Free DBB-006, Application for Commingling of Wells - Colorado

DBB-006 (8/2008)

APPLICATION FOR COMMINGLING OF PERMITS COLORADO GROUND WATER COMMISSION Room 818 Centennial Building, 1313 Sherman Street Denver, CO 80203

Part I - Basic Information NOTE: This application can only be used for wells located within a Designated Ground Water Basin.

Application must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed.

I am the owner of the wells with permit numbers as referenced below and I hereby apply to commingle these permits. I understand that I am not allowed to commingle these permits without first obtaining such a permit from the Commission. Acres Allowed for Permit No. Well Location Irrigation _______________ ____________________________________________________ ____________ _______________ _______________ _______________ _______________ _______________ ______1/4 of _____1/4 of Sec. _______, T_____N/S, R______W ____________ ______1/4 of _____1/4 of Sec. _______, T_____N/S, R______W ____________ ______1/4 of _____1/4 of Sec. _______, T_____N/S, R______W ____________ ______1/4 of _____1/4 of Sec. _______, T_____N/S, R______W ____________ ______1/4 of _____1/4 of Sec. _______, T_____N/S, R______W ____________

I request permission to irrigate, with commingled water, _______________ acres of land described as follows:______________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Enclosed herewith is the nonrefundable application fee of $____________. (The fee required is $100.00 per permit involved.) Also enclosed is Part II of this application (one form for each permit involved) giving power and crop data. I understand that this request will be published in the local newspaper(s) as may be required by law and that I will pay the actual publication cost to the Commission when the same is billed to me. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. [Pursuant to Section 24-4-104(13)(a), C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a Class 1 misdemeanor.] Signed and dated this _____________ day of _______________________________, 20____________. Signature of Applicant: ________________________________________________________________ Applicant's Name: Address: City, State & Zip Telephone No. ________________________________________________________________
(Please Print)

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ FOR OFFICE USE ONLY Basin MD

Div.

Co.

WD

Use

Receipt No._______

APPLICATION FOR COMMINGLING OF PERMITS Part II - Well Use Data

The following minimum information is required to verify the current use of each permit and their compatibility. Please provide this well use data report for each permit specified in Part I for the latest three years in which the well has been used. Additional information including the well pump tests may be required if necessary. Well Permit No. __________________________:

Table A - Power Consumption

Electric Billing H.P.

Natural Gas Thousand Cu. Ft. (MCF)

Diesel or Gasoline (Indicate which type of fuel used each year) Gallons H.P.

Year

KWH

H.P.

Attach copies of the power billings or a letter from the power company to support above power use.

Table B - Crops Grown

Crop A Year Crop Acres Irrig. Method Crop

Crop B Acres Irrig. Method Crop

Crop C Acres Irrig. Method

Attach copies of the FSA crop records to support above crop data or a letter affirming that such records are not available for the lands involved.

(THIS FORM MAY BE REPRODUCED BY PHOTOCOPY OR WORD PROCESSING MEANS)

APPLICATION FOR COMMINGLING OF PERMITS Part II - Well Use Data

The following minimum information is required to verify the current use of each permit and their compatibility. Please provide this well use data report for each permit specified in Part I for the latest three years in which the well has been used. Additional information including the well pump tests may be required if necessary. Well Permit No. __________________________:

Table A - Power Consumption

Electric Billing H.P.

Natural Gas Thousand Cu. Ft. (MCF)

Diesel or Gasoline (Indicate which type of fuel used each year) Gallons H.P.

Year

KWH

H.P.

Attach copies of the power billings or a letter from the power company to support above power use.

Table B - Crops Grown

Crop A Year Crop Acres Irrig. Method Crop

Crop B Acres Irrig. Method Crop

Crop C Acres Irrig. Method

Attach copies of the FSA crop records to support above crop data or a letter affirming that such records are not available for the lands involved.

(THIS FORM MAY BE REPRODUCED BY PHOTOCOPY OR WORD PROCESSING MEANS)

APPLICATION FOR COMMINGLING OF PERMITS Part II - Well Use Data

The following minimum information is required to verify the current use of each permit and their compatibility. Please provide this well use data report for each permit specified in Part I for the latest three years in which the well has been used. Additional information including the well pump tests may be required if necessary. Well Permit No. __________________________:

Table A - Power Consumption

Electric Billing H.P.

Natural Gas Thousand Cu. Ft. (MCF)

Diesel or Gasoline (Indicate which type of fuel used each year) Gallons H.P.

Year

KWH

H.P.

Attach copies of the power billings or a letter from the power company to support above power use.

Table B - Crops Grown

Crop A Year Crop Acres Irrig. Method Crop

Crop B Acres Irrig. Method Crop

Crop C Acres Irrig. Method

Attach copies of the FSA crop records to support above crop data or a letter affirming that such records are not available for the lands involved.

(THIS FORM MAY BE REPRODUCED BY PHOTOCOPY OR WORD PROCESSING MEANS)

Part III - Applicant's Statement I recognized that the aquifer is overappropriated at this location and that in order to allow this change of water right for the well Permit No(s). ________________________________ without material injury to the rights of other appropriators, the future withdrawals from the well(s) must be limited to prevent an increase over the historic depletions to the aquifer. I am willing to comply with the following conditions to provide for the proper administration of the requested change, if approved. 1. The terms of the Commission's change of water right approval shall be considered as covenants running with the land as described, modifiable in the future only by the Colorado Ground Water Commission or its successors in conformity with Title 37, Article 90 of the Colorado Revised Statutes, also known as the Colorado Ground Water Management Act, as it exists on the date such modification is made. A certified copy of this approval shall be recorded in the public records of the county clerk of the applicable county. Any modifications shall likewise be recorded. 2. Applicant agrees to pay all reasonable costs associated with the administration of the change of water right. The applicant also agrees to enter into a contract with the Commission, local Ground Water Management District ("District"), or a person or entity acceptable to the Commission for this purpose. The change of water right shall not be implemented until the applicant or subsequent well owner have signed a contract with the Commission, District, or a person or entity acceptable to the Commission Contracts with entities other than the Commission or District must be Commission approved. 3. The contracted services required under this administration shall include site inspections covering the peak water use period during the calendar year. Each inspection will include the readings of water-measuring devices and a description of use of water from the subject well(s). Any perceived violation of the permit conditions shall also be reported. A copy of the contractor's inspection report shall be available to the applicant upon request. 4. The Applicant (or the contracted entity) shall be required to report to the Commission and District all readings of the measuring device(s) and total amount(s) pumped by February 15 of each year for the prior calendar year. The Applicant is also required to report the number of kilowatt-hours of electricity, thousand cubic feet of gas, or other fuel used for the prior calendar year. 5. All meter installation information and readings must be reported on forms DBB-003 Administrative Reporting-Meter Information and DBB-004 Administrative Reporting-Meter Readings, respectively, and or any other Commission approved forms. All water volumes must be converted to an acre-foot amount. Incomplete forms shall not be acceptable for fulfillment of reporting requirements. 6. Prior to implementation of the approval of the change of water right, the applicant or subsequent owner shall acquire water-measuring devices satisfactory to the Commission and District, which shall be installed according to the manufacturer's recommendations under the supervision and to the satisfaction of the Commission and the District. These measuring devices shall be inspected annually and promptly repaired or recalibrated as needed whenever it comes to the applicant's attention that they are not in good working condition or whenever so notified by authorized representatives of the Commission or District. All of these obligations shall be fulfilled at applicant's sole expense. No repairs or replacement of parts of said measuring devices shall be made by applicant without prior notification to the Commission and District. All parts replaced shall be retained by applicant and given to Commission or District Representatives who may inspect the measuring devices after their repair or replacement. Any pump shall be turned off by applicant while the measuring device for that well is not working properly or is being repaired or replaced, and shall not be turned on again until approved by the Commission or District. 7. The requirements outlined in Commission Policy Memorandum 95-3, concerning the use of flow meters and power meters, must be met. 8. Applicant is required to observe the water-measuring device(s) and shall be responsible to turn off the

pump(s) once the withdrawal limit(s) for that year is reached. 9. The applicant hereby authorizes _________________________ (name of electric or natural gas company or fuel supplier) to release to authorized Commission or District personnel all power use data within its records regarding this well(s).

10. The applicant agrees to allow access to all lands at all reasonable times to representatives of the Commission or District for inspection and other necessary visits to administer this application. The measuring devices must be accessible for examination and reading by the authorized persons. 11. Where applicable, the applicant agrees to make any and all records regarding irrigation from this well(s) at the respective F.S.A. offices available to Commission and District personnel at all reasonable times, and authorizes the release of all such records to Commission and District personnel. 12. Where applicable, the applicant agrees to provide yield records for crops irrigated by this well upon request or accept the appropriate county average yields. 13. Field certification of the water-measuring devices by a certified well tester as determined by the State of Colorado is required every four (4) years as stated in Commission Policy Memorandum 95-3. The well owner shall promptly submit the results of these field certifications to the Commission. Results must be submitted to the Commission on attached form DBB-019(A) Power Consumption Coefficient Rating for Electrical Pumps where electrical pumps are used and on attached form DBB-019(B) Pump and Motor Efficiency Tests must be where non-electrical pumps are used. At least three (3) days prior notice of the date of this test must be given to Commission and District, so that Commission or District personnel might be present during the test.
14. The applicant agrees to pay all court costs and reasonable attorney fees incurred by the Commission and/or

District in any court or administrative action which results in a determination that applicant have violated any provision of this Applicant's Statement or any conditions of the change of water right approval. If in violation of a Commission or State Engineer Order, the violator may be required to pay a sum not to exceed five hundred dollars ($500) for each day such violation continues. Furthermore, if such ground water violation results in the violation of compliance with an interstate compact, the violator shall be liable for all direct, actual, and necessary expenses incurred by the State of Colorado in performing any action, including the purchase of water or payment of damages necessary for the State of Colorado to remedy the violation of such compact. 15. Any person who, when complying with the conditions of this Applicant's Statement, fails to submit data, falsifies or makes a fictitious report of the amount of designated ground water pumped from a well, makes a false or fictitious report of a power coefficient for a well, or falsifies any power coefficient test shall forfeit and pay a sum not to exceed five hundred dollars ($500) for each violation. 16. Also, any person who willfully interferes with or damages a power meter, totalizing flow meter, or other devices used to measure designated ground water diversions or who tampers with or falsifies any record made or being made by any such power meter, totalizing flow meter, or other devices shall forfeit and pay a sum not to exceed five hundred dollars ($500) for each violation. 17. The applicant may be required to agree to additional terms and conditions that are deemed appropriate to prevent material injury to the vested water rights of other appropriators before the approval can be granted or implemented. Signed and dated this ________ day of ____________________________, 20________.

________________________________________________ Signature of Applicant