2008-08-28_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: General Documents
• Doc Date: 8/28/2008
• Doc Name: Registration of Existing Wells
• From: WWCEngineering
• To: State Engineer
• Permit Index Doc Type: Exploration
• Email Name: JDM
• Media Type: D
• Archive: No

Form STATE OF COLORADO For Office Use Only
No. OFFICE OF THE STATE ENGINEER
GWS-1 818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
6/2006 [phone] Fax [phone]
hftp://water.state.co.us/default.htm
REGISTRATION OF EXISTING WELL
NAME. ADDRESS AND PHONE OF THE WELL OWNER:
NAME(S)
Robert S. Dick and Kathr e E. Crawford
MAILING ADDRESS
P. O. Box 776236
CITY: STATE: ZIP CODE:
Steamboat S rings CO 80477
TELEPHONE NUMBER E-MAIL (OPTIONAL)
[phone]

WELL LOCATION County Routt Owner's Well Designation (optional) GMC3
N/A N/A CO N/A
(Address) (City) (State) (Zip)
SE 1/4 of the SE 1/4, Sec. 25 , Twp. 5 ® N. or ? S., Range86 ? E. or ® W., 6th Principal P.M.
Distance from Section Lines 1235 Ft. ? N. or ® S. Line, 787 Ft. ® E. or ? W. Line.
PLEASE ATTACH A COPY OF A CURRENT DEED FOR THE SUBJECT PARCEL
Subdivision Name N/A , Lot , Block , Filing/Unit
Optional: GPS well location information in UTM format. The following GPS settings are required: Easting 332024.25
Format must be UTM. Units must be in meters. Datum must be NAD83. Unit must be set to true
north. ? Zone 12 or ® Zone 13
Was GPS unit checked for above items? ® YES ? NO Northing 4469321.12

The well has historically been used for the following purpose(s): Monitoring Well

Water from the well was first used beneficially by the original owner for the above described purposes on Unknown
The total depth of this well is 154.1 & 28 feet.
The pumping rate of this well is N/A gallons per minute.
The average annual amount of water diverted is N/A acre-feet.
The lawn and garden irrigated (watered) by water from this well is N/A ? Acre or ? Square feet.
Number
The making of false statements herein constitutes perjury in the second degree, which is punishable as a-class 1 misdemeanor pursuant to
C.R.S. 23-3-104(13)(a). I have read the statements herein, know the contents thereof, and state that they are true to my knowledge.
S nat re(s) f th II Owner P ' t Name and Title of Well Owper
17(513fzo; Date

For Office Use Only
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CWCB
TOPO
MYLAR Div WD _ Basin MD