2014-05-12_PERMIT FILE - C2010089 ‎(8)‎

• Permit No: C2010089
• IBM Index Class Name: Permit File
• Doc Date: 5/12/2014
• Doc Name: Approved Well Permits
• Section_Exhibit Name: Appendix 2.05.6‎(3)‎-4
• Media Type: D
• Archive: No

COLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
Office Use Only Form GWS-45 (07/2009)
1313 SHERMAN ST, RM 818, DENVER, CO 80203
phone — info: (303) 866 -3587 main: (303) 866 -3581
fax: [phone] http:1/www.water.state.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be completed in black or blue Ink or typed.
1. Applicant Information
6. Use Of Well check applicable boxes
Name of ap~
Attach a detailed description of uses applied for.
Western- FuelB- Colorado, LLC
® Industrial ® Dewatering System
❑ Municipal ❑ Geothermal (❑ production or ❑ reinjection)
Mailing address
P.O. BOX 33424
Ill Irrigation Dust suppression and sediment
I@ Other (describe): control, including but not limited
® Commercial to storage in pond for these uses.
city
Denver
State Zip code
CO 80233
7, Well Data (proposed)
Telephone #
[phone] 1
E -mail (optional)
Madmum pumping rate
1795 9Pm
Annual amount to be wW rm hdrs
1000 acre-feet
2. Type Of Application (check applicable boxes)
® Construct new well ❑ Change source (aquifer)
❑ Replace existing well [I Reapplication (expired permit)
Total depth
110 feet
Aquifer
Bedrock /Coal
8. Land On Which Ground Water Will Be Used
❑ Use existing well ❑ COGCC well
❑ Change or increase use ❑ Other.
Legal Description (may be provided as an attachma,q:
West 1/2 of Section 25, Township 47 North, Range 16
West of the N.M. P.M.
3. Refer To (if applicable)
WON permit#
Water Court case#
10CW208,09CW171
Designated Basin DetenNnadon #
Wei now or #
New Horizon North Mine
(if used for crop Irrigation, attach a scaled map that shows irrigated area)
4. Location Of Proposed Well Im ortantl See Instructions
Co
Co unty
Montrose
NE la of the NW 114
A. #Acres
320
B. owner
See Attachment A
Section
25
Township N or S
47 ®❑
Range E or W
16 ❑ ®
Principal Meridian
NM
C. List any other wells or water dghts used on tuts lend:
Not Applicable
Distance of well from section tyres (sec#on lines are typically not property tines)
Ft from ❑ N ❑ S Ft. from ❑ E ❑ W
9. Proposed Well Drliler License # o bona) :
For replacement wells only— distance and directlon from old well to now well
feet direction
10. Signature Of Applicant(s) Or Authorized Agent
The making of false statements herein constitutes perjury in the second
degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S.
Well location address (Include City, State, Zip) Check it well address is same as In item 1.
24 -4-104 (13)(a). I have read the statements herein, know the contents
thereof and state that they are true to my knowledge.
Sign (Must be hirral )
,
Date
2 y "Z& t L
Optional: GPS well location information in UTM format You must check GPS unit for
required settings as follows:
Formal must be UTM
Print name & fide t s+'0 f1A4 ( "T- A vsek 6L
❑ Zone 12 or S Zone 13
Unite must be Meters
Datum must be NAD83
Unit must be set to true north
Easting
Northing
p �
tA.dha },r r e4m$ r414w.•44 �C�r APf )i CQ-e+
Office Use Only
USGS map name
DWR map rho.
Surface elev.
Was GPS unit checked for above? ❑ YES
Remember to set Datum to NM83
5. Parcel On Which Well Will Be Located
Receipt area only
(YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL
A. Legal Description (may be provided as an attachment):
West 1/2 of Section 25, Township 47 North, Range 16
West of the N.M. P.M.
AQUAMAP
B. # of axes in parcel
C. owner
320
See Attachment A
WE
W R
D. Wig this be the ordy wal on Ws pawl? ❑YES ❑NO (if no — 1st other wells)
Not Applicable
CWCB
ToPo
MYLAR
E. state Parcel im (optional):
SB5 DIV WD BA MD