MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY

WATER BUREAU

Drinking Water and Environmental Health Section

Request for Large Quantity Water Withdrawal Registration Notification

Completion of this form is voluntary

Michigan’s Water Withdrawal legislation allows for electronic notification of the registration of a Zone B or Zone C large quantity withdrawal (a 30-day average of >100,000 gallons/day within a consecutive 30-day period) and any Part 327 (Great Lakes Preservation) of PA 451 (Natural Resources and Environmental Protection Act) or Act 399 (Safe Drinking Water Act) permit issued for a Zone B or Zone C withdrawal.

To request electronic notification, please print the following information:

*Name:
Organization:
*E-mail:
Telephone:
.
Choose areas of notification by supplying the following information:
By Address:
Street Address:
City: / Zip:
County: / Township:
By Latitude/Longitude:
Latitude: / Longitude:
By Watershed Hydrologic Unit Code (8 or 10 digit – please use attached listing and map)
ex: 0401030201

*required fields

Please fax, e-mail, or mail this form to:

David DeYoung, Environmental Quality Analyst / Andrew LeBaron – Environmental Quality Analyst
DEQ, Water Resources Division
Hydrologic Studies & Dam Safety Unit
P.O. Box 30273
Lansing, Michigan, 48909-7773 / DEQ, Water Resources Division
Hydrologic Studies & Dam Safety Unit
P.O. Box 30273
Lansing, Michigan, 48909-7773
517-241-1409 / 517-241-1435
Fax: 517-241-1328 / Fax: 517-241-1328
/

EQP 5964 (7/2009)