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COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES

GWS-78 (7/2009)

INSTRUCTIONS FOR ROOFTOP PRECIPITATION COLLECTION SYSTEM PERMIT APPLICATION
This form must be completed in black or blue ink or typed. Initial and date any changes made on the form.
FEES: Refer to the section below titled, HOW TO APPLY to determine if you need to pay a fee and the amount. Fees are nonrefundable. Acceptable forms of payment are check or money order payable to the Colo. Div. of Water Resources (CDWR), and Visa, MasterCard or Discover (card number and expiration date must be provided on a separate attachment). Pursuant to Senate Bill 09-080 (signed by the Governor on 4/22/2009) on or after July 1, 2009, any person wishing to use a system or method of rooftop precipitation collection must qualify under Colorado Revised Statutes (C.R.S.) 37-92-602(g) or 37-90105(f). TO QUALIFY, ALL OF THE FOLLOWING MINIMUM CRITERIA MUST BE MET: 1. The property on which the collection will take place is residential property; and, 2. The property must either have a water well or be legally entitled to have a water well as the water supply; and, 3. The well use does not exceed those uses described in C.R.S. 37-92-602(g) or 37-90-105(f), being ordinary household purposes, lawn/garden irrigation of not more than one acre, watering of poultry, domestic animals, and livestock on farms and ranches, and fire protection; and, 4. There is no water supply to serve the property available from a municipality or water district; and, 5. The precipitation is collected only from the roof; and, 6. The collected precipitation is only used for those uses that are allowed by the existing well permit, or on a well permit that the property would be legally entitled to. If you do not meet ALL of the above criteria, or if your well permit number ends with a suffix other than "-A" such as "-F" or "-R", the provisions of Senate Bill 09-080 do not apply to you, and it is illegal for you to collect or divert and use precipitation falling on your property, unless a water court decree (unusual) specifically allows such use. HOW TO APPLY: Follow the instructions below that best fit your situation; completed forms should be submitted to the Division office where your property is located. For Divisions 1 & 2, submit form(s) to the Denver office. A. If you have an existing permitted well or unexpired well permit issued pursuant to C.R.S. 37-92-602 or 37-90-105; and, you want to include a rooftop precipitation collection system as an approved use, complete this form. There is no filing fee. If you don't know whether or not your existing well is permitted and you need assistance in determining this, you may complete and submit the online "Find My Well Permit Request Form" on the CDWR website at http://www.water.state.co.us. If the well was in use prior to May 8, 1972, it is less likely to have been issued a permit. B. If you are applying for a permit to construct a well and use a rooftop precipitation collection system, complete Form No. GWS-44, Residential Water Well Permit Application, and this form. The filing fee for Form No. GWS-44 is $100. There is no filing fee for this form. C. If you do not intend to construct a well, but want to use a rooftop precipitation collection system, complete this form and Form No. GWS-44, Residential Water Well Permit Application so the CDWR can determine if your property is entitled to the issuance of a well permit. The filing fee for this form is $60. There is no filing fee for Form No. GWS-44 in this case since a permit to construct a well will not be issued. D. If you have an existing unpermitted well that was in use prior to May 8, 1972, for those uses described in C.R.S. 37-92602(g) or 37-90-105(f), and you want to include a rooftop precipitation collection system as an approved use, complete this form and Form No. GWS-12, Registration Of Existing Well. The filing fee for Form No. GWS-12 is $100. There is no filing fee for this form. You must review the instructions for completing Form No. GWS-12 prior to submitting it to determine if you will also need to complete and submit Form No. GWS-12-A, Statement of Historical Uses, or contact the Division office in which your well is located to request a field inspection for verification of the well's existence and uses. If you have any questions, contact the Division office where your property is located, or the Denver office. Water Divisions and offices are based on major river drainage areas. For example, the Division 1 office administers the South Platte River Basin.

Division 1 th 810 9 St., Ste. 200 Greeley, CO 80631 (970) 352-8712 Fax (970) 392-1816 Division 5 Direct mail to P.O. Box 396 Glenwood Spgs CO 81602 50633 U.S. Hwy 6 & 24 Glenwood Spgs., CO 81601 (970) 945-5665 Fax (970) 945-8741

Division 2 310 E. Abriendo Ave., Ste. B Pueblo, CO 81004 (719) 542-3368 Fax (719) 544-0800 Division 6 Direct mail to Box 773450 505 Anglers Dr. Suite 101 Steamboat Spgs, CO 80477 (970) 879-0272 Fax (970) 879-1070

Division 3 301 Murphy Drive Alamosa, CO 81101 (719) 589-6683 Fax (719) 589-6685 Division 7 160 Rock Point Dr., Ste. E Durango, CO 81301 (970) 247-1845 Fax (970) 259-0944

Division 4 1871 East Main St. Montrose, CO 81401 (970) 249-6622 Fax (970) 249-8728 Denver Office 1313 Sherman St., Rm. 818 Denver, CO 80203 (303) 866-3587 Fax (303) 866-2223

Form No. GWS-78 7/2009

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) 866-2223 http://www.water.state.co.us

For Office Use Only

ROOFTOP PRECIPITATION COLLECTION SYSTEM Permit Application
For existing permitted well or unexpired permit, insert the permit # on line below (Review form instructions before completing or submitting form). ____________________ __
Div_____ WD_____ Basin_____ MD_____

Applicant Information: Name(s) Mailing Address City, St. Zip Phone ( )

Disclaimer Statement: The State Engineer/Division of Water Resources assumes no responsibility or liability regarding the quality of collected precipitation as a water supply.

Location: County 1/4 of the 1/4, Section , Township N. or S., Range E. or W., P. M.

Property Address: ____________________________________________________________________________________ Check here if property address is same as above under Applicant Information. Is/will the property be served by a domestic water system that serves more than three single-family dwellings such as a municipality or water district? Yes / No: If "Yes", you do not qualify for a rooftop precipitation collection system. See instructions for this form or CDWR's website referenced at the top of this form for more details. Describe the rooftop precipitation collection system below. The use of collected precipitation is limited to those uses allowed by the existing well permit, or on a well permit that the property would legally be entitled to.

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. Signature(s) of the Applicant or Agent: Print the Signer's Name: Date:

For Office Use Only

__________________________________________
State Engineer

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By

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Date