2009-07-23_REVISION - M2001023

• Permit No: M2001023
• IBM Index Class Name: REVISION
• Doc Date: 7/23/2009
• Doc Name: Response to adequacy letter dated 7/21/2009
• From: Baseline Corporation
• To: DRMS
• Type & Sequence: AM1
• Email Name: PSH
• Media Type: D
• Archive: No

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Form` No. COLORADO DIVISION OF WATER RESOURCES For Office Use only
GWS-27 DEPARTMENT OF NATURAL RESOURCES
6/2006 1313 Sherman St., Rm 818, Denver, Colorado 80203
Phone: [phone]
REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM
GRAVEL PIT WELL PERMIT APPLICATION
1. TYPE OF PERMIT

NEW PIT(S) ,AJ,1 r td\t T To Ekts -11 P C;Fir1. E LE 1 ! AA1L1J ?, l . Z)
? PIT(S) EXIST
CONSTRUCTED AFTER DEC
31
1
,
.
,
980
2. APPLICANT INFORMATION COL00--iD i S7 TE 0r10 OF.-
NAME(S) ! iq,L, SO)o-- _rh G L-AfJ , <c,?rn? (S51c??% l`
Mailing Address F(.) (j e3), (rf i 13 (t n?, l J 5 T .. T !? Z- i
City, St. Zip fA ILL6r< (.u f oW?7 i7 r'JV 7P , Ch `EJ"2-O
Phone L22-0 . )'3-73 -N3`l f }rte ° ? - ??{
3• CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than #2)
NAME(S) }ci L?ISf(ail) %XCAIA-r 10C . ,JC '
PIT NAME
Mailing Address 7-0
City, St. Zip -(r°'? fart rJ ., CrJ o ?C? 3 1 DMG NO. ?? -r?J I L G S
Phone L_2,-70
4. GENERAL LOCATION OF PIT(S)' COUNTY R:`) (1 TI
? ti'2 >%C. 15)
ti L A t4, Sec. Z.-z- Twp. t'a [ON. E S
Range T&
? E
? W
r, -l' P
.,
.
.
.NI.
5. Estimated maximum water surface to be exposed: (v Acres. Number of Pits ?-
6. Estimated depth of pit(s) 7- q Ft. Estimated depth to groundwater Ft.
7. Estimated date to expose groundwater_ A A -0 ; to complete mining ? /r1 /U5
8. ATTACHMENTS: (Check which have been attached.)
(a) Scaled map of pit area with range, township, & section clearly identified (REQUIRED)
.
(b) Copy of the reclamation permit
if applicable
°?%'
,
.
Jl"s 54`6" f
(c) ? Copy of pre 1/15/89 water conservanc
di
t
t
y
s
. or wa
er user assoc. augmentation agreement, if applicable.
(d) ? Copy of proposed substitute water plan or augmentation plan application
if applicable
,
.
Q
(e)
Copy of court approved augmentation plan, if applicable. Case No.
(f) ® Other y,<«1::-7Y MAP AAA f?rF F'(-:7 Ct!A/otA-1 tc.f"-) PL"4IJ /-1, AP C OS5 -5t-C
9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of
diversion of any water withdrawn from the pond.
rF i' r f ?, > I)IS(k'.IFT)oj

10. 1 (we) have read the statements made h /-i f L < 1
`?" ( ? "' " ire true to my (our)
knowledge. [Pursuant to Section 24-4-1
(F; t. srein constitutes perjury
in the second degree and is punishable
Name/Title (Please type or print) Signature f ,.
I
, Date
f
(f( f// f
For Office Use only I All" rm+? r T itl+c LPie_. C -+ype tr ?'.";hf1y f 5" ;n? i,:ra t? 4

Court Case No. Div. Co. ` << K
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