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Form No. <br />COLORADO DIVISION OF WATER RESOURCES <br />For Office Use only <br />GWS -27 <br />DEPARTMENT OF NATURAL RESOURCES <br />11/2011 <br />1313 Sherman St., Ste 821, Denver, Colorado 80203 <br />Phone: (303) 866 -3581 Fax (303) 866- 3589 <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />GRAVEL PIT WELL PERMIT APPLICATION <br />1. <br />TYPE OF PERMIT <br />1X 1 NEW PIT(S) <br />❑ PIT(S) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 <br />2• <br />APPLICANT INFORMATION <br />NAME(S) Western Fuels- Colorado, LLC <br />Mailing Address P.O. Box 33424 <br />City, St. Zip Denver, CO 80233 <br />Phone( 303 ) 255 -5800 <br />3• <br />CONSULTANT /ATTORNEY /OPERATOR CONTACT (If different than #2) <br />New Horizon Mine <br />NAME(S) Bishop- Brogden Associates, Inc. <br />PIT NAME Pond No. 12 <br />Mailing Address 333 W. Hampden Ave. Suite 1050 <br />City, St. Zip Englewood, CO 80110 <br />DRMS NO. c- 1981 -oos <br />Phone( 303 ) 806 -8952 <br />4. <br />GENERAL LOCATION OF PIT(S): COUNTY Montrose <br />NW 1/4 SE 1/4, Sec. 36 Twp. 47 0 N. ❑ S., Range 16 ❑ E. ❑ W. N.M. P.M. <br />5. <br />Estimated maximum water surface to be exposed: 0.57 Acres. Number of Pits 1 <br />6. <br />Estimated depth of pit(s) 6 Ft. Estimated depth to groundwater 4 Ft. <br />7. <br />Estimated date to expose groundwater 2005 ; to complete mining 2027 (estimated) <br />8. <br />ATTACHMENTS: (Check which have been attached.) <br />(a) X Scaled map of pit area with range, township, & section clearly identified (REQUIRED). <br />(b) ❑ Copy of the reclamation permit, if applicable. <br />(c) ❑ Copy of pre 1/15/89 water conservancy dist. or water user assoc. augmentation agreement, if applicable. <br />(d) ❑ Copy of proposed substitute water plan or augmentation plan application, if applicable. <br />(e) ❑ Copy of court approved augmentation plan, if applicable. Case No. <br />❑ <br />(f) Other <br />9. <br />Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of <br />diversion of any water withdrawn from the pond. <br />None <br />10. <br />Will dewatering occur within the DRMS permit bounds ❑ Yes ❑ No N/A <br />11. <br />1(we) have read the statements made herein and know the contents thereof, and that they are true to my (our) <br />knowledge. [Pursuant to Section 24-4 -104 (13)(a) C.R.S., the making of false statements herein constitutes perjury <br />in the second degree and is punishable as a class 1 misdemeanor.] <br />Name/Title (Please type or print) <br />&,r,i.foV^r ?, S w,4r_& Rb. <br />Signature <br />Q— <br />9J <br />Date <br />2 — 1 W - ZGlZ <br />Wa+c'f CvNS.+t4+.�fi -fir aQipl�c.►.�+ <br />For Office Use only <br />Court Case No. Div. Co. WD Basin MD Use <br />