Free GWS-53, APPLICATION FOR DETERMINATION OF WATER RIGHT WITHIN A DESIGNATED GROUND WATER BASIN PURSUANT TO SECTION 37-90-107(7) C.R - Colorado

COLORADO GROUND WATER COMMISSION DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 Sherman St, Room 818, Denver, CO 80203

APPLICATION FOR DETERMINATION OF WATER RIGHT WITHIN A DESIGNATED GROUND WATER BASIN PURSUANT TO SECTION 37-90-107(7), C.R.S.
Please note: This application may only be used to apply for a determination of rights to ground water from the Dawson, Denver, Arapahoe or Laramie-Fox Hills aquifer underlying land areas located within a Designated Ground Water Basin. Review the instructions on the reverse of this form. This form must be completed, signed, dated and submitted to the Ground Water Commission with a non-refundable $60 filing fee. A separate form must be used for each aquifer determination. Type or print in black ink.

1. APPLICANT INFORMATION
Name of Applicant

Applicant Mailing Address

Applicant Telephone Number (include area code)

2. AMOUNT OF OVERLYING LAND ­ the total land area
claimed and described by the applicant in Item #8 below, consisting of acres.

3. AQUIFER

4. EXISTING WELLS ­ Are there any wells located on the claimed and described overlying land?

Yes____ No____ If yes, provide a complete list of all wells located on the overlying land area as an attachment to this application.

5. ANNUAL AMOUNT OF GROUND WATER ­ to be withdrawn, for intended beneficial uses, from the aquifer underlying the
described land area claimed by the applicant in Item #8 below. Please specify one of the following: Maximum allowable annual acre-feet

______ acre-feet annually

Maximum allowable annual acre-feet, excluding __________ acre-feet from that amount

6. USE OF GROUND WATER ­ description of intended beneficial uses of the ground water to be withdrawn from the aquifer

7. PLACE OF USE ­ of the ground water shall be considered to be that overlying land area claimed and described by the applicant in
Item #8 below, unless a legal description or accurate scale map is provided which describes an alternate/additional place of use.

8. REQUIRED LANDOWNERSHIP DOCUMENTATION - The Ground Water Commission shall allocate ground water from the
Dawson, Denver, Arapahoe or Laramie-Fox Hills aquifer on the basis of ownership of overlying land. For this reason, a Nontributary Ground Water Landownership Statement (form GWS-1) or Nontributary Ground Water Consent Claim (form GWS-48), including a description of the overlying land area subject to this determination, must be submitted as an attachment to the application.

9. SIGNATURE OF APPLICANT - must be original signature ­ The making of false statements herein constitutes perjury in the
second 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.

Signature - print name and title

Date

FOR OFFICE USE ONLY

DIV_______ CO_______WD______BASIN________MD_______

Form GWS-53 (6/2006)

COLORADO GROUND WATER COMMISSION DIVISION OF WATER RESOURCES - DEPARTMENT OF NATURAL RESOURCES

GWS-53 INST (6/2006)

INSTRUCTIONS - APPLICATION FOR DETERMINATION OF WATER RIGHT
ITEM 1 - APPLICANT INFORMATION - Provide the applicant's name and mailing address where all correspondence will be sent. Also, provide the applicant's telephone number in the appropriate space. ITEM 2 ­ AMOUNT OF OVERLYING LAND ­ Indicate the total amount of acres of the claimed overlying land area described in the landownership documents provided in Item #8. ITEM 3 - AQUIFER - Indicate the aquifer to be considered for this determination. ITEM 4 ­ EXISTING WELLS ­ Provide a complete list and information for all existing wells located on the overlying land area. ITEM 5 - ANNUAL AMOUNT OF GROUND WATER - This is the intended average annual amount of ground water (in acre-feet) to be allocated and withdrawn, for intended beneficial uses, from the specified aquifer underlying the land area claimed and described in the landownership documents provided in Item #8. Indicate "maximum allowable annual acre-feet" as the amount ­ OR - indicate a specific annual acre-feet amount ­ OR ­ indicate "maximum allowable annual acre-feet" as the amount, excluding a specified acre-feet amount from that maximum amount. ITEM 6 - USE OF GROUND WATER - Provide a description of all intended beneficial uses of the subject ground water. Such uses must be beneficial, non-speculative, and may not create unreasonable waste. Nonspecific or non-explicit phrases or terms such as "all beneficial uses" are not acceptable. Municipal type use is limited to municipalities or water service districts. ITEM 7 - PLACE OF USE - The place of use for the intended beneficial uses described in Item #6 shall be considered to be that land area claimed and described in the landownership documents provided in Item #8 - unless a complete legal description or accurate scale map is provided which describes an alternate or additional place of use. ITEM 8 - REQUIRED LANDOWNERSHIP DOCUMENTATION - A Nontributary Ground Water Landownership Statement (form GWS-1) or Nontributary Ground Water Consent Claim (form GWS-48) must be submitted as an attachment to the application. Any statement claiming ownership of overlying land must be signed by the actual property owner. A complete legal description, survey plat, or accurate scale map of the claimed overlying land area - that is subject to the requested determination - must be provided with these forms. (Note: complete landownership consent documentation must be provided with form GWS-48; applications made by municipalities or water service districts must attach form GWS-52 for areas claimed in accordance with Rule 5.3.10 of the Designated Basin Rules.) ITEM 9 - SIGNATURE OF APPLICANT - Must be an original signature. The individual signing the application must be the applicant. If the applicant is a corporation or business, an officer of the corporation or owner of the business must sign the form. The designated manager or member manager must sign applications for Limited Liability Companies. The title or position of the person signing the form must be indicated, the name of this person must be printed below the signature in the form, and the date when the application was signed must be noted. An applicant's authorized agent or attorney may sign the application if a letter signed by the applicant is submitted with the application authorizing them to act as agent for the specific purpose of applying for a determination of water right. · Applications for determinations of rights to ground water from the Dawson, Denver, Arapahoe, and Laramie-Fox Hills aquifers underlying land areas within Designated Ground Water Basins are submitted to the Colorado Ground Water Commission and evaluated pursuant to Section 37-90-107(7), CRS, and Rule 5.3 of the Designated Basin Rules, 2 CCR 410-1. A separate application form and filing fee is required for each aquifer determination for a described land area. An application for a land area that consists of noncontiguous areas shall only be considered under a single application if withdrawal of ground water may occur in accordance with Rule 5.3.7.2 of the Designated Basin Rules. If the application can be given favorable consideration by the Commission, the application will be published for public review in the county where the overlying land is located once each week for two successive weeks, followed by a 30 day objection period. The applicant shall be responsible for the actual cost of such legal notice publication. If Commission approval of a replacement plan is required to obtain well permits to withdraw ground water from the aquifer specified in the application for determination, an application for replacement plan may be submitted on form GWS-69 in accordance with Section 37-90-107.5, C.R.S., and Rule 5.6 of the Designated Basin Rules. An application for replacement plan may be submitted concurrent with an application for determination of water right or any time after approval of a determination.
IF YOU HAVE ANY QUESTIONS - call the Division of Water Resources - Ground Water Information Desk - at 303-866-3587

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