NeDNR SW Form 100 Application for a Temporary Change of Location of Use and to Change the Purpose of Appropriation to Augment the Flow in a Specific Stream Reach for a Privately Held Water Appropriation - Nebraska

NeDNR SW Form 100 is a Nebraska Department of Natural Resources (Surface Water) - issued form also known as the "Application For A Temporary Change Of Location Of Use And To Change The Purpose Of Appropriation To Augment The Flow In A Specific Stream Reach For A Privately Held Water Appropriation".

Download a PDF version of the latest NeDNR SW Form 100 down below or find it on the Nebraska Department of Natural Resources (Surface Water) Forms website.

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SW Form #100
Private 7-2010
STATE OF NEBRASKA
DEPARTMENT OF NATURAL RESOURCES
APPLICATION FOR A TEMPORARY CHANGE OF LOCATION OF USE
AND TO CHANGE THE PURPOSE OF APPROPRIATION
TO AUGMENT THE FLOW IN A SPECIFIC STREAM REACH FOR A PRIVATELY HELD WATER APPROPRIATION
FOR DEPARTMENT USE ONLY
1.
Name and Address of Appropriator of Record:
Filed in the office of the Department of Natural Resources
at
a.m. / p.m.
on
,
20
Mod No.
Zip Code:
Telephone No.: (
)
Map No.
Cell Phone No.: (
)
Water Division
Receipt No.
Amount
e-mail address:
2.
Name and Address of each mortgage holder or deed of trust holder for land now under permit.
(If more than one, please use DNR form 962-4)
Zip Code:
Telephone Number:
(
)
Cell Phone Number:
(
)
e-mail address:
3.
List the water appropriation number that this application is proposed to modify:
4.
List the current use:
5.
Is the entire surface water appropriation to be transferred?
YES
NO
If no, will the remaining appropriation be (check one):
A.  Relinquished
B.  Continue to be diverted
C. Other (attach explanation)
6.
This application is for a change in the location and use. The legal descriptions of the beginning and ending stream reach
to which the appropriation is proposed to be transferred for the purpose of augmenting flows:
Stream:
Beginning:
, Township
North, Range
E
W
County
¼
¼, Section
E n d i n g :
¼
¼, Section
, Township
North, Range
E
W
County
7.
a.
Date temporary change to BEGIN on:
b.
Date temporary change to END on:
Number of years:
c.
If Lease is involved, attach copy of lease agreement or document that lists all parties involved and the intent of the lease.
8.
Check one below:
The Department shall determine the amount of historic consumptive use subject to this transfer and I will provide history
of water use for land listed in item 10 (on page 2 of this form) on consumptive use calculation worksheets provided by
1
the Department.
The amount of water requested to be transferred to the new location of use is
and an analysis of consumptive use is attached and made a part of this application.
This land has been irrigated using (mark all that apply): A.  Surface water
B. Groundwater
C. Other
9.
(attach explanation)
1
Length of time for historical use information is subject to adjustment, as determined by DNR.
Page 1 of 2
SW Form #100
Private 7-2010
STATE OF NEBRASKA
DEPARTMENT OF NATURAL RESOURCES
APPLICATION FOR A TEMPORARY CHANGE OF LOCATION OF USE
AND TO CHANGE THE PURPOSE OF APPROPRIATION
TO AUGMENT THE FLOW IN A SPECIFIC STREAM REACH FOR A PRIVATELY HELD WATER APPROPRIATION
FOR DEPARTMENT USE ONLY
1.
Name and Address of Appropriator of Record:
Filed in the office of the Department of Natural Resources
at
a.m. / p.m.
on
,
20
Mod No.
Zip Code:
Telephone No.: (
)
Map No.
Cell Phone No.: (
)
Water Division
Receipt No.
Amount
e-mail address:
2.
Name and Address of each mortgage holder or deed of trust holder for land now under permit.
(If more than one, please use DNR form 962-4)
Zip Code:
Telephone Number:
(
)
Cell Phone Number:
(
)
e-mail address:
3.
List the water appropriation number that this application is proposed to modify:
4.
List the current use:
5.
Is the entire surface water appropriation to be transferred?
YES
NO
If no, will the remaining appropriation be (check one):
A.  Relinquished
B.  Continue to be diverted
C. Other (attach explanation)
6.
This application is for a change in the location and use. The legal descriptions of the beginning and ending stream reach
to which the appropriation is proposed to be transferred for the purpose of augmenting flows:
Stream:
Beginning:
, Township
North, Range
E
W
County
¼
¼, Section
E n d i n g :
¼
¼, Section
, Township
North, Range
E
W
County
7.
a.
Date temporary change to BEGIN on:
b.
Date temporary change to END on:
Number of years:
c.
If Lease is involved, attach copy of lease agreement or document that lists all parties involved and the intent of the lease.
8.
Check one below:
The Department shall determine the amount of historic consumptive use subject to this transfer and I will provide history
of water use for land listed in item 10 (on page 2 of this form) on consumptive use calculation worksheets provided by
1
the Department.
The amount of water requested to be transferred to the new location of use is
and an analysis of consumptive use is attached and made a part of this application.
This land has been irrigated using (mark all that apply): A.  Surface water
B. Groundwater
C. Other
9.
(attach explanation)
1
Length of time for historical use information is subject to adjustment, as determined by DNR.
Page 1 of 2
SW Form #100
Private 7-2010
10.
List below the number of acres in each quarter-quarter to which the appropriation is now appurtenant, and which will be subject to this
transfer. Attach aerial photography clearly marked to show the location of land listed below:
¼
¼
¼
¼
NW
NE
SW
SE
.
.
SEC
TWP
RANGE
TOTALS
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
NW
NE
SW
SE
NW
NE
SW
SE
NW
NE
SW
SE
NW
NE
SW
SE
Total Number of Acres Subject to This Transfer:
11.
List the history* of water use for the last ten years for the tracts listed above:
A
NNUAL
Attach additional history information for each appropriation if more than one.
M
S
W
AXIMUM
URFACE
ATER
Y
D
W
D
A
I
C
T
EAR
AYS
HEN
IVERTED
CRES
RRIGATED
ROP
YPE
P
C
(
)
V
UMP
APACITY
GPM
OLUME
*The Department may require additional information about the history of the project.
12.
If no water use occurred within the last five (5) years, describe on separate paper the last use made of this appropriation, list each of
the elements described in item 11 above., and describe any excusable reasons for non-use that may apply as described in §46-229.04.
Attach the paper to this application.
13.
Select all that apply:
Required Attachments:
Aerial photograph of tract(s) described above in item 10.
Copy of lease agreement item 7c.
Document attached describing the actual method of transfer, timing and amounts of water proposed to be transferred.
Describe any effects that this transfer may have, including other appropriators.
Optional Attachments:
Addendum attached describing the use of the remaining water appropriation for item 5.
Addendum(s) attached for additional land for item 10. (use DNR form 962-18).
Addendum(s) attached for additional history of use for item 11.
Addendum attached describing reasons for non-use during the last five (5) years for item 12.
Addendum(s) attached for additional landowner(s) signatures for item 14 (use DNR Form 962-24-B).
Documentation attached for person signing on behalf of appropriator for item 14.
Other attachment(s) included. Please describe:
14.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief such information
is true, complete and accurate. I have initialed and dated all addendums and attachments to this transfer. I agree to pay for the cost of publication
of legal notice. I agree to pay for the cost to file documentation of an approved temporary transfer in the County Clerk, Register of Deeds Office,
and, if necessary, a portion of hearing costs:
Date
Signature of Appropriator of Record (or representative with proper documentation)
Submit this application with a $10.00 filing fee to:
Nebraska Department of Natural Resources
P.O. Box 94676
Lincoln, Nebraska 68509
(402) 471-2363
Page 2 of 2

Download NeDNR SW Form 100 Application for a Temporary Change of Location of Use and to Change the Purpose of Appropriation to Augment the Flow in a Specific Stream Reach for a Privately Held Water Appropriation - Nebraska

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