2014-05-21_REVISION - M1998071

• Permit No: M1998071
• IBM Index Class Name: REVISION
• Doc Date: 5/21/2014
• Doc Name: Preliminary Review Response AM01
• From: Randy Schafer
• To: DRMS
• Type & Sequence: AM1
• Email Name: ECS
• Media Type: D
• Archive: No

OFFICE OF THE STATE ENGINEER
DIVISION OF WATER RESOURCES
303 -866 -3581
FOR OFFICE USE ONLY
DAM NAME NO. WATER DIV: DIST:
NOTICE OF INTENT TO CONSTRUCT A NON-JURISDICTIONAL
WATER IMPOUNDMENT STRUCTURE'
This notice is required per Section 37 -87 -125, C.R.S. (1998).
This notice must be submitted to the Division Engineer's Office a minimum of 45 days prior to construction.
(PLEASE PRINT OR TYPE NOTICE)
OWNER INFORMATION
Name:
Address:
Street / P.O. Box/ Rural Route City
Responsible Person:
Address:
Street / P.O. Box/ Rural Route City
Contractor:
STRUCTURE INFORMATION
Name of Dam:
Location 2:
.Option 1
OR
.Option 2--1,-
Telephone:
State
Telephone: ( )
State
Telephone: ( )
Zip Code
Zip Code
Water Division: Water District:
% / % Sect: % of the 'h; Sect: , Township: , Range: _ P.M.
Distance of dam from Section lines ft from ❑N ❑ S, ft from ❑E ❑W
Utilizing GPS: Set to UTM Datum. Measured on crest of dam above streamline /outlet.
Northing m. Easting M.
Note: GPS settings must be NAD83 CONUS.
Dam Dimensions: Vertical Height 3: ft., Length: ft., Slopes: U /S: H:1 V, D/S H:1 V
Reservoir. Surface Area: acres, Capacity: acre feet, Drainage Area: acres
Emergency Spillway: Width: ft., Side Slopes: HAV, Freeboard4: ft
Outlet Drain: Type: , Size: inches, Location:
Stream Name or Water Source s:
Proposed Water Use:
DIVISION ENGINEER'S REQUIREMENTS:
Water Court Case No. (if applicable)
Signature of Owner
Date
DWR (03/07)
Signature of Division Engineer Date
t A "Non- Jurisdictional Structure' is a dam creating a reservoir with a capacity of 100 acre -feet or less and a surface area of 20 acres or less and a vertical height (see
footnote 3) of 10 feet or less.
2 Please see example on reverse side (or page 2) of this form.
3 "Vertical Height° is measured from the elevation of the lowest pant of the natural surface of the ground where that point occurs along the longftudinel centerline of the dam
up to the crest of the emergency spillway of the dam.
4 "Freeboard' is the vertical distance from the bottom of spillway to the crest of the dam.
s if construction in reservoir intercepts groundwater, a well permit is required. (Well permit applications can be found at www. water .state.co.ustpubslfomxs.asp)