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COG500000 Permit Application www.coloradowaterpermits.com <br />Page 4 of 8 – Revision 2/2021 <br />C.PERMITTED FACILITY INFORMATION <br />Facility or Project Name ____________________________________________________________________ <br />Street Address (or cross streets) ______________________________________________________________ <br />City__________________________________ Colorado, Zip Code __________ <br />County __________________________________ <br />Type of Facility Ownership <br />□City Government □Corporation □Private □Municipal or Water District <br />□State Government □Mixed Ownership _________________________________ <br />Facility or Project Latitude/Longitude — List the latitude and longitude of the center point of the facility. <br />Latitude: . Longitude: . <br />(Provide coordinates in decimal degrees to 6 decimal places (e.g., 39.703345°,-104.933567°)) <br />Standard Industrial Classification (SIC) Code(s) for this FACILITY (please use dropdown menu to select up to 4 <br />SIC codes, in order of importance) <br />Note: see the SIC codes covered by permit link (general permit COG500000) on the division website for <br />descriptions of SIC codes associated with this permit. <br />1.__________________ 2. ________________3. _________________4. _________________ <br />D.PROJECT DESCRIPTION - Provide an overview of the industrial activities that are conducted at the facility. <br />E.SITE MAPS AND SCHEMATICS - provide as an attachment to the application - no larger than 11x17 inches <br />1.Location Map – Application must include a location map that shows the location of the project/facility, the <br />boundaries of the area subject to the application, and all receiving water(s). A north arrow must be shown. <br />2.Legible Site Sketch - showing all surface features (buildings, ponds, diversion ditches, stockpiles, processing <br />areas, batch plants, other pollutant sources, etc.); stream location(s); numbered outfalls; and direction(s) of <br />water flow at the facility indicated by arrows (stormwater and process water). Label outfalls to correspond <br />with the numbers listed Table G.1 of this application. <br />Are the required maps/sketches attached? □ Yes <br />□No - Application cannot be processed without required maps <br />F.SITE-SPECIFIC CONDITIONS - Nearby Sources of Potential Groundwater Contamination/Facility pollutant sources <br />Note: The division may require representative analytical data of the effluent (e.g., mine pit water or discharge) as <br />part of the application review process. The division will notify the applicant if any additional information is <br />required. Failure to provide this data may delay permit application processing until such data is submitted to the <br />division. <br />Note: see Appendix B of Application Guidance Document (Construction Dewatering - COG070000) on the division <br />website for resources useful in identifying ground water contamination near the facility. <br />P125 <br />County Road 28 and County Road 17 <br />Platteville 80651 <br />Weld <br />40 1941509 -104 9076694 <br />1442 <br />The current mining plan includes dry mine gravel extraction from four pits that will encompass <br />approximately 196 acres. Mined material will be transfered to a neighboring pit via conveyors <br />for processing.