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FORM 7 - N OTICE OF I NACTIVATION
To be Filed in Compliance with Rule 7 of the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN WATER DIVISION NO. 3, THE RIO GRANDE BASIN.
To: Division Engineer, Water Division No. 3 P. O. Box 269 301 Murphy Drive Alamosa, CO 81101
OWNER Name: Address: City, State, Zip: Phone: E-Mail: WELL LOCATION Well Permit No.: ¼, ¼, Section
AND

Telephone: FAX:

(719) 589-6683 (719) 589-6685

CONTACT INFORMATION: USER (IF NOT SAME AS OWNER)

INFORMATION: Case or Decree No.: , Township Ft. from N S , Structure ID No.:
(if known):

Range Ft. from

, E

PM W

Distance of Well from Section Lines

T H I S N O T I C E I S F O R : CHECK ONE OF THE FOLLOWING AND LIST ANY METERS THAT WILL NO LONGER BE ACTIVE ENTIRE WELL (ALL DISCHARGE POINTS) ONLY DISCHARGE POINTS/METERS AS LISTED

HAS THIS WELL BEEN INACTIVATED AS PART OF AN APPROVED WATER CONSERVATION PROGRAM?

WELL DISCONNECTED

FROM

POWER - YOU MUST CHECK ONE

OF THE

FOLLOWING:

.............. well has no pump, OR The .............. pump is electrically powered, BUT there is no electric meter, OR The .............. pump is electrically powered, BUT electric power has been disconnected, OR The .............. of the above. IF THIS BOX IS CHECKED, DO NOT SIGN BELOW. COMPLETE NEXT PAGE! None FILL OUT AND SIGN THE BACK OF THIS FORM
WELL OWNER/USER CERTIFICATION: By my signature on this form, I acknowledge and agree that this notice of inactivation has the same effect as an order by the DIVISION ENGINEER pursuant to section 37-92-502, CRS, that no water shall be diverted from this WELL/PUMP until such time as it has a MEASUREMENT METHOD meeting the standards of the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN THE RIO GRANDE BASIN ("MEASUREMENT RULES"). I hereby verify that the WELL/PUMP as described above is inactive and disconnected from any and all power sources and will not be used until such time as I notify the Division Engineer in writing of my intent to re-activate this WELL/PUMP by filing a FORM 7.1, NOTICE OF WELL RE-ACTIVATION. Form 7.1 must be filed with the Division Engineer at least 10 days prior to the well being used. I agree that, before I re-activate this WELL/PUMP, I will submit to the DIVISION ENGINEER a Form 7.1 along with proof of a valid MEASUREMENT METHOD on FORM 3.1 or 3.2 , OR, if proof of a valid MEASUREMENT METHOD is already on file with the DIVISION ENGINEER, I WILL provide NOTICE OF RE-ACTIVATION on FORM 7.1. I acknowledge that should I reactivate this WELL/PUMP without submitting the necessary information to the DIVISION ENGINEER, I will be in violation of the MEASUREMENT RULES and in violation of this ORDER of the DIVISION ENGINEER, and 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. I agree to the release of information pertaining to my use of electrical energy to pump ground water including Current Transformer Factor, Voltage/Potential Transformer Factor, and Electric Meter Readings, to the COLORADO DIVISION OF WATER RESOURCES by my electric supplier for the purposes of determining or verifying WATER USE from the WELL/PUMP. I have read and understand the conditions this notice of in-activation. I understand that should I desire to re-activate the above-described WELL/PUMP that all aspects of the MEASUREMENT RULES apply to any use of this well. The inactivation of this well under the MEASUREMENT RULES, in and of itself, is neither proof nor disproof of intent to abandon the WATER RIGHT(S), if any, associated with this WELL/PUMP.

SIGNATURE:
CHECK ONE: WELL OWNER
COUNTY OF

DATE:
WELL USER
OF

THIS

SUBSCRIBED AND AFFIRMED, OR SWORN TO BEFORE ME IN THE ___________DAY OF ______________, 20______. MY COMMISSION
EXPIRES:

_______________________, STATE

_______________________,

____________________________

NOTARY PUBLIC: _____________________________________
UPDATED: 04/01/08

DIV 3 FORM 7.0.DOC

FORM 7 - NOTICE OF INACTIVATION

2

**Complete this page ONLY if you checked the last box on the first page**
A variance request MUST be renewed annually. Approval is subject to a Field Inspection of the well.

TYPE OF VARIANCE REQUESTED: You must check ONLY ONE box AND answer every question for that box. ... There is power at the electric meter, but the pump is the only electrical device on that meter: Name of Power Company: Provide the following information: From Power Co. Bill Power Company Account No.: On Power Meter Power Company Meter No.: ... There is power at the electric meter, but the pump is NOT the only electrical device on that meter: The pump must be in some way disabled such that it cannot be used. How is the pump disabled?: Describe how the pump is disabled: Provide the following information: Power Company Account No.: Power Company Meter No.: Name of Power Company:
From Power Co. Bill On Power Meter

... Pump is not electrically powered (e.g., it is powered by solar energy, propane, gasoline, etc. or is artesian): The pump/well must be in some way disabled such that it cannot be used. Describe how the pump/well is disabled:

V A RIA N C E R E Q UE S T F O R A W E LL T HA T R E M A IN S C O N N E C TE D T O P O W E R
WELL OWNER/USER CERTIFICATION: By my signature on this form, I acknowledge and agree that if this variance requested is granted, it will have the effect of an order by the Division Engineer pursuant to section 37-92-502, CRS, that no water shall be diverted from this well until such time as it has a measurement method meeting the standards of the RULES GOVERNING THE MEASUREMENT OF GROUND WATER DIVERSIONS LOCATED IN THE RIO GRANDE BASIN ("MEASUREMENT RULES"). Pursuant to Rule 11 of the MEASUREMENT RULEs, I request a variance from the requirement to disconnect the well from the power source. I understand that as a condition of approval of this variance request, I must re-file a Notice of Inactive Well each year or bring the well into compliance with the metering requirements of the MEASUREMENT RULES. Prior to using the well, I will notify the Division Engineer in writing of my intent to re-activate this well by filing a Form 7.1, Notice of Well Re-activation. Form 7.1 must be filed with the Division Engineer at least 10 days prior to the well being used. I agree that should I plan re-activate this well, I will submit to the Division Engineer a Form 7.1 along with proof of a valid measurement method on Form 3.1 or 3.2 , OR, if proof of a valid measurement method is already on file with the Division Engineer, I will provide notice of re-activation on Form 7.1. I acknowledge that should I reactivate this well without submitting the necessary information to the Division Engineer, I will be in violation of the MEASUREMENT RULES and in violation of an Order of the Division Engineer, and 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 sec. 37-92-503, CRS. For ELECTRICALLY-POWERED WELLS/PUMPS, I agree to the release of information pertaining to my use of electrical energy to pump ground water including CURRENT TRANSFORMER FACTOR, VOLTAGE/POTENTIAL TRANSFORMER FACTOR, and ELECTRIC METER READINGS, to the COLORADO DIVISION OF WATER RESOURCES by my electric supplier for the purposes of determining or verifying WATER USE from the WELL/PUMP. I have read and understand that the granting of the requested variance will have the effect of an Order of the Division Engineer not to divert water from this well. I understand that should I plan to re-activate the above described well, that the MEASUREMENT RULEs apply to any use of this well. The inactivation of this well under the MEASUREMENT RULES, in and of itself, is neither proof nor disproof of intent to abandon the water right(s) associated with this well.

SIGNATURE:
CHECK ONE: WELL OWNER WELL USER

DATE:

THIS

SUBSCRIBED AND AFFIRMED, OR SWORN TO BEFORE ME IN THE ___________DAY OF ______________, 20______.

COUNTY OF

_______________________, STATE

OF

_______________________,

MY COMMISSION EXPIRES: ____________________________

NOTARY PUBLIC: _____________________________________

FOR DWR USE ONLY Inspected by: Approved: YES.. NO .. Date: FIELD COMMENTS:

DIV 3 FORM 7.0.DOC

UPDATED: 04/01/08