Free Microsoft Word - 64General Extension.DOC - Colorado

COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES

GWS-64 (6/2009)

INFORMATION FOR AN EXTENSION OF THE EXPIRATION DATE OF A WELL PERMIT
The form must be completed in black or blue ink or typed. Initial and date any changes made on the form.

Be sure to include the well permit number in the space provided at the top of the form.
The filing fee for well permit extension requests varies depending on what statute the permit was issued under. The statute under which the permit was issued is found in the conditions of approval on your well permit. Below, please find the statute your well permit was issued under to determine the appropriate filing fee, and for additional information. 1. CRS 37-92-602 or CRS 37-90-105: The permit to construct a well is valid for a two-year period. A request for extension is required when the well will not be constructed by the permit expiration date. Successive oneyear extensions to construct the well may be granted for good cause shown. Pumping equipment does not have to be installed in the well prior to the permit expiration date. This extension request form must be completed and received by the Division of Water Resources prior to the permit expiration date. There is no filing fee. Refer to CRS 37-92-602(3)(d) or CRS 37-90-105(3)(e), respectively. 2. CRS 37-90-137: The permit to construct a well and install pumping equipment is valid for a one-year period. A one-time, one-year extension may be granted for good cause shown in order to construct a well and/or install pumping equipment. This extension request form must be completed and received by the Division of Water Resources with a $60 filing fee prior to the permit expiration date. Once the well is constructed and/or pumping equipment is installed, and prior to the expiration date, a completed Well Construction and Test Report (Form No. GWS-31) and/or a completed Pump Installation and Test Report (Form No. GWS-32) must be received by the Division of Water Resources. Refer to CRS 37-90-137(3)(a)(I). 3. CRS 37-90-107 or CRS 37-90-107(7): The permit to construct a well inside Designated Groundwater Basins is valid for a one-year period. A one-time, one-year extension of the expiration date may be granted, for good cause shown, in order to construct the well. This extension request form must be completed and received by the Division of Water Resources with a $60 filing fee prior to the permit expiration date. Refer to CRS 37-90-108(1)(c). 4. CRS 37-90.5-106: The permit to construct a geothermal resource exploration, production, or re-injection well is valid for a one-year period. Successive one-year extensions of the expiration date may be granted in order to construct the well. This completed form requesting an extension of the expiration date, including a $240 filing fee must be received by DWR prior to the expiration date. Refer to the Geothermal Rules, 2 CCR 402-10 (Rule 6).

If you have questions, contact the Denver or the Division Office where your well is located.
Division 1 th 810 9 St., Ste. 200 Greeley, CO 80631 (970) 352-8712 Fax (970) 392-1816 Division 5 Direct mail to Box 396 Glenwood Spgs CO 81602 50633 U.S. Hwy 6 & 24 Glenwood Spgs., CO 81601 (970) 945-5665 Fax (970) 945-8741 Call first 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-64 6/2009

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

REQUEST FOR EXTENSION OF WELL PERMIT EXPIRATION DATE
Insert the Well Permit Number
Well permittee information Name(s) Mailing Address City, St. Zip Phone ( )

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

Estimated date of well Completion Statement of good cause why the well will not be constructed and/or pumping equipment installed, or water put to beneficial use (if in a Designated Basin) prior to the expiration date of the permit

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 well owner or agent Please print the Signer's Name & Title Date

INSTRUCTIONS: This form is used to request an extension of the expiration date of the permit. This request for extension must be accompanied by a non-refundable filing fee if applicable (see reverse side for details). The completed request must be received prior to the expiration date of the well permit. See the reverse side for more information regarding well permits and requests for extension of the expiration date. Type or print neatly in black or blue ink. This form may be reproduced by photocopy or word processing means. Div WD

For Office Use Only

Basin

MD