Form 602 - Notice Of Completion Of Groundwater Development - 2009
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1
2Form No. 602 R 4/21/2009
NOTICE OF COMPLETION OF
GROUNDWATER DEVELOPMENT
FOR DEPARTMENT USE ONLY
Use this form for completed groundwater
Notice No. _________________ Basin _________________
developments where the water has been put to use for
Priority Date ________________ Time ___________AM - PM
Rec'd By
_______________________________________
the purposes identified with a maximum use of
Fee Rec'd $ ____________
Check No. _____________
35 GPM not to exceed 10 AC-FT per year.
Deposit Receipt # __________________________________
Payor (if different from name(s) listed in item 1 below)
Incomplete forms will be returned.
__________________________________________________
Refund $
______________
Date __________________
Deficiency Letter Sent ________________________________
Filing Fee $125.00
Your priority is determined by the date of filing. If it is determined this form was improperly filed, your priority date may be changed.
If your development is within a Controlled Ground Water Area, the regional office will contact you to explain the correct filing requirements.
1.
NAME
____________________________________________________________________________________________________________
MAILING ADDRESS
____________________________________________________________________________________________________
CITY _________________________________
STATE
________________________
ZIP______________________________
WORK PHONE
_______________________
HOME PHONE____________________
CELL PHONE_____________________
2.
DIVERSION USED TO OBTAIN GROUNDWATER
Well – Attach well log, if available
Water Well Contractor Name: __________________________________________________________
Developed Spring (Excavation performed at the spring location.)
Pit/Pond –
Surface Area ________________ Acres __________Depth
3.
FLOW RATE USED ____________GPM
4.
COMBINATION OR SHARED DEVELOPMENT
a. Will this development be used in combination with another well or spring?
Yes
No
b. Will this development be shared by other users?
Yes
No
If yes for either question, list the water right numbers and explain how the development is used. ____________________________________
____________________________________________________________________________________________________________________
5.
PURPOSE AND PERIOD OF USE
Number of homes supplied _______________________________
Domestic
Year round use?
Yes
No
If no, from _______ to ________, inclusive of each year.
Total Size of lawn and/or garden - length x width
_____________________
Lawn & Garden
April 1 – October 31
Yes
No
If no, from _______ to ________, inclusive of each year.
Irrigation
Type of crop ________________________
Total Crop Acres Irrigated _________________
April 1 – October 31
Yes
No
If no, from _______ to ________, inclusive of each year.
Stock
Number and type _____________________________________________________________________________________
(Example: 100
Year round use?
Yes
No
If no, from _______ to ________, inclusive of each year.
Cows & 1 Horse)
Describe the purpose of the use _________________________________________________________________________
Other
Amount of water used ______________ gallons per day
Number of days used _______________________________
Year round use?
Yes
No
If no, from _______ to ________, inclusive of each year.
6.
POINT OF DIVERSION – Location of Ground water Development
_____1/4 _____1/4 _____1/4 Section _____ Twp _____N / S Rge _____E /W County __________________________________________________
Lot _______ Block _______Tract No. _______
Subdivision Name ____________________________________________________________
Government Lot No. _____________________________
COS No.
__________________________________________________
Street or Road Address, including City, State & Zip Code of the Development __________________________________________________________
7.
PLACE OF USE - Enter the 17 digit geocode applicable to the place of use legal land description. ________________________________________ If
there are multiple places of use, attach additional sheets and list the geocode for each legal land description. The geocodes can be found in county
records.
Is the place where water is used the same as the point of diversion?
Yes
No
If no, enter the place of use land description below. Attach additional sheets if necessary.
Domestic
Stock
Irrigation
Other
_____1/4 _____1/4 _____1/4 Section _____ Twp _____N / S Rge _____E /W County _________________________________________________
Lot _______ Block _______Tract No. _______
Subdivision Name ___________________________________________________________
Government Lot No. _________________________
COS No. __________________________________________________________________
Street or Road Address, including City, State & Zip Code of the Place of Use _________________________________________________________
8.
AFFIDAVIT OF OWNERSHIP OR WRITTEN CONSENT
I have possessory interest in the property where the water has been put to beneficial use and I have the exclusive property rights
in the ground water development works OR I have attached written consent of the person owning the ground water development
works and/or written notification to the land owner pursuant to MCA 85-2-306(1).
The statements appearing here are to the best of my knowledge true and correct.
Appropriator's Signature
________________________________________________________
Date: ___________________
________________________________________________________
Date: ___________________
Go to web site
to learn additional information about the use of this form.
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