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 I 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://vim.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
City _ State Zip code
Steamboat Springs CO ( 80477
[phone]
2. Type Of Application (check applicable boxes)
® Use existing well ? Replacement for existing monitoring well:
? Construct new well Permit no.:Not Permitted
? Other:
3. Refer To (if applicable)
Monitoring hole acknowledgment Well name or #
MH- N/A 05-01-0007
4. Location Of Proposed Well -__ _ .....__.--._,_...-._..
County
Routt SW 1/4 of the SW 1/4
. .............._
Section Township N or S Range E or W PrinGpal Meridian
30 5 - - ® 11 85 ? ® „6
Distance of well from section lines (section lines are typically not property lines)
410 Ft. from ? N ® S 563 Ft. from ? E ® W
For replacement wells only - distance and direction from old well to new well
N/A feet N/A director
Well location address (include City, State, Zip) ? Check if well address is same asitem 1.
N/A
Optional: GPS well location information in UTM format
You must check GPS unit for required settings as follows:
Format must be UTM
p Zone 12 or ® Zone 13 Easting 332434.45
Units must be Meters
Datum must be NAD83 Northing 4469110.20
Unit must be set to true north
Was GPS unit checked for above? ® YES Remember to set Datum to NAD83
5. Property Owner Information
._.._.___._....... _.
uName 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 # --- -"'
[phone]
55.8 feet I Unknown
8. Consultant Information (if applicable)
...__._ -...._.-_....._-.-_.__......__.... _
Name of contact person
Troy Summers
_..._...._....
----.....__-....-.--._............
Company name
WWC Engineering
--._ -._.._.........._._..._......._........._..........._.....^
Mailing address
611 Skyline Road
.. ...... -----.- -....._-_...-_-.........__. ....._.._....__...._..
City State Zip Code
Laramie WY 82070
__._.__.... ......... -..__...... ........
Telephone #
[phone]
9. Proposed Well Driller License #(optional):N/A
10. Signature Of Well Owner, Consultant Or Authorized
Agent
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.
24-4-104 (13)(a). I have read the statements herein, know the contents
thereof and state,'~o}rr° true to my.knowledge -..._.
046106
Print
l tzo`t ASIM?p-& C-Aa-061ST
ce Use Only
-......... ....-...... ---...__............ -
map name I DWR map no. Surfa
Receipt area
DIV WD BA MD