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Form No. COLORADO DIVISION OF WATER RESOURCES For Office Use only <br />GWS 27 DEPARTMENT OF NATURAL RESOURCES <br />6/2006 1313 Shennan St, Rm 818, Denver, Colorado 80203 <br /> Phone: (303) 866-3581 <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />VEL PIT WELL PERMIT APPLICATION <br />1. TYPE OF PERMIT <br />- <br /> 1 <br />1 NEW PIT(S) <br /> PIT <br />S <br />EX <br /> ( <br />) <br />IST, CONSTRUCTED AFTER DEC. 31, 1980 <br />2. APPLICANT INFORMATION <br /> NAME(S) Duckels Construction, dba Yampa Aggregates <br /> Mailing Address 3500 Duckels Ct. <br /> City, St Zip Steamboat Springs, CO 80487 <br /> Phone (97O ) 879-6072 <br />3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than #2) <br /> NAME(S) H.Bruce Humphries, Regulatory Permits Management, Inc. PIT NAME Hogue River Pit <br /> Mailing Address 7425 winter Berry Ian. <br /> <br />Castle Rock, CO 80108 <br />City, St Zip <br />DMG NO. M1992-066 <br /> Phone( 303 ) 854-7499 <br />4. GENERAL LOCATION OF PIT(S): COUNTY Routt <br /> NW 1/4 Ns 1/4, Sec. 9 Twp. 6 1fl N. ? S., Range 85 ? E_ a W. 6th P.M. <br />5. Estimated maximum water surface to be exposed: 43 - 5 Acres. Number of Pits one <br /> Estimated depth of pit(s) 47 Ft Estimated depth to groundwater 3 Ft <br /> Estimated date to expose groundwater Existing mining operat: complete mining 2020 <br />8. ATTACHMENTS: (Check which have been attached.) <br /> (a) x Scaled map of pit area with range, township, & section dearly identified (REQUIRED). <br /> b <br />? <br /> ( <br />) <br />Copy of the reclamation permit, if applicable. <br /> (c) ? Copy of pre 1/15/89 water conservancy dist or water user assoc. augmentation agreement, if applicable. <br /> (d) ? Copy of proposed substitute water plan or augmentation plan application, if applicable. <br /> (e) ? Copy of court approved augmentation <br />lan <br />if a <br />licabl <br />C <br />N <br /> p <br />, <br />pp <br />e. <br />ase <br />o. <br />R <br /> supportive material Note: No significant change to the approved DBMS reclamation pI <br />9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of <br /> diversion of any water withdrawn from the pond. <br /> Please see attached material <br /> <br /> <br /> <br />10. 1(we) have read the statements made herein and know the contents thereof, and that they are true to my (our) <br /> knowledge. [Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury <br /> in the second degree and is punishable as a class 1 misdemeanor.] <br />Name/Tide (Please type or print) Signature Date <br />Fred Duckels, President <br />*Office Use only <br />Court Case No. Div. Co. WD Basin MD Use