Form 602 R3-00 Notice Of Completion Of Groundwater Development printable pdf download

Form 602 R3-00

FOR DEPARTMENT USE ONLY

NOTICE OF COMPLETION OF

GROUNDWATER DEVELOPMENT

Notice No. __________________________ Basin _______________

For groundwater developments with a maximum use

Priority Date ________________ Time ________________ AM / PM

of 35 GPM not to exceed 10 AC-FT per year.

Transmittal # ____________ Rec’d By

______________________

GROUNDWATER IS DEFINED AS ANY WATER BENEATH THE GROUND SURFACE

Fee Rec'd $ ____________ Check No. ______________________

(Use Form 600, Application for Beneficial Water Use Permit for

Payor __________________________________________________

appropriations in excess of 35 GPM or 10 AC-FT per year.)

Refund $ ___________________________ Date ________________

State law requires this form be filed by the water user within 60 days after the water has been

put to use. Your priority is determined by the date of filing.

Complete the notice and attach an aerial photo, survey, or other map showing the location

Filing Fee: $25.00

of your development. Submit it with the filing fee, to your Water Resources Regional Office.

NAME(s) _______________________________________________________________________________________________________________

Mailing Address ________________________________________________________________________________________________________

City _____________________________________________________________________ State ___________ Zip _________________________

Home Phone ______________________________________________ Other Phone _________________________________________________

SOURCE OF GROUNDWATER SUPPLY:

Well

Pit — Dimensions (in feet) _____________ L _____________ W __________ D

Developed Spring (Excavation, increasing water yield, performed at spring location)

ACTUAL PUMPING RATE __________ GPM

Pump: HP Rating ____________________

Installation Depth ______________ Ft.

WHEN WAS THE WATER PUT TO ITS INTENDED USE? (water must be used before you send this form to DNRC) ________________________

Month / Day / Year

DOES THIS WELL REPLACE AN EXISTING WELL?

Yes

Old Well Depth _______________ Ft. Old Well GPM __________________________

Date Old Well Drilled or Dug ______________________

Month / Day / Year

WILL THIS DEVELOPMENT be manifolded (connected) with another well or spring?

Yes

If yes, list the water right numbers and explain how they are used. _________________________________________________________________

POINT OF DIVERSION

(At least 2 quarter sections are required) Legal land descriptions may be obtained from your county records.

1/4 _______ 1/4 ______ 1/4 Section ________ Twp ________ N/S Range __________ E/W County ___________________________

Lot ___________ Block _____________ Tract No. ___________ COS No. ____________ Government Lot _____________________________

Subdivision Name ________________________ Street / Road Address ___________________________________________________________

PLACE OF USE (where water is being used)

Domestic

Lawn & Garden

Stock

Irrigation

Other

If same as Point of Diversion, Check

1/4 _______ 1/4 _______ 1/4 Section _________ Twp ________ N/S Range ___________ E/W County _________________________

Lot ___________ Block ______________ Tract No. _________

COS No. ___________ Government Lot _______________________________

Subdivision Name ________________________ Street / Road Address ___________________________________________________________

PURPOSE AND PERIOD OF USE

Number of homes supplied by the well being filed on ______________________________________________________________

Year-round use?

Yes

If no, from _________________ to _______________ , inclusive of each year.

Domestic

Month / Day

If lawn & garden/shelterbelt is greater than 1/4 acre, complete section below.

Total size of lawn and/or garden _____________________ (length in feet x width in feet

43560 = acres)

Lawn & Garden

Total size of shelterbelt ____________________________ (length in feet x width in feet

43560 = acres)

Shelterbelt

Period of use: from ______________________________ to ___________________________ , inclusive of each year.

> 1/4 AC.

Month / Day

Number and type __________________________________________________________________________________________

Stock

Year-round use?

Yes

If no, from _________________ to _______________ , inclusive of each year.

Month / Day

Type of crop _____________________________________________________________ Total acres irrigated ________________

Irrigation

Period of use: from ______________________________ to ___________________________ , inclusive of each year.

Month / Day

Describe the purpose of use __________________________________________________________________________________

Amount of water used _____________________________ gallons per day

Other

Year-round use?

Yes

If no, from _____________________ to ____________________ , inclusive of each year.

Month / Day

10.

ADDITIONAL INFORMATION _______________________________________________________________________________________________

11.

AFFIDAVIT OF OWNERSHIP OR WRITTEN CONSENT:

The statements appearing here are to the best of my knowledge true and correct.

I have possessory interest in the property where the water has been put to beneficial use AND:

Check the box(es) that pertain to your situation: (REQUIRED)

I have the exclusive property rights in the groundwater development works

I do not have the exclusive property rights in the groundwater development works, but I have the written consent of the person with those property rights (COPY OF WRITTEN

CONSENT ATTACHED)

I have a possessory interest in the real property from which the groundwater is appropriated

I do not have possessory interest in the real property from which groundwater is appropriated, but I have given the required 30-day written notification to the landowner pursuant to

MCA 85-2-306(1) prior to appropriation from existing works or before constructing new or expanded works (COPY OF WRITTEN 30-DAY PRIOR NOTIFICATION ATTACHED)

Appropriator's signature ______________________________________________________________________ Date: _______________________

______________________________________________________________________ Date: _______________________

Subscribed and sworn before me this __________________________________ day of ____________________ , __________________________

Notary's signature ____________________________________________________________________________________

Notary for the State of __________________________ Residing at ___________________________________________

SEAL

My commission expires _______________________________________________________________________________

MONTANA DEPARTMENT OF NATURAL RESOURCES AND CONSERVATION

48 N. LAST CHANCE GULCH P.O. BOX 201601 HELENA, MT 59620-1601 444-6610

web site:

Form 602 R3-00 Notice Of Completion Of Groundwater Development

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