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Virginia Administrative Code
Title 9. Environment
Agency 25. State Water Control Board
Chapter 610. Groundwater Withdrawal Regulations
7/3/2025

FORMS (9VAC25-610).

Groundwater Withdrawal Application Submission Checklist (eff. 2/2023)

Department of Environmental Quality Water Division Permit Application Fee Form, Form 5 (rev. 10/2018)

Application for a Groundwater Withdrawal Permit (rev. 11/2022)

Groundwater Withdrawal Permit - Change of Ownership Agreement Form (rev. 7/2022)

Uncontested Termination Agreement (rev. 11/2013)

Uniform Water Well Completion Report, Form GW-2 (rev. 8/2016)

Uniform Water Well Completion Report Well Abandonment Form, GW-5 (rev. 8/2016)

Public Notice Authorization Form - Authorization for Public Notice Billing to Groundwater Withdrawal Permit Applicant (rev. 10/2019)

Preapplication Meeting - Application for a Groundwater Withdrawal Permit (rev. 6/2021)

Local Government Ordinance Form (rev. 9/2019)

Quarterly Groundwater Withdrawal Report (rev. 12/2019)

Mitigation Plan (rev. 10/2019)

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