Form 646 - Geothermal Heating/cooling Notice Of Completion - 2011 Page 2
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2Form No. 646 INS New 10/01/2011
Form 646—GEOTHERMAL HEATING / COOLING
NOTICE OF COMPLETION
There are special federal requirements regarding injection wells and water quality. Filing requirements may apply to your development.
Please visit
for more information regarding the Class V well inventory process.
To use this form, the following must apply to your water use.
The ground water must have been put to use.
The development is not located within the boundaries of a Controlled Ground Water Area.
The source is groundwater, meaning any water located beneath the ground surface. The water is diverted from the ground via a
well or developed spring.
The flow rate used is 350 gallons per minute or less. This is the rate you are taking water from the source. If the water use
exceeds that amount, then you must file an Application for Beneficial Water Use Permit, Form 600.
If the flow rate used is less than 35 gallons per minute and the volume used by the system is less than 10 acre-feet per year
you may utilize a Form 602 as your notice of completion.
Complete items 1 through 11 ONLY if you have determined this is the correct form to file.
All of the required information must be entered for your application to be considered correct and complete as required under 85-
2-306, MCA.
Item 1. Enter the complete name of the person to be listed as the water right owner(s), their mailing address, and phone
numbers.
Item 2. Check the type of ground water development used to obtain the ground water. If using wells, provide all well logs. If
extracting from a spring, provide a well log for the injection well or a written description of the injection apparatus showing the
water is injected into the same aquifer from which it is extracted.
Item 3. Enter the flow rate pulled from the aquifer.
Item 4. Enter the period of use.
Item 5. Location of extraction. Attach an additional sheet if more than one point of extraction.
Latitude and Longitude must be entered. Enter the land description for the location of extraction. Describe the location
to the nearest 10 acres if possible. Legal land descriptions, subdivisions, geocodes, and certificate of survey information
may be obtained from the county records, tax statements, or from the Montana Cadastral system at:
Subdivisions – In addition to the above description, enter the lot and block or tract number, subdivision name.
Government Lots – In addition to the land description, enter the government lot number.
Certificate of Survey - In addition to the land description, enter the survey number.
Street or Road Address – Enter the physical address of the development including city, state, and zip code.
Item 6. Location of Injection. Attach an additional sheet if more than one point of injection.
Follow standards listed above for Item 5.
Item 7. Enter distance (in feet) between point of extraction and point of injection.
Item 8. Enter distance (in feet) from the extraction well to both the nearest existing well and nearest hydraulically connected
surface water source.
Item 9. Enter the land description for where the water is used. The geocode of the place of use must be provided. Follow
standards listed above for item 5.
Item 10. Attach a map which includes the following information - North Arrow, Section, Township, Range and label the point(s) of
extraction, point(s) of injection, nearest existing well, and nearest hydraulically connected surface water. If nearest existing well /or
surface water is off the map, be sure at least twice the distance from the extraction to injection well is visible from the extraction well to
the edge of the map (i.e. if distance between points of extraction and injection is 500 feet be sure at least 1000 feet in all directions
from point of extraction is visible on map). Label distances between locations. DNRC may change the written legal land description to
match the map.
Item 11. If the statements are correct, sign and date the form.
Send the form to your local Water Resources Regional Office.
BILLINGS: 406-247-4415; Airport Industrial Park, 1371 Rimtop
HELENA: 406-444-6999; PO Box 201601,
Dr, Billings MT 59105-1978
Helena MT 59620-1601
Serving: Big Horn, Carbon, Carter, Custer, Fallon, Powder
Serving: Beaverhead, Broadwater, Deer Lodge, Jefferson, Lewis
River, Prairie, Rosebud, Stillwater, Sweet Grass, Treasure, &
& Clark, Powell, & Silver Bow Counties
Yellowstone Counties
KALISPELL: 406-752-2288; 655 Timberwolf Parkway, Suite 4,
BOZEMAN: 406-586-3136; 2273 Boot Hill Court, Suite 110,
Kalispell MT 59901
Bozeman MT 59715
Serving: Flathead, Lake, Lincoln, & Sanders Counties
Serving: Gallatin, Madison, & Park Counties
LEWISTOWN: 406-538-7459; 613 NE Main St, Suite E,
GLASGOW: 406-228-2561; PO Box 1269,
Lewistown MT 59457-2020
Glasgow MT 59230-1269
Serving: Cascade, Fergus, Golden Valley, Judith Basin, Meagher,
Serving: Daniels, Dawson, Garfield, McCone, Phillips,
Musselshell, Petroleum, & Wheatland Counties
Richland, Roosevelt, Sheridan, Valley, & Wibaux Counties
MISSOULA: 406-721-4284; PO Box 5004,
HAVRE: 406-265-5516; PO Box 1828, Havre MT 59501-1828
Missoula MT 59806-5004
Serving: Blaine, Chouteau, Glacier, Hill, Liberty, Pondera,
Serving: Granite, Mineral, Missoula, & Ravalli Counties
Teton, & Toole Counties
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