface-water
V (foreign substance)
effects)
W (well destroyed)
Z (other)

Use of site (list all that apply in order of use): _______________________________________________________________________________________________
A (anode)
C (standby emerg.)
D (drain)

E (geothermal)
G (seismic)
H (heat reservoir)

M (mine)
O (observation)
P (oil or gas)

R (recharge)
S (repressurize)
T (test)

U (unused)
W (withdrawal)
X (waste)

Z (destroyed)

Uses of water (list all that apply in order of use): _____________________________________________________________________________________________
A
B
C
D

(air cond., comm.)
(bottling)
(commercial)
(dewatering)

E
F
H
I

(power generation)
(fire fighting)
(domestic)
(irrigation)

J (industrial cooling)
K (mining)
M (medicinal)

N (industrial other)
P (public supply)
Q (aquaculture)

Domestic only: number of single family residences: __________; number of multifamily residences: __________

R (recreational)
S (stock watering)
T (institutional)

U (unused)
Y (desalination)
Z (other- explain)

Swimming pool: yes / no______________

Stock only: number: __________; type: __________ Irrigation only: number of acres served by this well:__________ ; other source of irrigation water: _________
Disposal of unconsumed portion of pumped water (list all that apply): ____________________________________________________________________________
ST (septic tank)

SS (sewer system)

EP (evaporation pond)

SR (surface return
PS (percolation into soil)
OT (other-explain)
to river)
If sewer system used, include name of municipality operating it: ________________________________________________________________________________
Property owner’s name (last, first, m.i.): ____________________________________________________________________________________________________
Property owner’s phone number: ____________________________________________________________________ Date property acquired: __________________
Property owner’s complete mailing address: _________________________________________________________________________________________________
Street address of well: __________________________________________________________________________________________________________________
Well operator’s name (last, first, m.i.): _____________________________________________________________________________________________________
Well operator’s phone number: _____________________________________________________________________ Date operation began: ____________________
Well operator’s complete mailing address: __________________________________________________________________________________________________
Please return to: U.S. Geological Survey WRD, 520 North Park Avenue, Tucson, AZ 85719, or call 520-670-6671

Revised 02/25/09

Driller’s name (company or individual): ____________________________________________________________________________________________________
Original well owner: ______________________________________________________________________________ Date well completed: ____________________
Annual volume pumped (acre-feet, gallons, cubic meters); (measured, estimated): ___________________________________________________________________
Is well within the service area of a water supplier?: ____ Name/address of water supplier: ____________________________________________________________
Well permit no.: _________________________________________________

Issuing agency: ___________________________________________________

Federal delivery contract name: _____________________________________

Assessor’s parcel no.: _______________________________________________

Latitude: _______________________________________________________

UTM Northing: __________________________________________________ m

Longitude: ______________________________________________________

UTM Easting: ___________________________________________________ m

Lat/Long. Accuracy: ______________________________________________

UTM Accuracy: _____________________m

Zone number:

11 _______

Geographic Datum:_______________________________________________

Location method: __________________________________________________

Elevation of reference point:________________________________________

Elevation of MP: _________________

Elevation method:_________________

Description of reference point for elevation: _________________________________________________________________________________________________
A (Altimeter)
B (GPS Autonomous Geographic)
If Map:

C (GPS Differential Correction Geographic)
D (GPS Differential Correction Geodetic)

L (Level-conventional survey)
M (Map)

Map name: _____________________________ Accuracy: _____________ Scale: _________________

Altitude of LS: ____________________ft

LCRAS field numbers watered by well: ____________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Remarks (additional comments or sketches): ________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________

Paperwork Reduction Act Notice
The Colorado River Basin Project Act and the Boulder Canyon Project Act authorize collection of this information. The primary use of this information is to determine
the contractual status and consumptive use of Colorado River water from wells. Records of volume of water being pumped, consumptive uses, and point of diversion will
be disclosed to interested parties upon written request. Public reporting burden for this form is estimated to average 20 minutes per response, including time for
reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Furnishing the information on this form is voluntary. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB)
control number.

Privacy Act Statement
Information contained on this form is protected by the Privacy Act of 1974 and will be maintained in INTERIOR/WBR-48 system of records.