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urvranurs Ur WATER AESQURCE�— For Office Us*only <br /> NO. <br /> DEPARTMENT OF NATURAL RESOURCES <br /> 12195 1818 Sherman St., nm 018,Demrer,Colorado 80208 <br /> phone:(8031 866-3Sa1 <br /> 'I REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br /> GRAVEL PIT WELL PERMIT APPLICATION <br /> R <br /> NEW PITIS) <br /> O PIT(S) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 <br /> 2. APPLICANT INFORMATION <br /> NAMEISI Coulson Excavating Company <br /> Mailing Address 3609 North County Road 13 <br /> City, St. Zip Loveland, CO 8OS38 <br /> Phone ( 970 ) 667-2178 <br /> 3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than 02) <br /> NAME(S) Tuttle Applegate, Inc. PIT NAME 11en er Pit <br /> Mailing Address 11990 Grant St. , Suite 304 <br /> City, St. Zip Denver, CO 80233-1136 DMG NO. MBS-026 <br /> Phone ( :n: 1452-6611 <br /> 4. GENERAL LOCATION OF PITISI: COUNTY <br /> 1/4 NW 1/4, Sec. 29 Twp. S ON. ❑S., Range 67 ❑E. ®W. 6thp.M. <br /> 5. Estimated maximum water surface to be exposed: 13 Acres. Number of M4 3 <br /> 8. Estimated depth of pits) 15 Ft. Estimated depth to groundwater 12 Ft. <br /> 7.1 Estimated date to expose groundwater 8 ;to complete mining Wcerber 2005 <br /> B. ATTACHMENTS: (Check which have been attached.) <br /> (a) ®Scaled map of pit area with range, township, !k section clearly indentffed (REQ IREI <br /> lb) ❑Copy of the reclamation permit, If applicable. <br /> (c) ❑Copy of pre 1/15/89 water conservancy dist. or water user assoc.augmentati agreement, H applicable <br /> Idl ®Copy of proposed substitute water plan or augmentation plan application, ifa icable. <br /> (a) ❑Copy of court approved augmentation plan, if applicable. Case No. <br /> (f) ❑Other t <br /> 9. Detailed description of any use,other than evaporation,and method of diversion, rate of dive raion,and annual amoun <br /> of diversion of any water withdrawn from the pond. <br /> Water retained in material- water p=ed from pit for dust control of aul roads and <br /> stock piles, Annual amount at full production, including Pvq r tin a roximatel <br /> acre-ft. I <br /> 0 1 (we) have read the statements made herein and know the contents thereof, and that the are true to my (our► <br /> knowledge. [Pursuant to Section 24-4-104 (13)1a) C.R.S., the making of false statements Groin constitutes perju <br /> in the second degree and is punishable as a class 1 misdemeanor.] <br /> Name/Title (Please two or print) Signature ate <br /> Richard Coulson President 09/18/98 <br /> For Office Use only <br /> Court Case No. Div. Co. WD— Basin — MD Use <br />