Form GWS-45 General Purpose Water Well Permit Application - Colorado

Form GWS-45 or the "General Purpose Water Well Permit Application" is a form issued by the Colorado Department of Natural Resources.

The form was last revised in July 1, 2013 and is available for digital filing. Download an up-to-date Form GWS-45 in PDF-format down below or look it up on the Colorado Department of Natural Resources Forms website.

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COLORADO DIVISION OF WATER RESOURCES
Office Use Only
Form GWS-45 (07/2013)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 821, DENVER, CO 80203
Main: (303) 866-3581 Fax: (303) 866-2223
dwrpermitsonline@state.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be computer generated, typed or in black or blue ink.
1. Applicant Information
6. Use Of Well (check applicable boxes)
Name of applicant
Attach a detailed description of uses applied for.
Industrial
Dewatering System
Mailing address
Municipal
Geothermal (production or reinjection
Irrigation
Other (describe): ______________________
City
State
Zip code
Commercial
7. Well Data (proposed)
Telephone # (area code & number)
E-mail (online filing required)
Maximum pumping rate
Annual amount to be withdrawn
gpm
2. Type Of Application (check applicable boxes)
acre-feet
Total depth
Aquifer
Construct new well
Use existing well
Replace existing well
Change or increase use
feet
Change source (aquifer)
Reapplication (expired permit)
8. Land On Which Ground Water Will Be Used
COGCC Well
Other: ________________
Legal Description of Land
(may be provided as an attachment):
3. Refer To (if applicable)
Well permit #
Water Court case #
Designated Basin Determination #
Well name or #
4. Location Of Proposed Well
County
(If used for crop irrigation, attach a scaled map that shows irrigated area.)
1/4
A.
B.
1/4 of the
# Acres
Owner
Section
Township
N or S
Range
E or W
Principal Meridian
C.
List any other wells or water rights used on this land:
Distance of well from section lines (section lines are typically not property lines)
N
S
E
W
Ft. from
Ft. from
9. Proposed Well Driller License #(optional):
For replacement wells only – distance and direction from old well to new well
10.
Sign or Entered Name Of Applicant(s) Or Authorized Agent
feet
direction
The making of false statements herein constitutes perjury in the second
Well location address (Include City, State, Zip)
Check if well address is same as in Item 1.
degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S.
24-4-104 (13)(a). I have read the statements herein, know the contents
thereof and state that they are true to my knowledge.
Sign or enter name(s) of person(s) submitting application
Date (mm/dd/yyyy)
Optional: GPS well location information in UTM format You must check GPS unit for
required settings as follows:
Format must be UTM
If signing print name and title
Zone 12 or
Zone 13
Easting
Units must be Meters
Datum must be NAD83
Office Use Only
Northing
Unit must be set to true north
USGS map name
DWR map no.
Surface elev.
Was GPS unit checked for above?
YES
Remember to set Datum to NAD83
5. Parcel On Which Well Will Be Located
Receipt area only
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A.
Legal Description
(may be provided as an attachment):
AQUAMAP
B.
C.
# of acres in parcel
Owner
WE
WR
D.
Will this be the only well on this parcel?
YES
NO (if no list other wells)
CWCB
TOPO
E.
MYLAR
State Parcel ID# (optional):
DIV _____ WD _____ BA _____ MD _____
SB5
COLORADO DIVISION OF WATER RESOURCES
Office Use Only
Form GWS-45 (07/2013)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 821, DENVER, CO 80203
Main: (303) 866-3581 Fax: (303) 866-2223
dwrpermitsonline@state.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be computer generated, typed or in black or blue ink.
1. Applicant Information
6. Use Of Well (check applicable boxes)
Name of applicant
Attach a detailed description of uses applied for.
Industrial
Dewatering System
Mailing address
Municipal
Geothermal (production or reinjection
Irrigation
Other (describe): ______________________
City
State
Zip code
Commercial
7. Well Data (proposed)
Telephone # (area code & number)
E-mail (online filing required)
Maximum pumping rate
Annual amount to be withdrawn
gpm
2. Type Of Application (check applicable boxes)
acre-feet
Total depth
Aquifer
Construct new well
Use existing well
Replace existing well
Change or increase use
feet
Change source (aquifer)
Reapplication (expired permit)
8. Land On Which Ground Water Will Be Used
COGCC Well
Other: ________________
Legal Description of Land
(may be provided as an attachment):
3. Refer To (if applicable)
Well permit #
Water Court case #
Designated Basin Determination #
Well name or #
4. Location Of Proposed Well
County
(If used for crop irrigation, attach a scaled map that shows irrigated area.)
1/4
A.
B.
1/4 of the
# Acres
Owner
Section
Township
N or S
Range
E or W
Principal Meridian
C.
List any other wells or water rights used on this land:
Distance of well from section lines (section lines are typically not property lines)
N
S
E
W
Ft. from
Ft. from
9. Proposed Well Driller License #(optional):
For replacement wells only – distance and direction from old well to new well
10.
Sign or Entered Name Of Applicant(s) Or Authorized Agent
feet
direction
The making of false statements herein constitutes perjury in the second
Well location address (Include City, State, Zip)
Check if well address is same as in Item 1.
degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S.
24-4-104 (13)(a). I have read the statements herein, know the contents
thereof and state that they are true to my knowledge.
Sign or enter name(s) of person(s) submitting application
Date (mm/dd/yyyy)
Optional: GPS well location information in UTM format You must check GPS unit for
required settings as follows:
Format must be UTM
If signing print name and title
Zone 12 or
Zone 13
Easting
Units must be Meters
Datum must be NAD83
Office Use Only
Northing
Unit must be set to true north
USGS map name
DWR map no.
Surface elev.
Was GPS unit checked for above?
YES
Remember to set Datum to NAD83
5. Parcel On Which Well Will Be Located
Receipt area only
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A.
Legal Description
(may be provided as an attachment):
AQUAMAP
B.
C.
# of acres in parcel
Owner
WE
WR
D.
Will this be the only well on this parcel?
YES
NO (if no list other wells)
CWCB
TOPO
E.
MYLAR
State Parcel ID# (optional):
DIV _____ WD _____ BA _____ MD _____
SB5
COLORADO DIVISION OF WATER RESOURCES
GWS-45 GENINST (07/2013)
DEPARTMENT OF NATURAL RESOURCES
GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS
Applications must be computer generated on-line, typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the
application must be completed. Incomplete applications may be returned to the applicant for more information.
Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form
may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the
original form. If filing online see online filing instructions! You may also save, print, scan and email the completed form to:
dwrpermitsonline@state.co.us
For further information please visit
www.water.state.co.us
FEES : This application must be submitted with a $100 filing fee. Acceptable forms of payment are check or money
order, payable to the Colorado Division of Water Resources. Visa, MasterCard or Discover are accepted by phone through
our Records Section at 303.866.3581. Fees are nonrefundable.
USES : This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot,
geothermal (see Geothermal Rules for fee requirements), recovery wells, and other uses not otherwise noted in the
following list:
RESIDENTIAL use wells – Use of form GWS-44 is required
LIVESTOCK watering on a farm, ranch, range or pasture (not feedlots) – Use form GWS-44
MONITORING/OBSERVATION wells – Use form GWS-46
GRAVEL PITS – Use form GWS-27
REGISTRATION of an existing well – Use form GWS-12 (must have been in use prior to May 8, 1972)
GEOEXCHANGE SYSTEM LOOP FIELDS – Use form GWS-72
REPLACEMENTS OF WELLS FOR THE ABOVE USES
ITEM INSTRUCTIONS : (numbers correspond with those on the front of this form)
1.
The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be
sent.
2.
Check all boxes that apply.
3.
Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of water right, the
case number or determination number must be indicated. If applying to replace or change the use of an existing well, the permit number of the existing
well must be indicated.
4.
The county, ¼ of the ¼ section designation, section #, township, range, principal meridian, and distances from section lines for the proposed well must
be provided. (An option to providing distances from section lines and the ¼ of the ¼ section designation is to provide an accurate GPS location in UTM
format. The required GPS unit settings must be as indicated on this form.) Colorado contains two (2) UTM zones. Zone 13 covers most of Colorado.
th
th
th
The boundary between Zone 12 and Zone 13 is the 108
Meridian (longitude). West of the 108
Meridian is UTM Zone 12 and east of the 108
th
Meridian is UTM Zone 13. The 108
Meridian is approximately 57 miles east of the Colorado-Utah state line. On most GPS units, the UTM zone is
given as part of the Easting measurement, e.g. 12T0123456. Check the appropriate box for the zone. Provide the property address of the well location
if one exists. If it is the same as the mailing address, check the box next to the well location address.
5.
Please attach a current deed for the subject parcel. Complete all boxes and provide a complete legal description of the parcel of land on which the
well will be located. If filing online please see online filing instructions for how to submit deed and or legal description attachments.
6.
Check all boxes that apply and attach a detailed description of the uses applied for.
7.
Complete all boxes.
8.
Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation
is a proposed use, provide a map of the land area with proposed irrigated areas accurately drawn, including section numbers and section lines. A list of
all other wells or water rights used on the described land must be provided.
9.
The well must be constructed by a Colorado licensed well driller, an authorized individual in accordance with the Water Well Construction Rules, 2 CCR
402-2, or under the “private driller” provision as defined in CRS 37-91-102(12). A listing of licensed well drillers/pump installers is available at:
http://water.state.co.us/groundwater/BOE/Pages/LicensedContractors.aspx
10. The individual signing the application or entering their name and title must be the applicant or an officer of the corporation/company/agency identified as the
applicant or their attorney. An authorized agent may also sign the application, if a letter signed by the applicant or their attorney is submitted with the
application authorizing that agent to sign or enter their name on the applicant’s behalf. If you filled the form out on-line you may save or print, sign, scan and
email the form to the Division of Water Resources. Payment must be received via phone, fax or mail prior to processing the application.
IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk (303-
866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683),
Montrose (970-249-6622), Glenwood Springs (970-945-5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to our web site at
http://www.water.state.co.us
for general information, additional forms, and access to state rules or statutes.

Download Form GWS-45 General Purpose Water Well Permit Application - Colorado

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