Free Form 7.1 Notice of Reactivation - Colorado

FORM 7.1

- N OTICE OF R EACTIVATION

To be Filed in Compliance with Rule 7 of the AMENDED RULES GOVERNING THE MEASUREMENT OF TRIBUTARY GROUND WATER DIVERSIONS LOCATED IN THE ARKANSAS RIVER BASIN to notify the DIVISION 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, DIVISION 2 310 E. ABRIENDO, SUITE B PUEBLO, CO 81004 TELEPHONE: FAX: 719.542.3368 719.544.0800

STRUCTURE ID NUMBER:

REACTIVATION DATE:

PROVIDE THE FOLLOWING ­ WHETHER OR NOT A STRUCTURE ID HAS BEEN ASSIGNED ­ USING INFORMATION SHOWN ON THE BRASS TAG FOR THE STRUCTURE. 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: T H I S N O T I C E I S F O R : CHECK ONE OF THE FOLLOWING AND L IST M ETERS ENTIRE WELL (ALL PUMPS/METERS) [LIST ALL METERS]
THAT WILL BE

USER (IF NOT SAME AS OWNER)

A CTIVE

ONLY PUMPS/METERS AS LISTED

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

AUGMENTATION METHOD (CHECK ONE THAT APPLIES AND INSERT NAME OF PLAN):
.... SUBSTITUTE WATER SUPPLY PLAN: ......... .... RULE 14 (PRE-1986) PLAN:................. .... DECREED AUGMENTATION PLAN: ............ .... EXCEPTED FROM ARKANSAS USE RULES ....

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 TRIBUTARY GROUND WATER DIVERSIONS LOCATED IN THE ARKANSAS 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:
FORM 71 041108

DATE:
WELL OWNER WELL USER
04/11/08