Gws 12a 2025

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The document provides detailed instructions for completing the Statement of Historical Use (GWS-12A) for well registration in Colorado. It outlines eligibility criteria for wells based on their historical use prior to May 8, 1972, including specific types of uses allowed and the necessary information required from well owners. The form must be submitted alongside the Registration of Existing Well form (GWS-12), and emphasizes the importance of accurate historical usage claims, as well as the consequences of false statements.

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Click ‘Get Form’ to open the GWS-12A in the editor.
Begin by entering your name as the well owner in the designated field. Ensure that you provide accurate information for verification.
Fill in the well's location details, including section, township, and range. This information is crucial for identifying your well's geographical context.
Indicate whether the historical use of the well is on the same parcel as its location. If not, provide the new location details.
Describe the existing condition and construction of your well. Include specifics such as type, distance to septic systems, and any sanitary features.
Document the historical uses of your well prior to May 8, 1972. Specify if it was used for household purposes, irrigation, or other exempt uses.
Review all entries for accuracy before submitting. Attach additional sheets if necessary to provide complete information.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (50 Votes)
2011	4.3 Satisfied (187 Votes)

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