Groundwater Withdrawal Notice of Intent (NOI) New Well Construction

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Discharge 1: Lat Long:

Groundwater Withdrawal Notice of Intent


Percentage of Water returned:

(NOI) New Well Construction


A. General Information
1. Facility Name:
2. Facility Address: City: State: Zip:
3. Owner Name: 8. Contact Name:
4. Owner Address: 9. Contact Address:

City: State: Zip City: State: Zip:

5. Owner Telephone Number: 10. Contact Telephone Number:


6. Owner Fax Number: 11. Contact Fax Number:
7. Owner E-Mail Address: 12. Contact E-Mail Address:
13. Name and phone number of Agent completing application:

B. Purpose for Groundwater Use: (please indicate number of wells or sources beside description which best
applies, include a combined estimated maximum monthly withdrawal in million gallons next to description)
Water Supply (WS) MG Industrial (IN) MG

Golf Course Irrigation (GC) MG Aquaculture (AQ) MG

Agricultural Irrigation (AI) MG Other (OT) MG

C. Well Driller Information

1. Company Name: 5. E-mail Address:


2. Well Driller's Name: 6. SC Certification Number:
3. Company Address: City: State: Zip:
4. Telephone Number: 7. Fax Number:
D. Well Location/Construction and Site Details

Include with the NOI the address of the facility, a map depicting the location of each existing and proposed well(s). Include irrigated areas
if withdrawing water for irrigation purposes. Include Latitude/Longitude for each well.

E. Signature/Certification

I certify that the information herein is complete and all documentation was prepared under my direction or supervision and the information,
to the best of my knowledge and belief is true, accurate, and complete.

Print/Type Name:

Signature: Date:

DHEC 3724 (01/2014)


NOI DHEC 3724 Directions
1. Purpose: To provide notifications and obtain information on the construction of new wells
that will be located in existing well systems, or will alone plan to withdraw in excess of 3-
million gallons in any one month located outside of a Capacity-Use Area and within the
Coastal Plain. These counties include all of Aiken, Allendale, Bamberg, Barnwell, Calhoun,
Clarendon, Orangeburg, Sumter counties, as well as those portions of Chesterfield,
Edgefield, Kershaw, Lexington, Richland, and Saluda counties east or southeast of the fall
line as identified on a Geologic Map.

2. Filing Process and Office Dynamics:


A. Once a NOI is received the Department will issue the facility a sequential Groundwater
Withdrawer registration number.

B. Once the well is drilled, the owner of the well is responsible to submit a Well
Driller’s Record, DHEC Doc. # 1903, or other approved construction forms to: SCDHEC
(Water Permitting Section), 2600 Bull St., Columbia, SC 29201.

3. Guide to Completing NOI Form:

A. Complete steps 1-11 as appropriate. For cells #1 – cell #6, complete for the owner of the
facility. For cells #7 - cell #11, complete for the main contact of the facility with the
Department.

B. To the left of the Groundwater Use description put the number of wells owned by the
facility used primarily for that purpose. To the right of the Groundwater Use description,
estimate the amount (in millions of gallons per month) to be used collectively by the
well(s).

C. Complete the well driller’s information, if known.

D. Include a map of the facility including operating wells, well identification, and a
latitude/longitude of each well.

E. This form should be signed by the individual who will hold ultimate legal responsibility.

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