The Dwr 55 56 form, issued by the Arizona Department of Water Resources (ADWR), serves as a crucial document for the completion of pump installations within the state. As a detailed report, it needs to be submitted by the registered well owner to the ADWR's Information Management Unit within 30 days following the installation of pump equipment. Designed to ensure compliance and proper management of water resources, this form captures comprehensive information, ranging from well owner details, well location, pump installation specifics, to pump test data. Completing this form requires attention to detail, using either black or blue ink, and following the instructions provided to avoid errors. Information such as the well registration number, type of pump installed, power source, and rated pump capacity are among the key details that need to be accurately reported. Additionally, the form includes a section for recording pump test outcomes, an essential part of verifying the operational efficiency and impact of the new installation on the water table. A certified signature by the well owner attests to the accuracy of the information provided, in compliance with Arizona Revised Statutes § 45-600(B). This document not only facilitates regulatory oversight but also contributes to the sustainable management and stewardship of Arizona's water resources.
| Question | Answer |
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| Form Name | Dwr 55 56 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Pitless, AZ, Centrifugal, azwater |
Arizona Department of Water Resources
Information Management Unit
P.O. Box 33589, Phoenix, AZ
(602)
Pump Installation Completion Report
Review instructions prior to completing form in black or blue ink.
The registered well owner should file this report with the Department within 30 days following installation of pump equipment.
** PLEASE PRINT CLEARLY **
FILE NUMBER
WELL REGISTRATION NUMBER
55 -
SECTION 1. REGISTRY INFORMATION
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Well Owner |
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Location of Well |
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FULL NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL |
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WELL LOCATION ADDRESS (IF ANY) |
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MAILING ADDRESS |
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TOWNSHIP (N/S) |
RANGE (E/W) |
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SECTION |
160 ACRE |
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40 ACRE |
10 ACRE |
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¼ |
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¼ |
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CITY / STATE / ZIP CODE |
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COUNTY ASSESSOR’S PARCEL ID NUMBER (MOST RECENT) |
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BOOK |
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MAP |
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PARCEL |
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CONTACT PERSON NAME AND TITLE |
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COUNTY WHERE WELL IS LOCATED |
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TELEPHONE NUMBER |
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FAX |
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SECTION 2. EQUIPMENT INSTALLED |
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DATE PUMP INSTALLED |
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Pitless Adaptor |
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CHECK ONE (SEE INSTRUCTIONS FOR DEFINITION) |
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Was a pitless adaptor installed? |
Yes |
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Pump Type |
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CHECK ONE |
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No |
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IF YES, DEPTH BELOW GROUND LEVEL THE DEVICE WAS INSTALLED |
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Air Lift |
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Rotary |
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FEET |
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Bucket |
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Submersible |
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Power Type |
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Centrifugal |
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Turbine |
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CHECK ONE |
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Jet |
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Other (please specify): |
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Diesel Engine |
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Natural Gas |
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Piston |
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Electric Motor |
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Windmill |
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Gasoline Engine |
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Other (please specify): |
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Hand |
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RATED PUMP CAPACITY |
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HORSE POWER RATING OF MOTOR |
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GALLONS PER MINUTE |
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SECTION 3. PUMP TEST |
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Pump Test Data |
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Method of Discharge Measurement |
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Method of Measuring Water Level |
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DATE WELL TESTED |
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CHECK ONE |
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CHECK ONE |
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Bailer |
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Air Line |
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STATIC WATER LEVEL (A) |
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Bucket – Barrel – Stopwatch |
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Electric Measuring Line (Sounder) |
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FEET BELOW LAND SURFACE |
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Current |
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Steel Tape |
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PUMPING WATER LEVEL (B) |
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Estimated – Air Lift |
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Other (please specify): |
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FEET BELOW LAND SURFACE |
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Gauge |
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DRAWDOWN [ (B) – (A) ] |
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Meter |
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FEET BELOW LAND SURFACE |
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Orifice |
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TEST PUMPING RATE |
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Volume |
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GALLONS PER MINUTE |
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Weir – Flume |
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DURATION OF PUMP TEST (Minimum 4 Hours) |
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Other (please specify): |
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HOURS |
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TOTAL PUMPING LIFT |
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FEET |
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FOR FLOWING WELL, |
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FT |
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MEASURED SHUT IN HEAD |
PSI |
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I HEREBY CERTIFY that the above statements are true to the best of my knowledge and belief according to A.R.S. §
SIGNATURE OF WELL OWNER
DATE
DWR