Free Form 7.1 - Notice of Reactivation - Colorado

FORM 7.1

- N OTICE

OF

R EACTIVATION

To be Filed in Compliance with Rule 16.9 of the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN THE REPUBLICAN RIVER BASIN WITHIN WATER DIVISION NO. 1. to notify the STATE ENGINEER of intent to REACTIVATE a WELL/PUMP previously reported as Inactive AND HAVING A CURRENTLY VALID MEASUREMENT METHOD. SUBMIT TO: DIVISION OF WATER RESOURCES 1313 SHERMAN ST. RM. #818 DENVER, CO 80237 TELEPHONE: FAX: 303-866-3581 303-866-3859

STRUCTURE ID NUMBER:

REACTIVATION DATE:

PROVIDE THE FOLLOWING: (IF THERE IS NO KNOWN PERMIT OR DECREE, PLEASE NOTE AS "NA") Well Permit No.: Case or Decree No.:

CONTACT INFORMATION:
OWNER Name: Address: City, State, Zip: Phone: THIS NOTICE IS FOR: CHECK ONE OF THE FOLLOWING AND L IST M ETERS THAT WILL NOW BE A CTIVE ENTIRE WELL (ALL PUMPS/METERS) [LIST ALL METERS] ONLY PUMPS/METERS AS LISTED USER (IF NOT SAME AS OWNER)

MEASUREMENT INFORMATION (CHECK ONE THAT APPLIES):
..... Report of NEW MEASUREMENT METHOD submitted on attached FORM 3.1 or 3.2, OR ..... Notice of TOTALIZING FLOW METER (FORM 3.1 ) previously approved and still valid, OR ..... POWER CONSUMPTION COEFFICIENT (FORM 3.2 ) previously approved and still valid
FAILURE TO HAVE A PREVIOUSLY-APPROVED OR NEW MEASUREMENT METHOD WILL RESULT IN THIS FORM BEING DENIED
AND RETURNED TO OWNER

WELL OWNER/USER CERTIFICATION:
The above information is true and correct to the best of my knowledge. I understand that the use of this WELL/PUMP is subject to the AMENDED RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN THE REPUBLICAN RIVER BASIN and that no water may be diverted from this WELL/PUMP until it is in compliance with those RULES, except to determine a POWER CONSUMPTION COEFFICIENT or install and verify a TOTALIZING FLOW METER. I further understand that to divert water in violation of those RULES may be subject to a complaint in the WATER COURT, fines of up to $500 per day, court costs and attorney fees as provided in 37-92-503, CRS.

SIGNATURE:
CHECK ONE: WELL OWNER WELL USER

DATE: