Free GWS-56, NOTICE OF COMMENCEMENT OF EXTRACTION OF RECHARGEd GROUND WATER - Colorado

Form No. GWS-56 4/99

STATE OF COLORADO OFFICE OF THE STATE ENGINEER
818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 (303) 855-3581 Fax (303) 866-3589

For Office Use Only

NOTICE OF COMMENCEMENT OF EXTRACTION OF
RECHARGED GROUND WATER Insert the Well Permit Number
_________________________.

Name, mailing address and phone number of the well owner: NAME(S) ____________________________________________________ Mailing Address _______________________________________________ City, St. Zip ___________________________________________________

Phone (

) __________________________

This notice is filed in accordance with Rule 9.5, Notice of extraction of the Denver Basin Artificial Recharge Extraction Rules 2 CCR-402-11.
WELL LOCATION: County ______________________ Owner's Well Designation ___________________

_________________________________________________________________________________________ (Address) (City ) (State) (Zip) _____1/4 of the____ 1/4, Sec. ____, Twp. _______ Distance from Section Lines ________ Ft. From N. or N. or S., Range ______ E. or W., ____ P.M. E. or W. Line.

S., _________ Ft. From

Date of first extraction of ground water _____________________________. Use of Ground Water ______________________________________________________________________________
___________________________________________________________________________________________________.

I (we) claim and say that I (we) (are) the owner(s) of the well described above and that the commencement of extraction of ground water from this well, lawfully made under the well permit, occurred on the date indicated, and that the statements made herein are true to my (our) knowledge.
Please print the Signature's Name & Title ____________________________________ ____________________________________ Signature(s) _____________________________________ _____________________________________ ____________________ Date

It is the responsibility of the owner of this well to complete and sign the form. Signatures of agents are acceptable if an original letter of agency signed by the owner is attached to the form upon its receipt.

This form is required for wells approved under permits issued pursuant to the Denver Basin Artificial Recharge Extraction Rules 2 CCR 402-11 and must be received by the Division of Water Resources within 60 days after commencing the first extraction of artificially recharged water.