Free GWS-69, APPLICATON FOR APPROVAL OF A REPLACEMENT PLAN WITHIN A WITHIN A DESIGNATED GROUND WATER BASIN PURSUANT TO SECTION 37-90- - Colorado

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

APPLICATION FOR APPROVAL OF A REPLACEMENT PLAN WITHIN A DESIGNATED GROUND WATER BASIN PURSUANT TO SECTION 37-90-107.5, C.R.S.
NOTE: This application may only be used to request Ground Water Commission approval of a replacement plan to allow use of ground water for areas located within a Designated Ground Water Basin. This form must be completed, signed, dated and submitted to the Commission with a non-refundable $100 filing fee. Type or print in black ink.

1. APPLICANT INFORMATION
Name of Applicant

Applicant Mailing Address

Applicant Telephone Number (include area code)

2. PROPOSED REPLACEMENT PLAN ­ the following information must be attached to this application form A. Provide as an attachment to this application - the complete details of the proposed replacement plan. The plan must contain, as a minimum, the elements described in Rule 5.6.1 of the Designated Basin Rules, 2 CCR 410-1, including: a detailed description of the source of replacement water; a detailed description of the proposed diversion, use and depletion of designated ground water that would result under the plan; proof that the plan will not cause material injury to water rights of other appropriators; proof that the plan will not cause unreasonable impairment of water quality; proof that the plan can and will be operated and administered on an ongoing and reliable basis. The applicant shall have the burden of proving the adequacy of the plan in all respects. B. If return flows are to be used as a source of replacement water to prevent injury to alluvial aquifer rights, provide an engineering report that establishes the timing, location and amount of such return flows reaching the affected alluvial aquifer(s). The applicant shall also provide evidence that said return flows occur over a saturated alluvium or a continuous shallow water table in hydraulic connection with the affected alluvial aquifer(s). C. If the replacement plan is for the purpose of allowing withdrawals of ground water from the Dawson, Denver, Arapahoe, or Laramie-Fox Hills aquifer in accordance with Section 37-90-107(7), C.R.S., indicate the subject aquifer and determination of water right approval, or pending application for such determination, in the plan. As an attachment to the application, provide a table showing calculated annual depletions to the affected alluvial aquifer(s). The annual amounts of replacement water must provide for the depletion of alluvial ground water for the first 100 years due to all previous pumping; and if pumping continues beyond 100 years, must replace actual impact until pumping ceases. D. Provide as an attachment to this application - a written summary of the replacement plan application. If the Commission determines the application for replacement plan to be complete, this summary will be incorporated into the required legal notice publication. The summary should be concise but complete enough to provide proper notice to the public. 3. SIGNATURE OF APPLICANT - must be original signature - 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-69 (6/2006)