2008-09-19_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: General Documents
• Doc Date: 9/19/2008
• Doc Name: Registration of Existing Wells
• From: WWC Engineering
• To: DRMS
• Permit Index Doc Type: Exploration
• Email Name: JDM
• Media Type: D
• Archive: No

COLORADO DIVISION OF WATER RESOURCES Office Use Only Form Gws-46 (12/2007)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., RM 818, DENVER CO 80203
phone - info: [phone] main: [phone]
Fax: [phone] http://www.water.state.co.us
MONITORING/OBSERVATION
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be completed in black or blue ink or typed.
1. Well Owner Information 6. Use Of Well
Name of well owner
Robert S. Dick and Kathryne E. Crawford
Use of this well is limited to monitoring water levels
and/or water quality sampling
Mailing address 7. Well Data (proposed)
P.O.
. BOX 776236 -
.-.....-...... .....
.
-_'--......_........... __....._. _........ -.
' ......----._.._....._.._.----..._...._.__......__............_...
-'To'tal depth 1 Aquifer
feet I
-----._....
... Siaie
code
zip 154.1, 28
Unknown
Steamboat Springs CO 80477 8. Consultant Information (if applicable)
....... .._._.......___ ............._.......
-._._..__...__...._ ..__......... _.__...... __..... _......... "-- ....... _... _.... ...
Telephone # E-Mail (Optional)
Name of contact person
[phone] Troy Summers
_..- -'--- --....... _...... -....... --.......... -' -- ...._......... _.
Type Of Application (check applicable boxes)
2 Company name
.
® Use existing well ? Replacement for existing monitoring well: WWC Engineering
? Construct new well
Permit no.:Not Permitted Mailing address
? Other: 611 Skyline Road

_.._.__.-..
--..._._._....-.-_.... ........ ...__._ ................. _................ _.._.... -............ ---........... --_ -- ._...... ......... _......
3. Refer To (if applicable) city State Zip Code

__.
-.._...... _.-.......... _-_....... _..... ....... .__..... _.............. _.....
Monitoring hole acknowledgment well name or #

Laramie WY 82070
-.........-.____...__...._..........._.__.......----'-'--_..........._..__.._._.._.__._.__...........---..........-_-............_...._....._......_.---._..__......._._........-_..
MH- N/A GMC3 Telephone #

osed Well
ti
Of Pro
4
L [phone]
on
p
oca
.
...... _....... __..._............ ___....
County .... _ ..... 9. Proposed Well Driller License #(optional):N/A
Routt SE 1/4 of the SE 114 10. Signature Of Well Owner, Consultant Or Authorized
-Section -I Township N or S Range E or W principal Merndan

25 5 ®? 86 E3 ® 6 A5ent
The making of false statements herein constitutes perjury in the second
which is punishable as a class 1 misdemeanor pursuant to C.R.S.
ree
de
.._-..................... _-...__..._.-_...__..-.__..__....... _.... ._..._._............... -...__...._-....._1-___....__..___._-....... .._. ,
g
24-4-104 (13)(a). I have read the statements herein, know the contents
Distance of well from section lines (section lines are typically not property lines) thereof and state t to my knowledge.
--.._..__._............__._. ....._.._....__._ _............ - -'' -..__.._........_ ...............
Date
t
1235 Ft. from [I N ® S 787 Ft, from ® E [I W ur
Sign here a
I
Far replacement wells only -distance and direction from old well to new well 7
'_. ........ ..... ---. _.. ____.-.............. _......... ..... ..... -'------'--.._........._..._...
N/A feet N/A directi
.._T---. _.__-_...... .__._..... _._-............ ..__.__.__.---.._.. _ Print name & ti e
?_-
?? w? (36XCG IST
-
Well location address (Include City, Slate, Zip) ? Check if well address is same asitem 1.
`I
MO
N/A
---_....... _.. Office Use Only
Optional: GPs well location information in UTM format
You must check GPS unit for required settings as follows:
_ ._.................. ._ .-_...._-._._._......-.-_.__................ ,___......... _............................... _......
USGS map name 1 DWR map no. i Surface elev.

_...
..... _____._._.............
.
For..
_mat must be UTM

_

eceipt area only
? Zone 12 or ® Zone 13 Fasting 332024.25
Units must be Meters
Datum must be NAD83 Northing 4469321.12
Unit must be set to true north
Was GPS unit checked for above? ® YES Remember to set Datum to NAD83
5. Property Owner Information
_._...__-.._..__._ ..................... -.... _..._...
Name of property owner
Robert S. Dick and Kathryne E. Crawford
Mailing address
P.O. Box 776236 ...... _.... -'-.._.... -......... __............. _...................... -'--......... _.._....... ._..

_.._.._...._..
.......... _--....... --..._........ _.-......... -_..... _..... ............
City State Zip Code
Steamboat Springs CO 80477
__..__. -.......... __-...__._._...._..._.... _..... _.... _...__ ........
__-....-.__---._._..._
Telephone #
DIV WD BA MD
[phone]