Pursuant to Rule 4.1(D) of the Blanco-Pedernales Groundwater Conservation District Rules, owner and operators of nonexempt wells must submit an annual report of groundwater production for the previous calendar year by January 31. If you hold an Operating Permit, please complete this form and report monthly groundwater withdrawals for the reporting year. If no water was withdrawn, check the "No Water Withdrawn" box and return the form. For questions or assistance, contact the District office at (830) 868-9196.

Instructions (For Downloaded Form): 

• Download and fill out the form
• Sign
• Mail, hand deliver OR scan and upload completed form using the form below

Instructions (For Online Form):

• Complete and submit the online form below
• Electronically sign 

Name of Permit Holder (required)

Permit Number (required)

Mailing Address (required)

Phone (required)

Email (required)

Check here if NO water was withdrawn from any well under this permit during the reporting year.

No Water Withdrawn

Meter Installed? (required)

Yes

No

If not, which method was used?

January (required)

February (required)

March (required)

April (required)

May (required)

June (required)

July (required)

August (required)

September (required)

October (required)

November (required)

December (required)

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I certify that the information contained in this report is true and accurate to the best of my knowledge, and that the withdrawals reported reflect all groundwater produced from nonexempt wells under my permit(s) during the reporting period.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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Failure to submit a completed report by January 31, the following calendar year, is a violation of Rule 4.1(D) of the District Rules and Texas Water Code Chapter 36, and will subject the permit holder to enforcement under Rule 9, including civil penalties of up to $25,000 per day per violation, suspension or revocation of the Operating Permit, and immediate cessation of all production authorized by the permit.