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
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
-...._.._._.__.
__.._._______---......._.......-......_._......... .__........ ___.....
Name of well owner
Robert S. Dick and Kathryn E. Crawford
Mailing address
P.O. Box 776236
Steamboat Springs ; CO 80477
_ ... ..._._...,._.._........._ ................_ ............ ?.._._.......... Telephone X_-'__""' E-Mail (Optional)
[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 UNK-3
4. Location Of Proposed Well _ _
County
Routt I NE 114 of the SW
_....__........
-shi.... _-N o"T_.S.__.
Section Townnship N or Range E or W Principal Me
36 5 ®? 86 ?® j 6
1 /4
Office Use Only
Form GWS-46 (12/2007)
6. Use Of Well
Use of this well is limited to monitoring water levels
and/or water quality sampling
7. Well Data (proposed)
>200 feet j 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 that they are true to my knowledge. _-
Distance of well from section lines (section lines are typically not property lines)
1984 Ft. from ? N ® S 2113 Ft. from ? E ® W
_.........-..__
........_.._.__._-..-..__-__.._..._..........
F-or replacement wells only - distance and direction from old well to new well
N/A feet N/A ogre
_... - ... _ .-..._-..?.._.-_.-_ - __..._.._.-__......._ _..._..._._........ _........ _....... _.-
Well location address (Include City, State, Zip) ? Check if well address is same asltem 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
[3 Zone 12 or ® Zone 13 Easting 331303.40
Units must be Meters
Datum must be NAD83 Northing 4467930.47
Unit must be set to true north
Was GPS unit checked for above? [DYES 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 #
[phone]
DIV WD BA MD
9116' o
ctlon ••,•,••a°?
&aMMC.f2.S t A,--,SaC.1A'MVtST
Office Use Only
....
_.. -........
-- ._._.....__.-._.__ ......................... _......
USGS map name r W map no. f Surface elev
Receipt area