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://vmw.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
Fredrick G. Hoeptner et All Partners c/o Scott Hayden
1 360 S. Monroe, 5th Floor
Denver CO 80209
_ ......_...._
Telephone # 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 OK2
4. Location Of Proposed Well
-County ....... _.__. _- j........_.. _ __. _. _.-. _._..-----
Routt I SW 1/4 of the NW 1/4
_._..._...._...--.--._____......._....
_.._.-.......... . _ _....._ . _......... ._...__._..___. ?__. _.._-----__.............. __....... _ .- ......
Section Township N or S Range E or W Principal Meridian
17 4 1Z 11 85 ?® 6
Distance of well from section lines (section lines are typically not property lines)
1229 Ft. from ® N ? S 151 Ft. from ? E ® W
wells
well to new
N/A feet N/A aired
._.... __.......... __.._...._....... _.._........ .A
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
C3 Zone 12 or ® Zone 13 Easting 333528.32
Units must be Meters
Datum must be NAD83 I Northing 4465258.54
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
Fredrick G. Hoeptner et All Partners c/o Scott Hayden
Mailing address
360 S. Monroe, 5th Floor
--.----.................... -
City State Zip Code
Denver CO 80209
-._..... _.__.......... ---..___ .................... _._..... __..-.._..... -_____.... -_....... __.... ...._...... _
Telephone #
[phone]
DIV WD BA MD
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)
20 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 that they are true to my knowledge. _.............. ....... _.........
91110108
vnnt name a nne???
spy SwN rRS( AS5IC (A'ZE C-ACLp6%3-r
Office Use Only
...
...-......... _......-- P_....__ .... ...
USGS map name 1 DWR..._ma no. ..... ..... i Surface elev..
area