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] hftp://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 6. Use Of Well
Name of well owner
Maplewood Financial, Inc. c/o William Dulan Use of this well is limited to monitoring water levels
and/or water quality sampling
-._-- ---------------....-- --..... _..._ ................_....
Mailing address_ _ 7. Well Data (proposed)
Total depth Aquifer
3001 S. Lincoln Ave.
--._..._..... ..... ....... ............ .... _.......... feet
City state zrp code 235, 164.3 Unknown
Steamboat Springs CO I80487 8. Consultant Information (if applicable)
..... _ ........ _ _ .................
- - - - --._.._....__._._------- _.......... _........_...... ...--------- ---
_._....._._...........1..._.....--- .... _......... _._..... . _ ......................
Telephone # ?- - ( p'ona1) Name of contact person
ail
' E-M O h
[phone] Troy Summers
_..-..._...__._..._._.... ._.......... -. .............. _
Type Of Application ?check aPP-l-ic-a-...-b--l-e-boxes) Company name
2.
-..-._.__........... _-...._..._................ _._ WWC Engineering
® Use existing well ? Replacement for existing monitoring well: ....... __........... _...... _..... _.._.........__.___........ _...... _.............................. ___.._.._...
? Construct new well Mailing address
? Other: Permit no.:Not Permitted 611 Skyline Road
-------...................... _.._.... _..... __.......... _....._.-__........... _ .............. __._........... -----........ _..... _.._..... _.._...................... _..__........
_................ _...... __..._......
3. Refer To (if applicable) City State Zip Code
__...__._._..._.___........_....__._.__ .................... _....... ..... ......_.__...........
Monitoring hole acknowledgment Well name or # Laramie WY 82070
MH- N/A GMC2 Telephone #
4. Location Of Proposed Well [phone]
-county......... ._....... -__.-_.-......_.. , ... ...._._-..___.......__..._..._.__..__._........._..__......._.-- _..... _.... _........ _- 9. Proposed Well Driller License #(o tional):N/A
Routt SW 1/4 of the NE 1/4 10. Signature Of Well Owner, Consultant Or Authorized
_._._......_ ..............._..._...---.-_-......_.................._. Agent
...... _...... . _
_-_........ ..-.._...
Section Township N or S Range E or W Principal Meridian --_ _ ... _-J_ _..._._.... -_...... __........ _.................... _.___..........____............ _.._.-._...__..._____.
i The making of false statements rein constitutes perjury in the second
36 I 5 ®? 1 86 ? ® 6 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
Distance of well from section lines (section lines are typically not property lines) thereof and state._that the ( are true _ .... to my knowledge. -- -......... ....... .,-_-.-
_..._..... ..._.....-.-.......-....
2606 Ft. from ® N 11 S 2502 Ft. from ® E ? W Sign here (Must lure) Date
For replacement wells only-distance and direction from old well to new well i
N/A feet N/A direction Print name &
---._.......... _ _._...___.......... -_....... _ ..................
_....___ Ett?S PSSoc'LA t? bmlo wST
Well location address (Include City, State, Zip) ? Check if well address is same asltem 1. Rof [
N/A Office Use Only
_ -_.._.._. ._ -...... ..... _.......... _.__.-...-
Optional: GPS well location.information_ in UTM format _.___...._-..... _.... _._......... _-....._____.... . ....... ........ ..........__.._.._._._.._.____....._._ _....................
........ ... .....................
USGS map name DWR map no. Surface elev.
You must check GPS unit for required settings as follows: I
Format must be UTM _...___.__ .................._......_..__ _._.....__.__. _? _.._...__....._._._-...._....-_....._.---._....
p Zone 12 or ® Zone 13 Receipt area only
Easting 331492.41
Units must be Meters
Datum must be NAD83 Northing 4468148.36
Unit must be set to true north I
Was GPS unit checked for above? ® YES Remember to set Datum to NAD83
5. Property Owner Information
-
... _........... ....... _._.._.........
Name of property owner
Maplewood Financial, Inc. c/o William Dulan
...................... _._.-............ ___.... _..-.___................. --
Mailing address
3001 S. Lincoln Ave. ......_.__......._.......-_........._..........._._...__._ ................... _..
....... ...._...... -- ------._.......... _. ............. _.._..._
City State Zip Code
Steamboat Springs CO 80487
_.......... - ._....... --..._-._...._ -_.._.....?
Telephone #
DIV WD BA MD
[phone]