Annual Water Use Reporting Form For Irrigators

Part 1 of 2

Authority

Collection of major water use data by the DNR is required under a law passed in 1983 by the Missouri General Assembly (RSMo Chapter 256.400, 256.405, 256.410, 256.415, 256.420, 256.425, and 256.430).

Instructions

Annual water use reporting shall be completed by March 31 for the previous calendar year.
Water use registration is required if a facility’s total combined withdrawl capacity is greater than 100,000 gallons per day, regardless of actual water withdrawal amount. This is equivalent to 70 gallons per minute.
If you have new wells or new surface water diversions, please report that information to us on Part 2 of the Annual Water Use Reporting Form.
Annual reports must be submitted even if no withdrawals were made.

Note: You may only report annual water use data for four withdrawal points on this online reporting form. If you have more than four withdrawal points, you may submit multiple times, however we recommend that you send us your annual water use data via U.S. Mail, fax or email.

Required Fields (*)

Reporting Year

Contact Information

Tenant or Water User Information

Company/Contact Name: *

Address 1: * Address 2:

City: * State: * Zip: *

Telephone 1: * Telephone 2: E-mail:

Property Owner Information

Company/Contact Name: *

Address 1: * Address 2:

City: * State: * Zip: *

Telephone: *

Facility Information

Major Water User ID No. (Leave blank if first time reporting.)

What months did water withdrawal or diversion take place?
All Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Approximately how many days was water withdrawn or diverted last year?

How many gallons of water is withdrawn or diverted on an average day of operation?
Please indicate gallons/acre-inches: Gallons Acre-inches

When did withdrawal or diversion originally begin (mm/yyyy)? (This will help establish historical use.)

Please check one of the following. Golf Course Crop Irrigation

Total number of acres irrigated:

Part 2 of 2

This data must be completed for all new withdrawal points. Previously reported data is also available online at /env/wrc/mwudata.htm. Please review your previously reported data for accuracy and make changes if necessary. At the bottom of this form there is a comment box to submit additional information or changes. Please specify which well or withdrawal point you are reporting water use for. It is not necessary to resubmit other general well or pump data if it is correct.
If you have never submitted a water use inventory form or if you have added new withdrawal points, a map showing the location of each point is required. Plat maps showing the legal description are preferred. We can provide a map upon your request. Please be sure to label each point.

Widthdrawl ID.
Owner Name
Other Information
Status
Well Data (Disregard this section if surface water)
Year Drilled
Well/Intake No.
Total Depth, ft.
Casing Depth, ft.
Static Water Level, ft.
Surface Water Data (Disregard this section if groundwater)
Water Body Type
Water Body Name
Pump Data
Pump Capacity, gpm
Metered (Y/N)	Yes No	Yes No	Yes No	Yes No
Location Data
Quarter Sections (Smallest 1st)	, ,	, ,	, ,	, ,
Legal Description	Sec Twp N Rng	Sec Twp N Rng	Sec Twp N Rng	Sec Twp N Rng
County
Latitude
Longitude
Elevation, ft.
Water Use Data
Please Specify Irrigation Method	Pivot Flood Other	Pivot Flood Other	Pivot Flood Other	Pivot Flood Other
Hours of operation
Crop type and acres Example: 30 acres corn, 50 acres soybeans
Estimated Water Use
Water Applied gallons or acre-inches (please specify)	Gallons Acre-inches Amount	Gallons Acre-inches Amount	Gallons Acre-inches Amount	Gallons Acre-inches Amount
Metered Water Use
Water use, gallons
Additional Information
Please enter any additional information or comments