Registration of Minor Nonrecurring Use of Water
|[pic] |Registration of Minor Nonrecurring |CASHIER’S USE ONLY |
| |Use of Water |0975-542-WATR-PA-0570 |
| |The maximum nonrecurring water use registration period is 12 months. Recurring water withdrawals over |Applicant Name |
| |25,000 gallons per day for any day over a 12-month period require a water use permit. | |
$7500 fee
Apply for a new permit or manage your permit ONLINE:
|Create an account at . |
|Call 515-725-0341 or email wateruse@dnr. for assistance. |
For more information regarding the Iowa DNR Water Allocation Program, please visit: Wateruse
For technical questions, contact Michael Anderson at 515-725-0336.
Payment options:
|APPLY & PAY ONLINE |PAY BY CHECK or MONEY ORDER |PAY BY CREDIT CARD |
| | |over the phone |
|DNR accepts: |Make check payable to Iowa Department of Natural |Email: a copy of the application to |
|Visa, MasterCard, Discover, AmEx |Resources |Webmaster@dnr. with the subject line: Credit |
|ACH (Electronic Check) |Attach this application to your payment and |Card Payment for (Company Name) |
| |Mail application and fee to: |OR |
| |IOWA DNR |Fax: to 515-725-8201 |
| |WATER SUPPLY ENGINEERING | |
|Fill out this application online by applying for a new|502 E 9TH ST |Wait 20 minutes after sending then call Customer |
|permit and pay the fee at the end of the application |DES MOINES IA 50319-0034 |Service at 515-725-8200 to make the payment. |
|process. | | |
| | |Email completed application to wateruse@dnr. |
| |Check #: | | | |
| | | |
|Contact Information |
|1a. Registration Holder |
|Business Name | |
|First Name | |Last Name | |
|Address 1 | |Address 2 | |
|City | |State | |Zip | |
|E-mail | |Primary Phone | |
|Secondary Phone | |Fax | | |
|1b. Property Owner |
|Same as Registration Holder? | Yes | No | |
|Business Name | |
|First Name | |Last Name | |
|Address 1 | |Address 2 | |
|City | |State | |Zip | |
|E-mail | |Primary Phone | |
|Secondary Phone | |Fax | | |
|WATER WITHDRAWAL LOCATION |
|To be completed by all applicants |
|Legal description of withdrawal site:|Quarter |Quarter |Section |Township |Range |County |
| | | | | | | |
|Legal description of land/property on|Quarter |Quarter |Section |Township |Range |County |
|which water is to be used: | | | | | | |
|Source of water (select all that | Well | Stream / River | Reservoir |
|apply): | | | |
| | Trench/Structural Excavation: Length |
|Attach a scaled map or aerial photo. Clearly label the water source(s) and water use location(s). Label depth of any wells. |
|Water Used for Highway Construction |
|Complete only if applicable. Ensure the map/photo also depicts the route of the road being constructed. |
|Project name | |County | |
|Road destination | |From | |To | |
| Description of alternate water withdrawal location(s): |OR | The water will be withdrawn from a stream or watercourse within the |
| | |right-of-way of the road being constructed and/or roads within one mile of the|
| | |road being constructed. |
|Water Usage Information |
|To be completed by all applicants. |
|The water withdrawn will be put to the following beneficial use(s): |
| Aquifer Remediation | Dewatering | Dust Suppression | Directional Drilling | Highway Construction |
| Mix Water | Pressure Testing | Test Pumping | Other | |
|Comments/Details (optional): | |
|Maximum quantity desired | | acre-ft | gallons | million gallons | |
|Maximum pumping rate | |gpm |
|Estimated Dates of Water Withdrawal (mm/dd/yyyy): |Begin | |End | |
Please note: An NPDES permit is required to discharge wastewater to waters of the State. More information can be found at npdes.
|Certification |
|I certify the above information is true and correct to the best of my knowledge and that I will provide any additional information to the Department as may be |
|requested. |
| |
|Water use registrations are usually approved or denied within 30 days. |
|Signature: | |Date: | |
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