2014-05-12_PERMIT FILE - C2010089A

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COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS45 (0412012) DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 821, DENVER, CO 80203 Main: 303 866 -3581 Fax: 303 866 -2223 dwr ernutsonline state co us GENERAL PURPOSE Water Well Permit Application Review Instructions on reverse side prior to completing form. The form must be computer generated, typed or in black or blue ink. 1. Applicant Information 6. Use Of Well (check applicable boxes) Nameofapplrcant -- _._________ - . _____ _ -- _ -_-__ , _ _ _ ___,_ __._ Western - Fuels- Colorado, LLC Attach a detailed description of uses applied for . -_ - - -- - - -- -- - - ®Industrial A Dewatering System _ Mailing address -- ..._ P.O. Box 33424 ❑ Municipal ❑ Geothermal (production or reinjection) City 1 Stale -" I Zip -aide - ❑ Irrigation ® Other (describe): Dust suppression Denver 1 CO ' 80233 IE-mail ❑ Commercial 7, Well Data (proposed) Telephone # (area a6de 8 number) (online filing required) -- _" "" -" - (303) 255 -5800 Mawmum pumpng fete -- - - - Annual amount to be withdrawri --- (In combination w/ gpm 1 DW12 -1 & DW_ 12 -2) 800 1 See Attachment B acre -feet Total de . - - de'p'th , Aquifer 2. Type Of Application check applicable boxes yp pp (check ) ©Construct new well ❑Use existing well ❑ Replace existing well ❑ Change or increase use 85 feet Bedrock/Coal ❑ Change source (aquifer) ❑ Reapplication (expired permit) ❑ 8. Land On Which Ground Water Will Be Used COGCC Well ❑ Other: Legal Description of Land (may be provided as an attaer,merx) 3. Refer To (if applicable) Wellpem.tu - -_- -_ __1'_WaterCourtcasen - "'" West 1/2 of Section 25, Township 47 North, Range 16 West N/A ( N/A Designated Bann Deternanation # I Well name or # - '-- ofthe N.M. P.M. I DW12 -3 4. Location Of Proposed Well County (If used for crop irrigation, attach a scaled map that shows irrigated area ) Montrose i SW 1/4ofthe SW 114 A. #Acres l B. Owner ----- -r - - %--' Section i "TownsMp - -N or S Range E or W p - Pnna � Mendan 320 i See Attachment A 25 147 i" 16 ©® N.M. _ _. _ ___ �___... _ - -.- -- _.. _ _ ._ _.- ........_. C. List any other wells or water nghts used an this land Distance of well from section lines ( aection lines are typically notpropertylines) Others wells and water rights operated under Case Nos. 1016 Ft from] N 15 S 1312 Ft fro4DE LkJW IOCW208 and 09CW171 and related SWSPs. 9. Proposed Well Driller License # o tional : - - - - "- For replacement wells only - rNSlance and drrecGon from old well to new well 10. Sign or Entered Name Of Applicant(s) Or Authorized Agent feet direction Well location address (Include City, Slate, Zip) ❑ cneck if well address is same as in Item .1 � " The making of false statements herein constitutes perjury in the second degree, which is punishable as a Gass 1 misdemeanor pursuant to C.R.S 24 -4 -104 (13)(a). I have read the statements herein, know the contents theregf and state that the are true to m knowledge. ysubmdting _ Optional: GPS well location information in UTM format You must check GPS unit for Sign e t a rw( of perso application Date (mmrddlyyyy) required settings as follows- Formal must be UTM � Zone 13 jM Zone 12 or[r] If signing print name and 5Ue i Easbng Units must be Meters i ,t k v +S�riDI4� S,cwc t 1ti'14 ! fc Pik &,,r1 --6 f !+ I ,r r^f Datum must be NA083 l Northing Office Use Only Ural must be set to true north was GPS unit checked for above? ❑YES � Remember to set Datum to NAD83 - _ - - US-GS . ma— p no ! Receipt area only 5. Parcel On Which Well Will Be Located (PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description (may be provided as an attachment) i West 1/2 of Section 25, Township 47 North, Range 16 West of the N.M. P.M. i - B - - -#-of . a -- -- -- - --- --- - -- - - -- - - . cres rn parcel � C. Owner I i AOUAMAP i 320 See Attachment A WE � D. Will this be the only well on tMs parcel? E] YES sx J NO (If no list other wells) WR Others wells operated under Case Nos. 10CW208 and CWCB 09CW171 and related SWSPs. TOPO E. State Parcel ID# (optional) MYLAR SB5 DIV WD BA MD