HomeMy WebLinkAboutRequest for New Well Form No.602 R 12/2016
NOTICE OF COMPLETION OF
GROUNDWATER DEVELOPMENT
Use this form for completed groundwater FOR DEPARTMENT USE ONLY
developments where the water has been put to use for Notice No. Basin
the purposes identified with a maximum use of Priority Date Time AM-PM
35 GPM not to exceed 10 AC-FT per year. Rec'd By
Fee Rec'd$ Check No.
Incomplete forms will be returned. Deposit Receipt#
Payor(if different from name(s)listed in item 1 below)
Filing Fee $125.00 Refund$ Date
Make checks payable to DNRC. Deficiency Letter Sent
b Your priority is determined by the date of filing. If it is determined this form was improperly filed, your priority
date may be changed.
b If your development is within a Controlled Groundwater Area, this form cannot be used. Contact
your Regional Office for more information.
1. NAME(S) William Thompson (Zoey Development LLC)
MAILING ADDRESS 414 S 9th Ave
CITY Bozeman STATE MT ZIP 59715
PHONE M HOME WORK 406-581-4025 CELL
EMAIL ADDRESS wt@zoeydevelopment.com
2. HAS THIS WATER BEEN PUT TO USE FOR THE PURPOSES ON WHICH YOU ARE FILING?
O Yes ❑ No (IF YOU ANSWER NO, YOU CANNOT FILE THIS FORMAT THIS TIME.)
3. DIVERSION USED TO OBTAIN GROUNDWATER
EI Well—Attach well log, if available. Water Well Contractor Name:
❑ Developed Spring (Excavation performed at the spring location)
❑ Pit/Pond—Surface Area Acres Depth
4. FLOW RATE USED GPM (Cannot Exceed 35 GPM)
5. COMBINATION OR SHARED DEVELOPMENT
a. Are there other groundwater developments on your property? ❑ Yes ® No
If yes, how far away are the existing groundwater developments from this new groundwater development?
Provide a DNRC water right number for each.
b. Is this development used for another water right or by another user? ❑ Yes ® No
If yes, please explain how and provide a DNRC water right number for each.
6. PURPOSE AND PERIOD OF USE: Check those that apply and answer applicable questions
❑ Domestic: Number of homes supplied:
Year round use? 0 Yes 0 No If no, from to , inclusive of each year.
❑ Lawn & Garden: Include only watered area. Do not include house footprint, driveway, graveled areas, etc.
Total size of lawn &garden - length x width -OR- Number of Acres < 1 ACRE
April 1 -October 31 ® Yes ❑ No If no, from to inclusive of each year.
Open Space- Landscaping irrigation
❑ Irrigation: (Do not include Lawn & Garden Irrigation)
Type of crop Total Crop Acres Irrigated
April 1 -October 31 ❑ Yes ❑ No If no, from to , inclusive of each year.
❑ Stock:
Number&type: (Ex: 100 Cows & 1 Horse)
Year round use? ❑ Yes ❑ No If no, from to , inclusive of each year.
Other: (Do not include purposes described above)
Describe the purpose of the use
Amount of water used gallons per day Number of days used
Year round use? ❑ Yes ❑ No If no, from to , inclusive of each year.
7. POINT OF DIVERSION-Location of the groundwater development
—1/4-1/4 1/4 of Section 35 Township 01 ❑ N 0 S Range 05 0 E ❑ W
County Gallatin Tract# COS# Gov't Lot#
Subdivision Name N/A Lot Block
Street Address, including City/State/Zip Code 2775 Baxter Ln, Bozeman, MT 59718 (Upland Way Condominiums)
8. PLACE OF USE - Enter the 17 digit geocode(s)applicable to the place of use legal land description.
Geocodes can be found in county records, tax statements, or at http://svc.mt.gov/msl/mtcadastral/.
Geocode: 06-0904-35-1-01-21-0000
IS THE PLACE WHERE WATER IS USED THE SAME AS THE POINT OF DIVERSION? ® Yes ❑ No
If no, enter the place of use land description below. Attach additional sheets if necessary.
-1/4-1/4 1/4 of Section Township ❑ N ❑ S Range ❑ E ❑ W
County Tract# COS# Gov't Lot#
Subdivision Name Lot Block
Street Address, including City/State/Zip Code
9. AFFIDAVIT OF OWNERSHIP OR WRITTEN CONSENT
I have possessory interest in the property where the water has been put to beneficial use and I have the
exclusive property rights in the groundwater development works OR I have attached written consent of the
person owning the groundwater development works and/or written notification to the land owner pursuant
to MCA 85-2-306(1).
"Please note, you must submit ORIGINAL owner signatures, copies will not be accepted."
declare under penalty of perjury & under the laws of the State of Montana that the foregoing is true & correct.
Printed Name" William Thompson (Zoey Development LLC)
Applicant Signature (� ' � L —,_ l Date: -' 9
Printed Name"
Applicant Signature Date:
Visit httr)://dnrc.mt.goy/divisions/water for additional water right related information.
FORM 602, NOTICE OF COMPLETION OF GROUNDWATER DEVELOPMENT
SMALL GROUNDWATER DEVELOPMENT INSTRUCTIONS
To use this form, the following must apply to your water use.
x The groundwater must have been put to use for the purpose(s) identified.
X The development is not located within the boundaries of a Controlled Groundwater Area, unless
instructed otherwise by DNRC.
x The source is groundwater, meaning any water located beneath the ground surface. The water is
typically diverted from the ground via a well, developed spring, or a collection of water in a groundwater
pit or pond.
X The flow rate diverted from the development is 35 gallons per minute or less.
X The total volume used from the development does not exceed 10 acre-feet per year. If you share a
well with others, the total volume used by all users cannot exceed 10 acre-feet per year. When the
water use exceeds that amount, you must file an Application for Beneficial Water Use Permit.
Maps submitted with this form should include the following: North Arrow, Section, Township, Range, and
an X where the development is located. If the required information is included on the map, DNRC will
confirm the written land description matches the map. If it does not, DNRC will change the legal land
description to match the map.
Complete items 1 through 9 ONLY if you have determined this is the correct form to file.
All of the required information must be entered for your application to be considered correct and
complete as required under § 85-2-306, MCA.
Item 1. Enter the complete name of the person to be listed as the water right owner(s), their mailing
address, and phone numbers. This will generally match property ownership (names on deeds).
Item 2. If you mark 'No,' you cannot file this form at this time. Once water has been put to use, you
may file the form. Contact your local water resources office for additional information.
Item 3. Check the type of groundwater development used to obtain the groundwater. If the source is
a well, provide the well driller's name. Attach a copy of the well log if it is available. If the source is a
groundwater pit or pond, provide the surface area and depth of the pond; this will be used to
determine the volume needed for the pond, including capacity and evaporation that will occur.
Item 4. Enter the flow rate used. The flow rate used is not always the same as the tested flow rate
listed on your well log. If a pit/pond, enter N/A.
Determining the flow rate you are pumping from a well:
Using a directly connected spigot (generally the frost-free hydrant located near the well head), turn the
water on until the pump comes on and stays on. Time how many seconds it takes to fill a 5-gallon bucket.
Use the following formula to calculate the flow rate: 300 _ number of seconds = flow rate in
GPM. Determining the flow rate you are pumping from a developed spring:
Time how many seconds it takes to fill a 5-gallon bucket. Use the following formula to calculate the flow
rate: 300 _ number of seconds = flow rate in GPM.
Item 5. Check `Yes' if you have other groundwater developments located on your land within '/4 mile
of this development. If you have a Groundwater Certificate, provide water right numbers and
distances between those developments and this development. Check 'Yes' if this development is
shared with others, such as two homes on one well. Provide the water right number and document
how the development is shared. If a shared well agreement exists, provide a copy of that agreement.
Item 6. Check the purposes for which the water is currently being used. If the water is used during the
months specified, check 'Yes'. If not, check 'No' and enter the months and days water is used each
year. For more information visit: http://dnrc.nit.g_ov/divisions/water/water-rights/docs/forms/615.pdf
Item 7. Enter the land description for the location of the development. Describe the location to the
nearest 10 acres if possible. Legal land descriptions, subdivisions, geocodes, and certificate of
survey information may be obtained from the tax statements, county records, or from the Montana
Cadastral system at: http://svc.mt.gov/msl/mtcadastral/
Subdivisions — Enter the lot and block or tract number, and subdivision name.
Government Lots — In addition to the land description, enter the government lot number.
Certificate of Survey— In addition to the land description, enter the survey number.
Street Address — Enter the physical address of the development including city, state, & zip code.
Item 8. Enter the geocode(s) of the place of use. If the place of use is generally the same as the
point of diversion, check 'Yes' and proceed to Item 9. If not, check 'No' and continue with Item 8
(using instructions for Item 7) to describe the place of use.
Item 9. If the statements are correct, print your name, then sign and date the form. All owners (or
trustees) listed in Item 1 should sign the form. **If the owner is a business or trust, include the title of
the representative(s) signing the form (i.e. president, trustee, managing partner, etc.)
SEND THE FORM TO THE APPLICABLE WATER RESOURCES REGIONAL OFFICE:
BILLINGS: 1371 RIMTOP DR, BILLINGS MT 59105-1978
PHONE: 406-247-4415 FAX: 406-247-4416
SERVING: Big Horn, Carbon, Carter, Custer, Fallon, Powder River, Prairie, Rosebud, Stillwater,
Sweet Grass, Treasure, and Yellowstone Counties
BOZEMAN: 2273 BOOT HILL COURT, SUITE 110, BOZEMAN MT 59715
PHONE: 406-586-3136 FAX: 406-587-9726
SERVING: Gallatin, Madison, and Park Counties
GLASGOW: 222 6TH STREET SOUTH, PO BOX 1269, GLASGOW MT 59230-1269
PHONE: 406-228-2561 FAX: 406-228-8706
SERVING: Daniels, Dawson, Garfield, McCone, Phillips, Richland, Roosevelt, Sheridan, Valley, and
Wibaux Counties
HAVRE: 210 6TH AVENUE, PO BOX 1828, HAVRE MT 59501-1828
PHONE: 406-265-5516 FAX: 406-265-2225
SERVING: Blaine, Chouteau, Glacier, Hill, Liberty, Pondera, Teton, and Toole Counties
HELENA: 1424 9TH AVE, PO BOX 201601, HELENA MT 59620-1601
PHONE: 406-444-6999 FAX: 406-444-9317
SERVING: Beaverhead, Broadwater, Deer Lodge, Jefferson, Lewis and Clark, Powell, and Silver
Bow Counties
KALISPELL: 655 TIMBERWOLF PARKWAY, SUITE 4, KALISPELL MT 59901-1215
PHONE: 406-752-2288 FAX: 406-752-2843
SERVING: Flathead, Lake, Lincoln, and Sanders Counties
LEWISTOWN: 613 NORTHEAST MAIN ST, SUITE E, LEWISTOWN MT 59457-2020
PHONE: 406-538-7459 FAX: 406-538-7089
SERVING: Cascade, Fergus, Golden Valley, Judith Basin, Meagher, Musselshell, Petroleum, and
Wheatland Counties
MISSOULA: 2705 SPURGIN RD / BLDG C, PO BOX 5004, MISSOULA MT 59806-5004
PHONE: 406-721-4284 FAX: 406-542-5899
SERVING: Granite, Mineral, Missoula, and Ravalli Counties