2009-06-11_INSPECTION - M1980120

• Permit No: M1980120
• IBM Index Class Name: INSPECTION
• Doc Date: 6/11/2009
• Doc Name: Additional Data-Response to 4/15/09 Inspection Report
• From: Weld County
• To: DRMS
• Inspection Date: 4/15/2009
• Email Name: MAC
• Media Type: D
• Archive: No

Form No. COLORADO DIVISION OF WATER RESOURCES For Office Use only
GWS-27 DEPARTMENT OF NATURAL RESOURCES
612006 1313, Sherman St., Rm 818, Denver. Colorado 80203
Phone: [phone]
REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM
GRAVEL PIT WELL PERMIT APPLICATION
1. TYPE OF P
UNEW PIT(S)
IT
S
S
(
P
) EXI
T, CONSTRUCTED AFTER DEC. 31,1980
2. APPLICANT INFORMATION
NAME(S) We.W C&, C (it 4.'6&5 M£hku2t• w A? n
Mailing Address _L1 ucea??
City, St. Zip G'nu-lty# CO
SQ632- ?5?s
Phone( ___) 3c+ul??
3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than #2)
NAME(S) tc^e c?.5 au? PIT NAME n
Mailing Address
City, St. Zip DMG NO. 011Q?D- t2o
Phone (?)
4. GENERAL LOCATION OF PIT(S): COUNTY
V2 W 5E 1/4, Sec. 13 Twp. 2 I!`J N. ? S., Range ___I ?'1 o E. ? W. __4:1__P.M.
5. Estimated maximum water surface to be exposed: 214 Acres. Number of Pits
6. Estimated depth of pit(s) 2 5 Ft. Estimated depth: to groundwater (a FL
7. , Estimated date to expose groundwater Ire _;to complete mining a 202,x,
8. ATTACHMENTS: (Check which have been attached.)
I.
(a) 1
! Scaled map of pit area with range, township! & section clearly identified (REQUIRED)
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.
I
?
b
(
) Copy of the reclamation permit, if applicable.
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(c)
opy of pre 1/15189 water conservancy dist. or water user assoc. augmentation agreement
if applicable
I?
,
,
(d)
F I Copy of proposed substitute water plan or augmentation plan application
if applicable. r
,
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l
J
(e)
-
Copy of court approved augmentation plan, if applicable. Case No.
(f) Other Z,M xr ,? me 1 cae +. kil 1 Cai.YCJ0 t c.r s¢+yc?.ty- ?L,clr?
9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of
diversion
o
f
any w
ater
withd
rawnfrom the
pond.
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10. 1 (we) have read the statements made herein and know the contents thereof, and that they are true to my (our)
knowledge. [Pursuant to Section 24-4104 (13)(a) C.R.S., the making of false statements herein constitutes perjury
in the second degree and is punishable as a class 1 misdemeanor.]
Name/Title (Please type or print) Signature Date
8
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For Office Use only
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Court Case No. Div. Co..- WD Basin _ MD Use