Free GWS-05, INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-90-105 - Colorado

Form No. GWS-5 6/2009

STATE OF COLORADO OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 Fax (303) 866-3589

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INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-90-105 (DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
PLEASE NOTE CAREFULLY THE CONDITIONS OF APPROVAL ON THE ATTACHED COPY OF YOUR PERMIT. THE CONDITIONS MUST BE COMPLIED WITH IN ORDER FOR THE PERMIT TO BE VALID. THE PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. The well must be constructed and evidence of its construction must be submitted to this office in the form of a well construction report from the well construction contractor confirming that construction was completed prior to expiration of the well permit. The permit number is located in the upper right hand corner of the permit. The expiration date is located in the lower right hand corner. The expiration date may be extended at the discretion of the State Engineer for good cause shown. If you desire an extension, you must file a written request with this office prior to the expiration date shown on the permit. The request must state why the well has not been constructed, must include an estimate of time required to complete the well, and must specify the length of extension you desire, not to exceed one (1) year. There is no filing fee for the extension. ADDITIONAL INFORMATION REGARDING WELL CONSTRUCTION AND WELL ABANDONMENT REGULATIONS ARE FOUND ON THE REVERSE SIDE OF THIS SHEET. THE WELL MUST BE CONSTRUCTED AND THE PUMP INSTALLED BY CONTRACTORS WITH CURRENT LICENSE(S) ISSUED BY THE STATE OF COLORADO unless exempted as described on the reverse side. The well construction and pump installation reports must be submitted to the office of the State Engineer within sixty (60) days of completion of the work or within seven days after expiration of the permit, whichever is earlier. Your contractor must provide you with a copy of the work report(s) he has filed with the State Engineer. The Well Construction and Test Report, Form Number GWS-31 and Pump Installation and Test Report, Form Number GWS-32 are available from the Division of Water Resources offices, or from our website at http://www.water.state.co.us. You have been provided with at least two copies of the well permit. Keep a copy for your records. There is also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller license number on the application, or two additional copies have been enclosed. You may make additional copies for the well construction contractor if you select one different from the one indicated in your application. The original permit is on file in the Denver Office Records Section. Additional copies may be obtained for a fee of 50 cents per page. Any change of mailing address or ownership should be reported to the State Engineer by the new owner on a "Change in Ownership/Address", form number GWS-11. If you have questions, contact the Denver Office or the Division Office and to a limited extent the local Ground Water Management District where your well is located.
Denver Office 1313 Sherman St., Rm 821 Denver, CO 80203 (303) 866-3581 Frenchman & Marks Butte Nate Midcap, Mgr. 103 E Emerson Holyoke, CO 80734 (970) 854-3484 Monday Upper Black Squirrel Tracy Doran, Dist. Mgr. 520 Colorado Ave., #C Calhan, CO 80808 (719) 347-0704 Division 1 810 9th St., Ste. 200 Greeley, CO 80631 (970) 352-8712 Lost Creek Thomas Sauter, Mgr. 50005 East 120th Ave. Bennett, CO 80102 (303) 644-3314 Southern High Plains Don Wood, Pres. 36663 Co. Rd. UU Two Buttes, CO 81084 (719) 326-5244 Division 2 310 E Abriendo, Ste. B Pueblo, CO 81004 (719) 542-3368 North Kiowa-Bijou Loyd Musgrave, Mgr. 76860 E 168th Ave Wiggins, CO 80654 (970) 483-5652 Washington-Yuma Jack Dowell, Mgr. P.O. Box 121 Yuma, CO 80759 (970) 848-5333 Arikaree Rod Mason, Mgr. 5462 CR TT Cope, CO 80812-9400 (970) 357-4289 Plains & E Cheyenne Deb Daniel, Mgr. P.O. Box 188 Burlington, CO 80807 (719) 346-8487 Republican River WC Dist. Stan Murphy 410 Main St., Ste. 8 Wray, CO 80758 (970) 332-3552 Central Yuma & Sandhills Nate Midcap, Mgr. 342 Main St. Wray, CO 80758 (303) 332-4155 Thursday Upper Big Sandy Leann Pyatt, Mgr. P.O. Box 241 Simla, CO 80835-0241 (719) 541-5600

THE WELL MUST BE CONSTRUCTED IN COMPLIANCE WITH THE WATER WELL CONSTRUCTION RULESunless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors. WELLS TO BE PLUGGED AND ABANDONED MUST BE PLUGGED IN ACCORDANCE WITH RULE 16 OF THE WELL CONSTRUCTION AND PUMP INSTALLATION RULES. A Well Abandonment Report, Form Number GWS-9, must be submitted to confirm the plugging and sealing of the well. This form is available from our offices. WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER. You may construct the well and/or install the pump yourself if the well is entirely for your own use, is on property you own, and is constructed or pump equipment is installed with equipment owned and operated by you. It is your responsibility to complete and submit the Well Construction and Test Report, Form Number GWS-31 and/or the Pump installation and Test Report, Form Number GWS-32. These forms are available from our offices. The well must be constructed and the pump installed in accordance with the construction standards of the State Board of Examiners of Water Well Construction and Pump Installation Contractors. THE WATER WELL CONSTRUCTION RULES, 2 CCR 402-2, ARE AVAILABLE FROM DIVISION OF WATER RESOURCES OFFICES FOR A FEE OF $5.00. They may also be viewed or copied from our website at http://www.water.state.co.us. The rules cover well construction, pump installation, disinfecting, abandonment and contractor licensing regulations. If you are constructing your own well or installing pumping equipment, it is recommended that you obtain a copy of these rules for reference.