Form 600 EVCGWA "East Valley Controlled Groundwater Area Permit Application" - Montana

What Is Form 600 EVCGWA?

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 February 1, 2016;
  • 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 printable version of Form 600 EVCGWA 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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Download Form 600 EVCGWA "East Valley Controlled Groundwater Area Permit Application" - Montana

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Form No. 600 EVCGWA C- 2/2016
EAST VALLEY CONTROLLED
GROUNDWATER AREA
PERMIT APPLICATION
Use this form for groundwater
FOR DEPARTMENT USE ONLY
developments located in the East Valley Controlled
Groundwater Area (Zone 2 only) for appropriations
Notice No. __________________________ Basin ________
up to 35 GPM and 10 AF per year.
Priority Date ________________ Time__________ AM - PM
Rec'd By
______________________________________
Fee Rec'd $ ____________
Check No. _____________
Incomplete forms will be returned.
Deposit Receipt # __________________________________
Payor (if different from name(s) listed in item 1 below)
Filing Fee $200.00
__________________________________________________
Refund $ ________________
Date __________________
Make checks payable to DNRC.
Deficiency Letter Sent ________________________________
Your priority is determined by the date of filing. If it is determined this form was improperly filed, your priority date may be changed.
In order to file this form, you must have prior written approval from (1) Lewis and Clark County Board of Health, (2) Lewis and Clark County
Water Quality Protection Bureau, (3) the U.S. Environmental Protection Agency, (4) the Montana State Dept. of Environmental Quality and
(5) the Montana State Dept. of Natural Resources and Conservation.* The written approval must include the following recommendations
which will also be included as conditions on the appropriation.
A.
Well design and construction requirements necessary to measure the water level and water quality for any well;
B.
Water level measurement and water quality sample reporting requirements for any new well; and
C.
Any other requirements necessary to ensure new wells can be operated in a manner consistent with purpose of the
EVCGWA.
* These agencies may establish a Technical Advisory Group (TAG) consisting of delegates from each for the purposes of reviewing, monitoring,
and making recommendations regarding applications and water use within the EVCGWA. Prior approval by the TAG satisfies the prior written
approval required for filing Forms 600, 606 and 635.
1.
NAME _________________________________________________________________________________________________________________
MAILING ADDRESS
____________________________________________________________________________________________________
CITY _________________________________
STATE
________________________
ZIP
_________________________
WORK PHONE
_______________________
HOME PHONE____________________
CELL PHONE_____________________
2.
IS DIVERSION LOCATED IN ZONE 1 AS DESIGNATED BY THE EVCGWA?
Yes
No
If YES, you cannot file this form.
3.
DIVERSION USED TO OBTAIN GROUNDWATER
Well – Attach the well log if well has been drilled.
Developed Spring (Excavation performed at the spring location.)
Pit/Pond –
Surface Area ________________ Acres __________Depth
4.
FLOW RATE REQUIRED ____________GPM
5.
COMBINATION OR SHARED DEVELOPMENT
Are there other groundwater developments on your property?
Yes
No
If yes, please provide the distance between developments and the DNRC water right number for each. __________________________________
____________________________________________________________________________________________________________________
6.
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 that will be watered (length x width) or acres _____________________
Lawn & Garden
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.
7.
POINT OF DIVERSION – Location of Ground water Development
______1/4 ______1/4 ______1/4 of Section ______ Township ______
N
S
Range______
E
W
County_________________________________ Tract # _______ COS # _________________________ Gov’t Lot # _______
Subdivision Name _______________________________
Lot ____________
Block __________________
Street Address, including City/State/Zip Code ________________________________________________________________________________
8.
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, tax statements, or at http://svc.mt.gov/msl/mtcadastral/.
 Yes  No
Is the place where water is used the same as the point of diversion?
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 of Section ______ Township ______
N
S
Range______
E
W
County_________________________________ Tract # _______ COS # _________________________ Gov’t Lot # _______
Subdivision Name _______________________________
Lot ____________
Block __________________
Street Address, including City/State/Zip Code ________________________________________________________________________________
Form No. 600 EVCGWA C- 2/2016
EAST VALLEY CONTROLLED
GROUNDWATER AREA
PERMIT APPLICATION
Use this form for groundwater
FOR DEPARTMENT USE ONLY
developments located in the East Valley Controlled
Groundwater Area (Zone 2 only) for appropriations
Notice No. __________________________ Basin ________
up to 35 GPM and 10 AF per year.
Priority Date ________________ Time__________ AM - PM
Rec'd By
______________________________________
Fee Rec'd $ ____________
Check No. _____________
Incomplete forms will be returned.
Deposit Receipt # __________________________________
Payor (if different from name(s) listed in item 1 below)
Filing Fee $200.00
__________________________________________________
Refund $ ________________
Date __________________
Make checks payable to DNRC.
Deficiency Letter Sent ________________________________
Your priority is determined by the date of filing. If it is determined this form was improperly filed, your priority date may be changed.
In order to file this form, you must have prior written approval from (1) Lewis and Clark County Board of Health, (2) Lewis and Clark County
Water Quality Protection Bureau, (3) the U.S. Environmental Protection Agency, (4) the Montana State Dept. of Environmental Quality and
(5) the Montana State Dept. of Natural Resources and Conservation.* The written approval must include the following recommendations
which will also be included as conditions on the appropriation.
A.
Well design and construction requirements necessary to measure the water level and water quality for any well;
B.
Water level measurement and water quality sample reporting requirements for any new well; and
C.
Any other requirements necessary to ensure new wells can be operated in a manner consistent with purpose of the
EVCGWA.
* These agencies may establish a Technical Advisory Group (TAG) consisting of delegates from each for the purposes of reviewing, monitoring,
and making recommendations regarding applications and water use within the EVCGWA. Prior approval by the TAG satisfies the prior written
approval required for filing Forms 600, 606 and 635.
1.
NAME _________________________________________________________________________________________________________________
MAILING ADDRESS
____________________________________________________________________________________________________
CITY _________________________________
STATE
________________________
ZIP
_________________________
WORK PHONE
_______________________
HOME PHONE____________________
CELL PHONE_____________________
2.
IS DIVERSION LOCATED IN ZONE 1 AS DESIGNATED BY THE EVCGWA?
Yes
No
If YES, you cannot file this form.
3.
DIVERSION USED TO OBTAIN GROUNDWATER
Well – Attach the well log if well has been drilled.
Developed Spring (Excavation performed at the spring location.)
Pit/Pond –
Surface Area ________________ Acres __________Depth
4.
FLOW RATE REQUIRED ____________GPM
5.
COMBINATION OR SHARED DEVELOPMENT
Are there other groundwater developments on your property?
Yes
No
If yes, please provide the distance between developments and the DNRC water right number for each. __________________________________
____________________________________________________________________________________________________________________
6.
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 that will be watered (length x width) or acres _____________________
Lawn & Garden
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.
7.
POINT OF DIVERSION – Location of Ground water Development
______1/4 ______1/4 ______1/4 of Section ______ Township ______
N
S
Range______
E
W
County_________________________________ Tract # _______ COS # _________________________ Gov’t Lot # _______
Subdivision Name _______________________________
Lot ____________
Block __________________
Street Address, including City/State/Zip Code ________________________________________________________________________________
8.
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, tax statements, or at http://svc.mt.gov/msl/mtcadastral/.
 Yes  No
Is the place where water is used the same as the point of diversion?
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 of Section ______ Township ______
N
S
Range______
E
W
County_________________________________ Tract # _______ COS # _________________________ Gov’t Lot # _______
Subdivision Name _______________________________
Lot ____________
Block __________________
Street Address, including City/State/Zip Code ________________________________________________________________________________
Form No. 600 EVCGWA C- 2/2016
9.
MAP- Attach a map (USGS Quadrangle Map or aerial photo) showing the point of diversion and place of use. The map should have a north arrow,
scale bar, section corners and number, and township and range numbers.
10.
WHEN WILL THIS APPROPRIATION BE COMPLETED?
__________________________________________________________________
*Note: once the project is complete, you must submit a Form 617 (Notice of Completion of Permitted Water Development).
I declare under penalty of perjury and under the laws of the state of Montana that the foregoing is true and correct.
Printed Name
______________________________________________
Applicant Signature
______________________________________________
Date: __________________
Printed Name
______________________________________________
Applicant Signature
______________________________________________
Date: __________________
**Please note, you must submit ORIGINAL signatures, copies will not be accepted.**
Visit
http://dnrc.mt.gov/divisions/water/water-rights/controlled-ground-water-areas/east-valley
to learn
additional information about the use of this form and view a map of the East Valley Controlled Groundwater Area,
Zone 1 and Zone 2.
FORM 600 EVCGWA, EAST VALLEY CONTROLLED GROUNDWATER AREA PERMIT APPLICATION
INSTRUCTIONS
To use this form, the following must apply to your water use.
The development is located within the boundaries of the East Valley Controlled Groundwater Area, Zone 2.
The source is groundwater, meaning any water located beneath the ground surface. The water is typically diverted from the ground via a well,
developed spring, or a collection of water in a ground water pit or pond.
The flow rate used is 35 gallons per minute or less. This is the rate you are taking water from the source.
The total volume used from the development does not exceed 10 acre-feet per year.
Complete items 1 through 9 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 ARM 36.12.1205.
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.
Choose Yes or No. If Yes, DNRC will return the form and filing fee.
Item 3. Check the type of ground water development used to obtain the ground water. If the source is a well and has been drilled, attach the well log.
If the source is a ground water pit or pond, provide the surface area and depth of the pond. This information will be used to determine the capacity and
the evaporation that will occur from the pond.
Item 4. Enter the flow rate used. To determine the actual flow rate you are pumping, turn the water on until the pump comes on and stays on. Time how
many seconds it takes to fill a 5-gallon bucket. Use the following formula to calculate the flow rate. 300/# of seconds = flow rate in GPM.
Item 5. Check ‘Yes’ if you have other groundwater developments located on your land within ¼ mile of this development. If you have a Groundwater
Certificate, provide water right numbers and distances between those developments and this development. Check ‘Yes’ if this development is shared
with others, such as two homes on one well. Provide the water right number and document how the development is shared. If a shared well agreement
exists, provide a copy of that agreement.
Item 6. Check the purposes for which the water will be used. If the water will be used during the months specified, check 'yes'. If not, check 'no' and
enter the month and day water is used each year.
Item 7.
Enter the land description for the location of the development. Describe the location to the nearest 2.5 acres. Legal land descriptions,
subdivisions, and certificate of survey information may be obtained from the deed, county records, well log, or from the Montana Cadastral system at:
http://svc.mt.gov/msl/mtcadastral/.
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 8.
Enter the land description for the location the water will be used. Describe the location to the nearest 2.5 acres. Legal land descriptions,
subdivisions, geocodes, and certificate of survey information may be obtained from the deed, county records, well log, or from the Montana Cadastral
system at http://svc.mt.gov/msl/mtcadastral/.
Subdivisions –
In addition to the above description, enter the lot and block or tract number, subdivision name.
Geocode(s) –
Enter the geocode(s) for the land description entered.
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 9.
Attach a map (USGS Quadrangle Map or aerial photo) showing the point of diversion and place of use. The map should have a north arrow,
scale bar, section corners and number, and township and range numbers. If the required information is included on the map, DNRC will confirm the
written land description matches the map. If it does not, DNRC will change the written description to match the map.
Item 10. A permit must be secured prior to putting the water to beneficial use. Enter approximately how long it will take to perfect the water usage. You
must file a Notice of Completion showing that the water has been put to use before the deadline assigned by the department based on the timeline
submitted in this field. If no time is given, DNRC will assign December 31 of the current year (or the following year if issued after September 30).
For Questions Contact:
DNRC Water Resources Helena Regional Office
th
1424 9
Avenue
PO Box 201601
Helena, MT 59620-1601
Ph. 406-444-6999
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