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• DIVISION OF WATER RESOURCES <br />P.O. Box 1880 - <br />Durango, CO 81302 ~ L° C ; ~.. ~ I <br />970-247-1845 I I I 1 i ~---" - <br />_ _ NOTICE OF INTENT TO CONSTRUCT A NON~IURiSDICTIONAL <br />WATER IMPOUNDMENT STRUCTUREI <br />This notice is required per Section 37-87-125, C.R.S. (1998). <br />This notice must be submitted to the Water Resources office in Durango at least 10 days prior to construction. <br />(PLEASE PRINT OR TYPE APPLICATION) <br />OWNER INFORMATION <br />Name: ~ t' o.~ ~ o v Q. Telephone: la7d S g8 'L2.~ 7 <br />Address: ~ ! 3 LI <br />StreeVP.O. Box/ Rural Route - City State Zip Code <br />Responsible Person: 6 t~c.~ 2„wc Telephone: 1°t7a) 588 22"17 <br />Address: ~1 1 3 ~ <- <br />((~~StreeUP.O. Box/ Rural Route City - State Zip Code <br />Contractor. \`c~y~ ~ c-o~v~` Telephone (g 7e) 5 ~ ZZ77 <br />Name of Dam: P'1 - ~~' O 3S Water Division: 7 Water District:.33 <br />Location: <br />%J % Sect:y~'/. Sect: N ~~ Sect: 1 b , Township: 3 ~, Range: 12, , P.M. f a <br />Distance of dam from Section lines _ !Es o ft from BN ^ S, 5 2 o ft from E OW <br />Optional Utilizing GPS: Set to UTM Datum. Measure at centerline of embankment at sUeamline. <br />InformatioM(v Northing m. Fasting m. <br />Dam Dimensions: Vertical Height: to fL, Length: ! 20 ft., Slopes: U/S: ~ H:1V, D/SZ: I H:1V <br />Reservoir. Capacity: I o acre feet , Surface Area: o ~+e acres, Drainage Area: acres <br />Emergencv Spillway: Width: '~ - ft., Side Slopes: ~~ H:1 V, Freeboard:~_R' <br />Outlet Drain: Type: _5 ~a 11 ~..,o,~ Size: inches, Location 5~.,.~1~v ~s~' ~ ~ .~~~ <br />Stream Name or Water Source:' <br />ho <br />Proposed Water Use: c5 -~~ c ~ ~ ~., d Water Court Case No (If applicable) <br />Signature of Owner Date <br />DWR (5/99) Signature of Division Engineer Date <br />' Verticl height is 10 feet or less at longitudinal centerline of dam from lowest point of ground surface to Oowline crest of spillway, <br />and reservoir is 20 surface aces or less at high water line, and impounds 100 acre-feet or less of water. <br />2.See Example on reverse side of form <br />~ Vertical distance from bottom of spillway to nest of dam. <br />' If construction in reservoir intercepts groundwater (note stream name that groundwater is tributary to), a well permit is required. <br />