Form 600 HRA "Hydrogeologic Assessment Report Addendum" - Montana

What Is Form 600 HRA?

This is a legal form that was released by the Montana Department of Natural Resources and Conservation - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 12, 2012;
  • The latest edition provided by the Montana Department of Natural Resources and Conservation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 600 HRA by clicking the link below or browse more documents and templates provided by the Montana Department of Natural Resources and Conservation.

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Form 600 HRA (New 10-12-2012)
Applicant Name ____________________________________
APPLICATION FOR BENEFICIAL WATER USE PERMIT
HYDROGEOLOGIC ASSESSMENT REPORT ADDENDUM
§ 85-2-361, MCA
ARM 36.12.120
This addendum must be completed and the required information attached to a permit application if the point of
diversion is located within a basin closure area. This information must be provided by a person qualified under
§ 85-2-361(2).
Attachments must be labeled as shown in the sections below (i.e: HRA.3.a). If a section is not applicable, label
the section as Not Applicable or NA.
Prepared By: __________________________________ Title: _________________________
I am a
Hydrogeologist
Qualified Scientist – Specify ________________________
Qualified Licensed Professional Engineer
Section 1. Area of Effect
HRA.1.a What is the source aquifer? ___________________________________________________
HRA.1.b Is the area of groundwater that will be affected by the proposed use smaller than the limits of the
aquifer? If so, explain.
___________________________________________________________________________________
___________________________________________________________________________________
HRA.1.c What surface waters will potentially be affected? Include surface waters specified under § 85-2-
361(1)(a),MCA that are subject to an existing appropriation right.
___________________________________________________________________________________
___________________________________________________________________________________
Section 2. Geology and Parameters of the Aquifer System
HRA.2.a What geologic formation is the proposed well completed in?
__________________________________________________________________________________
__________________________________________________________________________________
HRA.2.b Parameters of the aquifer system.
HRA.2.b.1 What is the lateral extent and thickness of the aquifer? ____________________________
____________________________________________________________________________
HRA.2.b.2 The aquifer is:
confined
or
unconfined
HRA.2.b.3 What is the effective hydraulic conductivity of the aquifer? __________________________
HRA.2.b.4 What is the transmissivity of the source aquifer?
______________________________
HRA.2.b.5 What is the storage coefficient of the source aquifer? ______________________________
HRA.2.b.6 What is the flow direction of ground water and rate of movement? ____________________
_____________________________________________________________________________
Page 1 of 3
Form 600 HRA (New 10-12-2012)
Applicant Name ____________________________________
APPLICATION FOR BENEFICIAL WATER USE PERMIT
HYDROGEOLOGIC ASSESSMENT REPORT ADDENDUM
§ 85-2-361, MCA
ARM 36.12.120
This addendum must be completed and the required information attached to a permit application if the point of
diversion is located within a basin closure area. This information must be provided by a person qualified under
§ 85-2-361(2).
Attachments must be labeled as shown in the sections below (i.e: HRA.3.a). If a section is not applicable, label
the section as Not Applicable or NA.
Prepared By: __________________________________ Title: _________________________
I am a
Hydrogeologist
Qualified Scientist – Specify ________________________
Qualified Licensed Professional Engineer
Section 1. Area of Effect
HRA.1.a What is the source aquifer? ___________________________________________________
HRA.1.b Is the area of groundwater that will be affected by the proposed use smaller than the limits of the
aquifer? If so, explain.
___________________________________________________________________________________
___________________________________________________________________________________
HRA.1.c What surface waters will potentially be affected? Include surface waters specified under § 85-2-
361(1)(a),MCA that are subject to an existing appropriation right.
___________________________________________________________________________________
___________________________________________________________________________________
Section 2. Geology and Parameters of the Aquifer System
HRA.2.a What geologic formation is the proposed well completed in?
__________________________________________________________________________________
__________________________________________________________________________________
HRA.2.b Parameters of the aquifer system.
HRA.2.b.1 What is the lateral extent and thickness of the aquifer? ____________________________
____________________________________________________________________________
HRA.2.b.2 The aquifer is:
confined
or
unconfined
HRA.2.b.3 What is the effective hydraulic conductivity of the aquifer? __________________________
HRA.2.b.4 What is the transmissivity of the source aquifer?
______________________________
HRA.2.b.5 What is the storage coefficient of the source aquifer? ______________________________
HRA.2.b.6 What is the flow direction of ground water and rate of movement? ____________________
_____________________________________________________________________________
Page 1 of 3
Form 600 HRA (New 10-12-2012)
Applicant Name ____________________________________
Section 3. Beneficial Use and Potentially Affected Water Rights
HRA.3.a
Yes
No Is the proposed amount to be diverted similar to the amount diverted for other
beneficial uses like the proposed use? If not, explain.
____________________________________________________________________________________
____________________________________________________________________________________
HRA.3.b What evidence do you have that water is physically available for the proposed use?
____________________________________________________________________________________
____________________________________________________________________________________
Section 4. Net Depletion Analysis
HRA.4.a The volume of net depletion resulting from the proposed use is:
Volume diverted
Volume consumed
Other
Explain your answer: __________________________________________________________________
____________________________________________________________________________________
HRA.4.b The timing of net depletion resulting from the proposed use is:
Constant year-round
Equal to the timing of withdrawal
Other
Explain your answer: __________________________________________________________________
____________________________________________________________________________________
HRA.4.c
Yes
No
Will net depletion, if any, result in adverse effect?
HRA.4.d
Yes
No
Does the proposed use include wastewater treatment?
If yes, describe. _____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
HRA.4.e How much conveyance loss will occur from the proposed project? ____________________________
Describe how this amount was determined. Include information about the distribution and storage
system. ___________________________________________________________________________
____________________________________________________________________________________
HRA.4.f The volume of return flow from the proposed use is:
The volume diverted minus the volume consumed
Other
Explain your answer: ________________________________________________________________
___________________________________________________________________________________
Page 2 of 3
Form 600 HRA (New 10-12-2012)
Applicant Name ____________________________________
HRA.4.g The timing of return flows resulting from the proposed use is:
Constant year-round
Immediate
Other
Explain your answer: ________________________________________________________________
___________________________________________________________________________________
HRA.4.h The location of return flows:
The potentially affected surface waters identified in HRA.1.c
Other
Explain your answer: _________________________________________________________________
____________________________________________________________________________________
Section 5. Water Quality Report
HRA.5.a
Yes
No
Are there existing documented hazards that could be affected or exacerbated by the
proposed project, such as areas of subsidence? If so, describe a plan to mitigate any of those
conditions or impacts. _______________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
HRA.5.b
Yes
No
Have any water quality permits been issued for this project? If so, attach copies of
any to this report.
NOTE: Information required for the hydrogeologic assessment may not be sufficient to meet applicable criteria under
85-2-
311, MCA, including but not limited to adverse effect to a prior appropriator. The applicant for a beneficial water use permit
pursuant to 85-2-311, MCA, is responsible for providing sufficient evidence to meet all applicable criteria.
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