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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-46 (07/2009)

MONITORING/OBSERVATION Water Well Permit Application
Review instructions on reverse side prior to completing form. The form must be completed in black or blue ink or typed.

1. Well Owner Information
Name of well owner

6. Use Of Well Use of this well is limited to monitoring water levels and/or water quality sampling 7. Well Data (proposed)
Total depth Aquifer

Mailing address

City

State

Zip code

feet

8. Consultant Information (if applicable)
Telephone # E-Mail (Optional) Name of contact person

(

)
Company name

2. Type Of Application (check applicable boxes)
Use existing well Construct new well Other: Replacement for existing monitoring well: Permit no.:

Mailing address

3. Refer To (if applicable)
Monitoring hole acknowledgment Well name or #

City

State

Zip Code

MH-

Telephone #

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. Proposed Well Driller License #(optional): 10. Signature Of Well Owner 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

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

N

S

Ft. from

E

W
Print name & title

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

feet
Well location address (Include City, State, Zip)

direction
Check if well address is same as Item 1.

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

Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows:
Format must be UTM Zone 12 or Zone 13

Receipt area only
Easting Northing
YES

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

5. Property Owner Information
Name of property owner

Mailing address

City

State

Zip Code

Telephone #

DIV _____ WD _____ BA _____ MD _____

(

)

COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES

GWS-46 MONINST (07/2009)

MONITORING/OBSERVATION WELL PERMIT APPLICATION INSTRUCTIONS
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. FEES: This application must be submitted with a $100 filing fee. (The fee for an application to replace or deepen an existing permitted monitoring/observation well is $100 for locations outside Designated Ground Water Basins, and $60 inside Designated Ground Water Basins.) 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). Fees are nonrefundable. USES: This form (GWS-46) is to be used when applying for a permit where the only uses are monitoring of water levels and/or water quality sampling. For well construction criteria refer to the Colorado Water Well Construction Rules, 2CCR 4022. A copy of the Rules may be obtained from any Division of Water Resources Office for a fee of $5, or you may access them online from the State Board of Examiners' (BOE) website at http://www.water.state.co.us/boe/. ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form)
1. 2. 3. Provide the name of the well owner and the mailing address where all correspondence will be sent. Check and complete all boxes that apply. Provide the MH number assigned by the Division of Water Resources in response to the notice of intent to construct a monitoring/observation well. Complete the well name if the structure has a name or identifying number. If applying for a permit to construct a new well, you must provide the county, section #, township, range and principal meridian. You do not need to provide the ¼ of the ¼ section designation, distances from section lines or an optional GPS location (UTM coordinates). If a permit is issued and a well constructed, the authorized individual will be required to provide an accurate GPS location (UTM coordinates) of the "as-built" well location. If applying for a permit to use an existing well you must provide the well location information stated above, as well as either a GPS location (UTM coordinates) of the existing well site, or distances from section lines (including the ¼ of the ¼ section designation) as follows: In a typical case, a township is comprised of 36 sections, with each section ideally one mile square, or 5,280 feet on each side. Sections are further divided into quarter sections. Each ¼ Section is 2,640 feet by 2,640 feet and comprises 160 acres. Each ¼ section can be further divided into additional quarters. Each ¼ of the ¼ Section is 1,320 feet by 1,320 feet and comprises 40 acres. The distances are measured from the section lines. In the following example, the well is located 2,500 feet from the South Section line and 1,400 feet from the East Section line:

4.

NW1/4

NE1/4

5280 ft

3
SW1/4
1320 ft

.
NW1/4 SE1/4 NE1/4 SE1/4 SW1/4 SE1/4 SE1/4 SE1/4

Well Location Example: NW1/4 of the SE1/4 of Section 3, being 2500 feet from the South Section Line and 1400 feet from the East Section Line.

2640 ft

If providing a GPS location (UTM coordinates), the required GPS unit settings must be as indicated on this form. Colorado contains th two UTM zones (12 & 13). Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 108 Meridian th th th (longitude). West of the 108 Meridian is UTM Zone 12 and east of the 108 Meridian is UTM Zone 13. The 108 Meridian is approximately 57 miles east of the Colorado-Utah 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. 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. Provide property owner information. Use of this well is limited to monitoring water levels and/or water quality sampling only. The actual or anticipated total depth must be provided. Provide the name of the aquifer in which the well will be completed. Provide consultant information (if applicable). Monitoring/observation wells must be constructed by a Colorado licensed well construction contractor or authorized individual, as defined in the Well Construction Rules, 2CCR 402-2. Only a licensed contractor may construct any monitoring/observation well that penetrates a confining layer, or, is to be converted into a future production well. The well must be constructed in compliance with the Well Construction Rules, unless a variance has been approved allowing an alternative construction design. 10. An ORIGINAL signature of the well owner, or their authorized agent must be on the application. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water 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 (970-249-6622), Glenwood Springs (970-945-5665), Steamboat Springs (970-8790272), or Durango (970-247-1845), or refer to CDWR web site at http://www.water.state.co.us for general information. 5. 6. 7. 8. 9.