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Required NE1/4 SWl/4 Section Township Range Principal <br />Description: of the 26 3S 72W Meridian 6`h <br />Gilpin County <br />Distance from section lines (section lines are typically not droperty lined: <br />2250 Feet from South section line and 2000 Feet from West section line (see attached Exhibit A) <br />Street Address: 1601 Highway 119, Black Hawk, CO 80422 <br />Subdivision: n/a Lot: n/a Block: n/a <br />4. A. Source: Fractured aquifers tributary to North Clear Creek <br />B. Depth: 950 feet <br />5, A. Date of appropriation: March 29, 2002 <br />B. How appropriation was initiated: By inclusion of the well in the City of Black Hawk's <br />Application for Plan for Augmentation in Case No. 94CW036. Applicant's well was included in <br />the augmentation plan pursuant to the Fourth Amendment to Application in Case No. 94CW036 <br />filed on March 29, 2002 and published in the March 2002 Water Court resume for Division 1. <br />C. Date water first applied to beneficial use: April 5, 2005. <br />5. Amount claimed: 15 gpm, absolute. <br />6. If well is non-tributary: n/a <br />7. Proposed use: <br />A. If irrigation, complete the following: n/a <br />B. If non-irrigation, describe purpose fully: The water will be used for municipal purposes, <br />including drinking water, toilets, showers, washing machines, ice makers, dishwashers, and <br />emergency eye wash stations, and other municipal uses at the Applicant's wastewater treatment <br />plant. <br />8. Name(s) and address(es) of owner(s) or reputed owners of the land upon which any new diversion or <br />storage structure, or modification to any existing diversion or storage structure is or will be <br />constructed or upon which water is or will be stored, including any modification to the existing <br />pool: Applicant. <br />9. Remarks: This well will divert under its own priority when water is available under the water right <br />to be decreed herein. At all other times, water pumped by this well is augmented pursuant to the <br />decree entered in Case No. 94CW036 on August 22, 2003. <br />JDF 298W R10/04 APPLICATION FOR UNDERGROUND WATER RIGHT Page 2 of 3 <br />