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Form No. COLORADO DIVISION OF WATER RESOURCES For Office Use only <br /> GWS-27 DEPARTMENT OF NATURAL RESOURCES <br /> 6/2006 1313 Sherman St., Rm 818, Denver, Colorado 80203 <br /> Phone: (303)866-3681 <br /> REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br /> GRAVEL PIT WELL PERMIT APPLICATION <br /> 1. TYPE OF PERMIT <br /> NEW PIT(S) <br /> EXIST, CONSTRUCTED AFTER DEC, 31, 1980 RE ­%E1VE1r- <br /> 2. APPLICANT INFORMATION <br /> NAME(S) ALBERT FREI & SONS, INC. C/O BEN FREI 1)E 2 7A 417 <br /> Mailing Address POB 700 WATER <br /> City, St. Zip HENDERSON, CO 80640 STATE ENGINEFR COLD, <br /> Phone (303) 289-1837 <br /> 3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (if different than*2) <br /> NAME(S) RICK PARSONS PIT NAME HATCHERY PIT <br /> Mailing Address 1619 MINEAR ROAD DMG NO, 2014-043 <br /> City, St, Zip MEDFORD, OR 97501 <br /> Phone (303) 667-5067 <br /> 4, GENERAL LOCATION OF PIT(S): COUNTY ADAMS -1. 10W. 6TH P.M. <br /> —1/4 SW 1/4, Sec. 20 _Twp. 2 FIN. El S., Range 67 <br /> 5. Estimated maximum water surface to be exposed: 1 —Acres. Number of Pits I <br /> 6. Estimated depth of pit(s) <28 Ft. Estimated depth to groundwater Ft. <br /> 7. Estimated date to expose groundwater 2018 to complete mining 2023 <br /> 8. ATTACHMENTS: (Check which have been attached.) <br /> (a) LXJ Scaled map of pit area with range, township, &section clearly identified (REQUIRED). <br /> (b) E]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) Fhopy of court approved augmentation plan, if applicable. Case No. <br /> (f) E]Other <br /> 9. 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 diversion of any water withdrawn from the pond.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 /> Note -thPri- 'qrP permitt-i allwi-ql-producAir�a-vuells,-}a�it4in-6GOLof-the-2014-043-mirilog permit ama <br /> 2017----20t9-SVtt8 TOTAt- 18.43 AF <br /> EXCAVATED MATERIAL- 14.68 AF; EVAP - AF; DUST CONTROL- 1.0 AF <br /> 10. 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) Signature Date <br /> < <br /> C <br /> _For-6ffice Use only <br /> J J()j j#7, AAPIW2. <br /> i lA"rI'A)I F-'M <br /> i0i"Ifildril: $1 00AX) <br /> Court Case No. Div. Co. _WD_ -7 Basin—MD—Use AR D $1 ooffj <br />