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COLORADO DIVISION OF WATER RESOURCES <br />DEPARTMENT OF NATURAL RESOURCES <br />GWS-27 INST (6/2006) <br />GRAVEL PIT WELL PERMIT APPLICATION - INSTRUCTIONS <br />This applications is for use in applying for a well permit for a gravel pit that exposes groundwater to evaporation as required <br />under the provision of 37=90-107(6) or 37-90-137(11), C.R.S. If this is not such a gravel pit, use General Purpose Application <br />Form GWS-45. A permit is not required if the pit was constructed prior to December 31, 1980 and has not been operated or <br />reactivated after that date. <br />FEES A $100 non-refundable filing fee is required. One application is required for each DMG permit area. <br />Checks should be payable to the COLORADO DIVISION OF WATER RESOURCES. <br />A substitute supply plan or augmentation plan may be required for approval where groundwater was exposed after <br />December 31, 1980. These plans are submitted separately and a filing fee of $1,593.00 is required. These plans <br />may not be needed in areas where water is available and all other water rights are satisfied. <br />Applications must be completed clearly, and legibly in BLACK INK or typed. ALL ITEMS in the application must be <br />completed. Incomplete applications may be returned for more information. Do not change or alter the application in any way. <br />Attach additional sheets if more space is needed. <br />ITEM 1 TYPE OF PERMIT - Check the appropriate box. <br />ITEM 2 APPLICANT INFORMATION - This is the applicant's name and the mailing address where all <br />correspondence will be sent. Include the phone number. <br />ITEM 3 CONSULTANT/ATTORNEY/OPERATOR CONTACT - If there is someone different than the applicant to be <br />contacted for additional information, then complete this item. <br />Indicate the name of the gravel pit and the assigned DMG number (include any prior DMG/MLRD permit <br />numbers that may be assoicated with this pit. <br />• ITEM 4 LOCATION OF WELL - The general location of the well (pit) must be indicated and include a quarter/quarter, <br />Section, Township, Range and Principal Meridian. An outline of the pit(s) on a USGS 7 1/2 minute <br />quadrangle map is desirable. <br />ITEM 5 Indicate the maximum number of acres of groundwater to be exposed to the atmosphere and the total <br />number of excavated areas (pits) covered within the DMG permit. <br />ITEM 6 Indicate the estimated proposed or actual depth of the pit(s), and estimated depth to groundwater. <br />ITEM 7 Indicate the estimated dates of beginning to expose groundwater and completing the mining. <br />ITEM 8 ATTACHMENTS - The list of attachments to this application provides information which is necessary to the <br />evaluation. A scaled map of the pit area tied to a section corner is required. <br />ITEM 9 USE - Complete this item if water is to be used for any purpose other than evaporation, those uses must be <br />detailed. The information required includes but is not limited to the volume of gravel mined, the method of <br />diversion of water from the pit, the pumping rate in gallon per minute, the average annual amount of water <br />diverted or used in acre-feet, and the proposed use. <br />ITEM 10 SIGNATURE - An ORIGINAL signature must be on each application. The individual signing the application <br />must be the applicant, or an officer of the company identified as the applicant. Clearly print the name, and <br />title, of the person signing the application and include the date. The applicant's authorized agent may sign <br />the application, if a letter signed by the applicant is submitted with the application authorizing them to act as <br />agent for the purpose of obtaining a well permit. <br />IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources <br />Ground Water Information Desk (303-866-3587), or the nearest Division of Water Resource Field Office located in Greeley <br />&970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683), Montrose (970-249-6622), Glenwood Springs (970-945- <br />5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845). <br />COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, ROOM 821, DENVER, CO 80203 <br />PHONE 303-866-3587 (Information), 303-866-3581 (Main), 303-866-3447 (Well & Water Rights Records), 303-866-3589 (Fax)