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COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST., RM 818, DENVER, CO 80203
phone ­ info: (303) 866-3587 main: (303) 866-3581 fax: (303) 866-3589 http://www.water.state.co.us

Office Use Only

Form GWS-44 (07/2009)

RESIDENTIAL Note: Also use this form to apply for livestock watering Water Well Permit Application
Review form instructions prior to completing form. The form must be completed in black or blue ink or typed.

1. Applicant Information
Name of applicant

6. Use Of Well (check applicable boxes)
See instructions to determine use(s) for which you may qualify A. Ordinary household use in one single-family dwelling (no outside use)

Mailing address City Telephone # State E-mail (optional) Zip code

B. Ordinary household use in 1 to 3 single-family dwellings: Number of dwellings: Home garden/lawn irrigation, not to exceed one acre: area irrigated sq. ft. acre Domestic animal watering ­ (non-commercial) C. Livestock watering (on farm/ranch/range/pasture)

(

) Construct new well Replace existing well Use existing well Change or increase use Change source (aquifer) Reapplication (expired permit) Rooftop precip. collection Other:
Water Court case #

2. Type Of Application (check applicable boxes)

7. Well Data (proposed)
Maximum pumping rate Annual amount to be withdrawn

gpm
Total depth Aquifer

acre-feet

3. Refer To (if applicable)
Well permit # Designated Basin Determination # Well name or #

feet

8. Water Supplier
Is this parcel within boundaries of a water service area? If yes, provide name of supplier:
YES NO

4. Location Of Proposed Well (Important! See Instructions)
County 1/4 of the Section Township N or S Range E or W Principal Meridian 1/4

9. Type Of Sewage System
Septic tank / absorption leach field Central system: District name: Vault: Location sewage to be hauled to:

Distance of well from section lines (section lines are typically not property lines) Ft. from

N feet

S

Ft. from

E

W

Other (attach copy of engineering design and report)

For replacement wells only ­ distance and direction from old well to new well

direction
Check if well address is same as in Item 1.

10. Proposed Well Driller License #(optional): 11. Signature Of Applicant(s) Or Authorized Agent
The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge.
Sign here (Must be original signature) Date

Well location address (Include City, State, Zip)

Optional: GPS well location information in UTM format. GPS unit settings are as follows: Format must be UTM Zone 12 or Zone 13

Easting: Northing:
YES Print name & title

Units must be Meters Datum must be NAD83 Unit must be set to true north Was GPS unit checked for above?

Remember to set Datum to NAD83

Office Use Only
USGS map name DWR map no. Surface elev.

5. Parcel On Which Well Will Be Located
(YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. You must check and complete one of the following: Subdivision: Name Lot Name/# Block Filing/Unit Lot # County exemption (attach copy of county approval & survey):

Receipt area only

Parcel less than 35 acres, not in a subdivision, attach a deed with metes and bounds description recorded prior to June 1, 1972, and a current deed Mining claim (attach a copy of the deed or survey): Name/# Square 40 acre parcel as described in Item 4 Parcel of 35 or more acres (attach a metes and bounds description or survey) Other (attach metes & bounds description or survey and supporting documents) B. # of acres in parcel C. Are you the owner of this parcel?
YES NO (if no ­ see instructions) NO (if no ­ list other wells)

AQUAMAP WE WR CWCB TOPO MYLAR SB5

D. Will this be the only well on this parcel? E.
State Parcel ID# (optional):

YES

DIV _____ WD _____ BA _____ MD _____

COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES
Applications must be typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned for more information. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the original form. DO NOT use this form for the registration of an existing well in use prior to May 8, 1972; (use Form GWS-12). FEES: This application must be submitted with the appropriate filing fee. The filing fee for applications is $100. Exceptions are as follows: 1) An application to replace or deepen an existing permitted well that in the same source (aquifer) which does not have a "-F" or "-R" suffix after the original permit number is $60. 2) Applications to register an existing well (use Form GWS-12), and replace or deepen the well (use Form GWS-44) into the same aquifer is $100 if submitted together. Fees are nonrefundable. Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources, and Visa, MasterCard or Discover (card number and expiration date must be provided on a separate attachment). USES: This form (GWS-44) is to be used when applying for a permit for the following types of uses: A. Ordinary household use inside one single-family dwelling (NO outside water use allowed): Generally, this is all that can be approved on parcels less than 35 acres. Ordinary household use in 1 to 3 single-family dwellings, irrigation of up to one acre of home garden and lawn, and watering of domestic animals: Generally, permits can be approved on parcels of land of 35 or more acres, or in areas inside the Designated Basins, the Denver Basin, limited areas on the Western Slope, and for subdivisions under a courtapproved plan for augmentation that allow outside uses. Livestock watering on farm, ranch, range, or pasture (on parcels of 35 or more acres). 8.

GWS-44 RESINST (07/2009)

RESIDENTIAL WELL PERMIT APPLICATION INSTRUCTIONS
Provide the property address of the well location if one exists. If it is the same as the mailing address, check the box next to the well location address. 5. A current deed for the subject parcel must be attached. If the subject parcel is 35 or more acres, a complete metes and bounds type legal description or surveyor's plat map that references a section point must be provided to enable us to plot the parcel in our mapping system. If the parcel is less than 35 acres and not in a subdivision, a deed with metes and bounds legal description, recorded prior to June 1, 1972 must be attached. Complete Items 5A through 5E (5E is optional). If you answered NO to Item 5C, please state in an attachment who the landowner is. If you are under a contract to purchase the subject property, please state this as well. If the parcel is inside the Denver Basin, the application must be in the name of, and signed by, the current landowner. See above comments under USES to determine those uses for which you may qualify, and then check the applicable box or boxes. The maximum pumping rate is limited to 15 gpm for most residential type well permits. The annual amount of water to be withdrawn is a volume measured in acre-feet. One acre-foot equals 325,851 gallons. For ordinary household use inside one single-family dwelling and no outside use, the annual amount will be about 1/3 acre-foot. For ordinary household use in three single-family dwellings, one acre of home garden/lawn irrigation, and watering of domestic animals, the annual amount will be about 3 acre-feet. For 100 head of livestock, the annual amount will be about 1.35 acre-feet. Please indicate the estimated depth of the proposed well. The proposed aquifer for the well must be indicated if the well is to be located within the Denver Basin (the approximate area of the Denver Basin extends south from Greeley to an area east of Colorado Springs and from Golden east to Limon), the San Luis Valley, the Southern High Plains basin in Baca or Prowers Counties, or in areas where it is believed the well will penetrate a confining layer. Aquifer information should be provided if known, for well locations outside of these areas. The issuance of well permits may depend on the availability of another source of water, pursuant to CRS 37-92-602(6), such as water from a municipality or water district. (Statutes can be accessed through the CDWR web site.) Check the applicable box, and complete or attach any additional information as requested in this item.

6.

7.

B.

C.

ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form) 1. The applicant is the entity for whom the permit is to be issued. Since the well owner is ultimately responsible for the use of the well, their name should be in this area. The mailing address is where the applicant currently receives mail. Check all boxes that apply. If you check the box for Rooftop precip. collection, you must also complete and submit Form No. GWS-78. Complete all boxes that apply. You must provide a well spot location under the following circumstances: (a) the location is decreed by a water court; (b) the well will be inside the Denver Basin or other location where a sitespecific well depth restriction will apply; (c) your application is for a permit to use an existing well. When a spot location is required, you must provide the county, ¼ of the ¼ section designation (example: NE ¼ of the SE ¼), section #, township, range, principal meridian, and either distances from section lines or a GPS location (UTM coordinates). If providing a GPS location, the required GPS unit settings must be as indicated on this form. Colorado contains two UTM zones (12 & 13). Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 108th Meridian (longitude). West of the 108th Meridian is UTM Zone 12 and east of the 108th Meridian is UTM Zone 13. The 108th Meridian is approximately 57 miles east of the ColoradoUtah state line. On most GPS units, the UTM zone is given as part of the Easting measurement, e.g. 12T0123456. Check the appropriate box for the zone. For all other applicants, you must provide the following minimum information: (a) the county, section #, township, range and principal meridian; and, (b) the subdivision lot, block & filing/unit designations as applicable if in a subdivision. You do not need to provide distances from section lines or a GPS location (UTM coordinates).

9.

2.

3. 4.

10. Wells must be constructed by a Colorado licensed well driller, or under the "private driller" provision as defined in CRS 37-91102(12). A listing of licensed well drillers/pump installers is available at http://www.state.co.us/boe/contractors.asp. 11. An ORIGINAL signature must be on the application. The individual signing the application must be the applicant or an officer of the corporation/company/agency identified as the applicant. An authorized agent may sign the application, if a letter signed by the applicant is submitted with the application authorizing that agent to sign on the applicant's behalf.

IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Colo. Division of Water Resources Information Desk (303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683), Montrose (970-2496622), Glenwood Springs (970-945-5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to the CDWR web site at http://www.water.state.co.us for general information, additional forms, and access to state rules or statutes.