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OFFICE OF THE STATE ENGINEER <br />DIVISION OF WATER RESOURCES <br />718-589-6683 (Alamosa) 303-866-3581 (Denver) <br />FOR OFFICE USE ONLY <br />DAM NAME <br /> <br />NO. WATER DIV: DIST: 2- <br />NOTICE OF INTENT TO CONSTRUCT A NON-JURISDICTIONAL <br />WATER IMPOUNDMENT STRUCTURE' RECEIVED <br />This notice is required per Section 37-87-125, C.R.S. (1998). ??/? <br />This notice must be submitted to the Division Engineer's Office a minimum of 10 days prior to cAl9tr C60?y? <br />liN+? <br />Yom pisoLun <br />(PLEASE PRINT OR TYPE NOTICE) eTAAI <br />iMER INFORMATION <br />Telephone: ?71 ???? ` 319 <br />/' A n <br />Responsible Person: <br />Contractor. <br />Street/P.O. <br />r[u.0. MUUM <br />Telephone: L? ) 5W - ? .3 ?, p <br />state <br />STRUCTURE INFORMATION r-?( S5 rltj s'IV V Are <br />L I <br />S-iia <br />Zip Code <br /> <br />Name of Dam: _ Wer-o, Set S (1,11"0 County o S Water Division: 3 Water District: Z ?- <br />Location: Y,/ Y. Sect: NW Qtr Sect: S 6 Sect: /$ Township: M l? , Range: I P.M.N•d(. <br />Option 1 Distance of dam from Section n ; //-7 o 6 ft from oN tt. i o o ft from it OW <br />OR Utilizing GPS: Set to UTM Datum. Measure on crest of dam at streamline/outlet. <br />Option 2 Northing m. Easting m, <br />Note: GPS settings must t NAD83 CONUS <br />Dam Dimensions: Vertical Height: Length: '10 0 ft., Slopes: U/S: ?/I HAV, D/S 311 HAV <br />Reservoir: Surface Area: 0. 37 acres, Capacity: ?• S_ acre feet, Drainage Area: N (A acres <br />Emergency Spillway: Width: Cramp d/a?rt ft., Side Slopes: HAV, Freeboard: ft. 3 <br />Outlet Drain: Type: C M4 , Size: inches, Location P6 carnA,^ <br />Stream Name / or Water Sour+ce:4 <br />Wt ec+ has A,U 3v.99 ear 6;24 <br />Proposed Water Use: WJJV- S ?*T sP rin,t(,e f Water Court Case No. (If applicable) 1A <br /> <br />S 4 be VS4. Ar Nk ihifl!) t rr,,; it 1r <br />DWR(03/05) O` oLsf S,jfprelslofi . <br />as a N i <br />Signature of Division Engineer Date <br />B7 <br />Vertical height is 10 feet or less at longitudinal centerline of dam from lowest point of ground surface to flowline crest of spillway, <br />and reservoir is 20 surface acres or less at high water line, and impounds 100 acre-feet or less of water. <br />=See Example on reverse side of form <br />3 VPrtiral rficfanrta frnm hnffnm of enillwav to rraaf of rfam