2018-10-22_REVISION - M2008078 (11)

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COLORADO DIVISION OF WATER RESOURCES Office Use Only RECEIVED I Form GWS-45(07/2013) DEPARTMENT OF NATURAL RESOURCES f 1313 SHERMAN ST,RM 821,DENVER,CO 80203 REC b' 7 16 zy -F- Main: 303 866-3581 Fax: 303 866-2223 d ermitsonline state.co.us A449. It I 701:5 SEP 1 2015 GENERAL PURPOSE (a►+ O#Wfw 7 Water Well Permit Application Review instructions on reverse side prior to completing form. ;v i'i ER RESOURCES The form must be computer generated,typed or in black or blue ink. STATE ENGINEER P g COLO 1.Applicant Information 6. Use Of Well(check applicable boxes) Name of applicant Attach a detailed description of uses applied for. GP Resources, LLC Industrial ❑ Dewatering System Mailing address — Municipal Geothermal❑Shaffer Pkwy, m ation (Production or reinjection 7991 Sha Ste 200 __ _ -- _—-- ❑ s City _state code ® Other(describe): Per SWSP i Littleton co ]80127 © Commercial Telephone#(area code&number) E-mail(online filing required) 7.Well Data(proposed) 303-369-5100 amy@cacompanies.com mpingrate Annual amount to be withdrawn 2.Type Of Application(check applicable boxes) 1,600 sPm 8.1 acre-feet ❑Construct new well W1 Use existing well Total depth — --- Aquifer --------- ❑Replace existing well ❑ Change or increase use 53 feet Alluvial ❑Change source(aquifer) ❑ Reapplication(expired permit) 8, Land On Which Ground Water Will Be Used ❑COGCC Well ❑ Other:3. Refer To(if applicable) Legal Description of Land(may be provided as an attachment): Well permit# I water Court rase# — n/a-Commercial and Industrial Uses in accordance with 4231-F W-1822 Designated Basin Determination# —___. Wall name or# `----- ----- substitute Supply plan. n/a Lamar Farms Well No. 5 4. Location_Of Proposed_ Well County (If used for crop irrigation,attach a scaled map that shows irrigated area.) Prowers NE 1/4ofthe NW 114 A. #Acres ; B. owner Section Township Nor S Range E or W -T Pnndpal Meridian n/a I n/a 33 22 46 ® El 16th C. List any other wells or water rights used on this land: Distance of well from section lines(section lines are typically not property lines) n/a 1140 Ft.from r N j S 2650 Ft.fromME pW Forreplacerrentwellsonly-distance and direction from old wall to new wall 9• Proposed Well Driller License#o tional :n/a-existing feet direction 10.Sign or Entered Name Of Applicants)Or Authorized Agent Well location address(Indude City,State,Zip) ❑Check ifwell address is same as in kem 1. The making of false statements herein constitutes perjury in the second degree,which is punishable as a Gass 1 misdemeanor pursuant to C.R.S. 24-4-104(13)(a). I have read the statements herein,know the contents they d state that they are true to my knowledge. Optional: GPS well location information in UTM format You must check GPS unit for nor ent names)of erson(s)submitting appli lion Dale(mn✓dd/yyyyj required settings as follows: Format must be UTM -- ---------.. .---._ ._._._......_. ..... .._.._-.__._. _-�-- igning print name an e �IZone 12 orU Zone 13 I Easting y� Units must be Meters \ 3 ' �r Datum must be NAD83 Northing Office Use On Unit must be set to true north ------❑YES Remember to set Datum to NAD83 USGS map name DWR map a-------------------------------T----- ------- Was GPS unit checked for above? no. Surface elev. 5. Parcel On Which Well Will Be Located ----.----. -- - ---!---------- .1__—.____________ PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL Receipt area only -i ---- ---- ------ - - - -----------)-- cop 10 i A. Legal Description(may be provided as an attachment): b-zo5Y73 1Supersedes application submitted March NE1/4 NW1/4 Sec. 33,T.22S., R.46W., 6th P.M. us+e. ne"AC_ 11, 2015, Receipt No. 3668741B. a-gA va{,ue s - 7116'74 E 4 N two 33�'ZS- `tlaull@ �tgz4� lit 'N z6Sd W - - - `) B. pofacresin parcel C. Owner AQUAMAP l i� ��W/ 40 A licant WE ------_—�._ PP WR D_ Will this be the only well on this parcel? M YES m NO(if no list other wells) CWCB 68574-F(owned by Applicant) TOPO ----- - -- - ----- _.._. E. State Parcel ID#(optbnal): MYLAR p +7 SB5 DIV WD t� / BA MD