Form 519 Application for Permit to Withdraw Groundwater for Drainage Purposes Within an Active Management Area - Arizona

Form 519 is a Arizona Department of Water Resources form also known as the "Application For Permit To Withdraw Groundwater For Drainage Purposes Within An Active Management Area". The latest edition of the form was released in July 1, 2016 and is available for digital filing.

Download a PDF version of the Form 519 down below or find it on Arizona Department of Water Resources Forms website.

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ARIZONA DEPARTMENT OF WATER RESOURCES
GROUNDWATER PERMITTING AND WELLS UNIT
MAIL TO: P.O. BOX 36020, PHOENIX, ARIZONA 85067-6020
1110 W. WASHINGTON ST. SUITE 310, PHOENIX, ARIZONA 85007-2952
Phone (602) 771-8527 Fax (602) 771-8690
APPLICATION FOR PERMIT TO WITHDRAW
GROUNDWATER FOR DRAINAGE PURPOSES WITHIN
FOR DEPARTMENT USE ONLY
AN ACTIVE MANAGEMENT AREA (A.R.S. § 45-519)
Application/Permit No.
I. INSTRUCTIONS
Filed
1. COMPLETE ALL APPROPRIATE ITEMS ON THIS APPLICATION
AMA
AND SIGN IN DESIGNATED PLACE.
2. Mail to: P.O. Box 36020, Phoenix, Arizona 85067-6020 or deliver in person
S/B
W/S
to the above address.
3. The initial fee for an Application for a Permit to Withdraw Groundwater for
Drainage Purposes is $1,000. Total fees for this application are based upon an hourly
billable rate, which can be found on the ADWR web site @www.azwater.gov. If the costs of reviewing your application exceed
$1,000, you will be invoiced for the difference, up to a maximum total fee of $10,000. Payment may be made by cash, check, or credit
card (if you wish to pay by credit card, please contact the Groundwater Permitting & Wells Program at 602-771-8527. Checks should be
made payable to the Arizona Department of Water Resources. In addition to the hourly application fee, the applicant must pay any review-
related costs associated with the application and the actual cost of mailing or publishing any legal notice of the application or any notice of a
pre-decision administrative hearing on the application. Review-related costs are: (1) costs associated with a pre-decision hearing on the
application, such as court reporter services and facility rentals for the hearing, and (2) mileage expenses for a site visit conducted before
issuing a decision on the application. Failure to enclose the initial application fee will cause the application to be returned. Fees for
Permit to Withdraw Groundwater for Drainage Purposes are authorized by A.R.S. § 45-113 and A.A.C. R12-15-103.
II. GENERAL DATA
Please check one:
New Application
Renewal or
Modification of Permit No. 59-
.
1. NAME OF APPLICANT ______________________________________________________________________________________
Mailing Address _____________________________________________________________________________________________
___________________________________________________________________________________________________________
City
State
Zip Code
Telephone Number
2. NAME OF LAND OWNER where groundwater will be withdrawn
Mailing Address
________________________________________________________________________________________________________
City
State
Zip Code
Telephone Number
3. Groundwater will be withdrawn within the
sub-basin of the
Active Management Area.
4. The specific purpose of this drainage permit:
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
5. If the drainage of irrigated lands is necessary for a reasonable economic return from agricultural production, please provide evidence
that documents this need. Attach separate sheets if necessary.
___________________________________________________________________________________________________________
45-519 Revised 7/2016
ARIZONA DEPARTMENT OF WATER RESOURCES
GROUNDWATER PERMITTING AND WELLS UNIT
MAIL TO: P.O. BOX 36020, PHOENIX, ARIZONA 85067-6020
1110 W. WASHINGTON ST. SUITE 310, PHOENIX, ARIZONA 85007-2952
Phone (602) 771-8527 Fax (602) 771-8690
APPLICATION FOR PERMIT TO WITHDRAW
GROUNDWATER FOR DRAINAGE PURPOSES WITHIN
FOR DEPARTMENT USE ONLY
AN ACTIVE MANAGEMENT AREA (A.R.S. § 45-519)
Application/Permit No.
I. INSTRUCTIONS
Filed
1. COMPLETE ALL APPROPRIATE ITEMS ON THIS APPLICATION
AMA
AND SIGN IN DESIGNATED PLACE.
2. Mail to: P.O. Box 36020, Phoenix, Arizona 85067-6020 or deliver in person
S/B
W/S
to the above address.
3. The initial fee for an Application for a Permit to Withdraw Groundwater for
Drainage Purposes is $1,000. Total fees for this application are based upon an hourly
billable rate, which can be found on the ADWR web site @www.azwater.gov. If the costs of reviewing your application exceed
$1,000, you will be invoiced for the difference, up to a maximum total fee of $10,000. Payment may be made by cash, check, or credit
card (if you wish to pay by credit card, please contact the Groundwater Permitting & Wells Program at 602-771-8527. Checks should be
made payable to the Arizona Department of Water Resources. In addition to the hourly application fee, the applicant must pay any review-
related costs associated with the application and the actual cost of mailing or publishing any legal notice of the application or any notice of a
pre-decision administrative hearing on the application. Review-related costs are: (1) costs associated with a pre-decision hearing on the
application, such as court reporter services and facility rentals for the hearing, and (2) mileage expenses for a site visit conducted before
issuing a decision on the application. Failure to enclose the initial application fee will cause the application to be returned. Fees for
Permit to Withdraw Groundwater for Drainage Purposes are authorized by A.R.S. § 45-113 and A.A.C. R12-15-103.
II. GENERAL DATA
Please check one:
New Application
Renewal or
Modification of Permit No. 59-
.
1. NAME OF APPLICANT ______________________________________________________________________________________
Mailing Address _____________________________________________________________________________________________
___________________________________________________________________________________________________________
City
State
Zip Code
Telephone Number
2. NAME OF LAND OWNER where groundwater will be withdrawn
Mailing Address
________________________________________________________________________________________________________
City
State
Zip Code
Telephone Number
3. Groundwater will be withdrawn within the
sub-basin of the
Active Management Area.
4. The specific purpose of this drainage permit:
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
5. If the drainage of irrigated lands is necessary for a reasonable economic return from agricultural production, please provide evidence
that documents this need. Attach separate sheets if necessary.
___________________________________________________________________________________________________________
45-519 Revised 7/2016
___________________________________________________________________________________________________________
6. Please provide documentation showing that the withdrawal of groundwater is consistent with the management plan of the AMA.
7. Legal description of land where groundwater will be used: ____________________________________________________________
____________________________________________________________________________________________________________
8. Will groundwater be added to an aquifer by a replenishment district? ____________________________________________________
If so, please indicate the legal description of the land where the groundwater will be added to the aquifer:
___________________________________________________________________________________________________________
9. Total amount of groundwater for which application is being made:
acre-feet.
10. Requested duration of the drainage water permit
.
11. Groundwater to be withdrawn by means of:
A. WELLS ALREADY IN EXISTENCE:
Registration No.
Location
Depth
Diameter of Casing
Casing Material
55-
_______________
55-
_______________
B. WELLS TO BE NEWLY CONSTRUCTED:
Complete and attach Well Construction Supplement, DWR form 55-90, for each new well to be drilled.
It is understood that the Permit, if granted, will be issued in accordance with the Groundwater Code (Title 45, Chapter 2). The
permittee will be bound by the provisions of such law and the provisions of the Permit issued.
I (we)
hereby affirm that all information provided in this application is true and correct
(print name)
to the best of my/our knowledge and belief.
Signature of Applicant
Date ___________________________
NOTICE
A.R.S. § 41-1030(B), (D), (E) and (F) provide as follows:
B.
An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule or state
tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant
to that general grant of authority that specifically authorizes the requirement or condition.
D.
This section may be enforced in a private civil action and relief may be awarded against the state. The court may award reasonable attorney fees, damages and all
fees associated with the license application to a party that prevails in an action against the state for a violation of this section.
E.
A state employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action or dismissal pursuant to the
agency’s adopted personnel policy.
F.
This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02.
45-519 Revised 7/2016

Download Form 519 Application for Permit to Withdraw Groundwater for Drainage Purposes Within an Active Management Area - Arizona

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