2015-11-30_INSPECTION - M2010002 ‎(2)‎

• Permit No: M2010002
• IBM Index Class Name: Inspection
• Doc Date: 11/30/2015
• Doc Name: Sept Inspection All PBs 90-Day Extension Approved
• From: DRMS
• To: Jay Wagner
• Email Name: ACY
• Email Name: GRM
• Media Type: D
• Archive: No

-1111W015
Weil pmtips
Form No.
COLORADO DIVISION OF WATER RESOURCES
For ofte use only
GWS -27
DEPARTMENT CF NATURAL RESOURCES
6/2006
1313 Sherman SL, Rm 818, Den(er, Celorado 80203
Phone: [phone]
REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM
GRAVEL PIT WELL PERMIT APPLICATION
1.
TY E F PERMIT
my PiI(5)
❑ PI I (5) GXIS i, CODs I RUG i Ell AF I ER DEC. 31, 1aBu
2.
APPLIUANi iMFORIGIAIIvIv
NAMEtar / -04-- A. -
Mailing Address 1
City, St. Zi P FUM'64
f
3.
CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than #2)
NAME(S)
PIT NAME VA -0A 1P _
Mailing Address
City, St. Zip
DMG N0.
Phone ( )
4
GENERAL LOCATION OF PIT(S): COUNTY Ar
S%
114--A9-. 1/4, Sec._ Twp.--,6-AN. ❑ S., Range ❑ E. PJ W. -16—iP.M.
5.
Estimated maximum water surface to be exposed: _LAIC _ Acres. Number of Pits 1
6.
Estimated depth of pits) Ft. Est' ated depth to groundwater JA Ft.
7.
Es6mat53 date to vNpvse groundwater ; to complete mining
8.
xTT RIGI I b. (t; t�ecK which have been attached.)
(a) 11 Scapa map UT pl% area with range, township, & section aeany 0517171o'd jREuuiRtI3).
(b) ZCopy of ine re-aarriativ., , pcarmit. R applicable,
(C) ❑ Copy or pre ins/By Ovate, conservancy dist. or water user assoc. aoyme, nation ayreeme, it, if applicable.
(d) ❑ Copy oT propzaela au6stitote water plan or augmentatio„ Plan appliwtivi iT applicable.
,
❑
(e) uOpy of wuff approved augmentation plan, IT applicaMe. Ease No.
❑
(t) Other
Detailed Uescnption of any use, other than evap mdo„_ aM method of diversion, rate of diversion, and annual am.n,l-it or
9.
diversion of any water withdrawn Trom the pa,
c
10.
1(wn) have read the statementa ,„al% Fieraiii and know the contents taereCr, and Inat May aid true to my (our)
knowledge. [Pursuant to becuon z4:4-104 (13)(a) C.R.S., the maRi„y oT Take statements FiFierein constitutes pedury
In the second degree aM is pd,iishable as a class 1 7.
NaTmeffitle(Pleasetype orpri �IUE
(gnat e/,
Date
3V —08
r -or office es,,, 0my
:aunt unse No. Div. Co. _ WD Basin _ MD Use
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