Free GWS-41, WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37-90-107 - Colorado

LARGE - CAPACITY

STATE OF COLORADO OFFICE OF THE STATE ENGINEER AND THE GROUND WATER COMMISSION

9/2008-FORM NO. GWS-41

821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581

WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37-90-107
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 ISSUANCE OF THIS PERMIT DOES NOT CONFER A FINAL WATER RIGHT. THE WELL CONSTRUCTION AND PUMP INSTALLATION WORK MUST BE COMPLETED PRIOR TO THE EXPIRATION DATE OF THE PERMIT. THE PERMIT EXPIRATION DATE IS ONE YEAR FROM THE DATE ISSUED.The well must be constructed, and the pump installed prior to the expiration date of the permit. Evidence of well construction and pump installation must be submitted to this office in the form of a well construction report and the pump installation report from the respective contractors showing that construction and pump installation was completed prior to the expiration date of the well permit. The well permit number is located in the upper right hand corner of the permit, and the expiration date is located in the lower right hand corner. The expiration date of the permit may be extended once for a maximum time of one year at the discretion of the Commission for good cause shown. If an extension of time is necessary to construct the well, you must file a written request with this office prior to the expiration date. The request must be received with a $60 filing fee and must state why the well has not been completed, must include an estimate of time required to complete the well, and must specify the length of extension you desire, not to exceed one year. A STATEMENT OF BENEFICIAL USE (FORM NO. GWS-10) MUST BE SUBMITTED WITHIN THREE YEARS FROM THE DATE OF ISSUANCE OF THE PERMIT BY THE WELL OWNER. If the well is constructed prior to the expiration date of the permit, then, for the permit to continue to remain in effect, the well must be used for the approved purposes and the evidence of such use must be received in this office in the form of a Statement of Beneficial Use within three years from the date of issuance of this permit. ADDITIONAL INFORMATION REGARDING WELL CONSTRUCTION REGULATIONS ARE FOUND ON THE REVERSE SIDE OF THIS SHEET. AND WELL ABANDONMENT

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 the Pump Installation and Test Report, Form Number GWS-32 are available from the Division of Water Resources offices, or from our website at www.water.state.co.us . You have been provided with at least two copies of the well permit. The owner's copy is for your records. The second copy is for the pump installation contractor. Permit copies have also been provided to the well construction contractor indicated in the application. You may make additional copies of your permit copy for a well construction contractor if you select one different from the one indicated in your application. If you did not indicate a proposed well construction contractor on the application, four copies of the permit are enclosed. DO NOT GIVE YOUR "OWNER'S COPY" TO THE CONTRACTOR . 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 Ground Water Commission Staff in the Denver Office at (303) 866-3581.

THE WELL MUST BE CONSTRUCTED IN COMPLIANCE WITH THE WATER WELL CONSTRUCTION RULES unless 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 WATER WELL CONSTRUCTION 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, or from our website at www.water.state.co.us .

WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER. You may be allowed to 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 and/or pump equipment is installed with equipment owned and operated by you. It will be 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, or from our website at www.water.state.co.us . The well must be constructed and the pump installed in accordance with the Water Well Construction Rules.

THE WATER WELL CONSTRUCTION RULES, 2 CCR 402-2, ARE AVAILABLE FROM THE RECORDS SECTION OF THE DIVISION OF WATER RESOURCES (DENVER OFFICE) OR FROM www.water.state.co.us. The rules cover minimum well construction and pump installation standards, disinfection requirements, well plugging standards and contractor licensing regulations. If you are constructing your own well or installing your own pumping equipment, it is recommended that you obtain a copy of these rules for reference.