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Form No. COLORADO DIVISION OF WATER RESOURCES For Office Use only <br />GWS-27 DEPARTMENT OF NATURAL RESOURCE <br />6(2006 1313 Shemran St, Rm 818, Denver, Colorado 80203 <br />Phone: (303) 866-3581 <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />GAVEL PIT WELL PERMIT APPLICATION <br />O--PEWIT RECEiVEG? <br />1 . TYPE F <br />t_1 NEW PIT(s) MAR 2011 <br />El PIT(S) EXIST, CONSTRUCTED AFTER DEC 31, 1980 WATER RESOURCES <br />TATCo ptSEER <br />2. APPLICANT INFORMATION <br />NAME(S) Duckels Construction, dba Yampa Aggregates <br />3500 Duclcels Ct. RECEIV50 <br />Mailing Address <br />City, St zip Steamboat Springs, CO 80487 A, R 0 y 7 2 h <br />U 11 <br />Phone ( 970 ) 879-6072 Divfslon or Reclamation, <br />3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than #2) E Y <br />NAME(S) H.Bruce Humphries, Regulatory Permits Mansgement Inc. PD NAME <br />Hogue River Pit <br />Matting Add(es.S 7425 winter Berry Ln. <br />TP Castle Rock, CO 80108 DMG NO. X992'066 <br />city, St -- 1 <br />Phone( 303 ) 854-7499 <br />4. GENERAL LOCATION OF PIT(S)- COUNTY Routt <br />NW NE <br />1/4 114, Secj 9 Twp. 6 rj N. ? S., Range s5 ? E - LE!J W. 6th P-M. <br />5. Estimated maXtmum water Surface to be eqX)Sed: 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 aperat . imp <br />eqe waning 2020 <br />8- ATTACH MENTS: (Check which have been attached.) <br />(a) ? Scaled map of pit area with range, township, & section dearly identified (REQUIRED). <br />(b) Copy of the reclamation permit, if applicable. <br />(c) Copy of pre 1115/89 water conservancy disc or water user assoc <br />? augmentation agreement if applicable. <br />(d) <br />SPY of proposed substitute water plan or augmentation plan appiication, if appricable. <br />(e) ? Copy of court approved augmentation plan, if aPPI <br />icable. Case No. <br />x <br />{f) 0thef Supportive material Note: No significant change to the approved DRMS reclamation pl <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diversion of any Water withdrawn from the pond.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 />10. I (we) have read the sCabelnents made herein and know the contents thwwf, and .. y.. .........,..~ ? V Y , <br />y <br />knowledge- [Pursuant to Section 24-4-104 (13)(a) C_RS-, the malting of false ? r lutes perjury <br />y <br />to the second degree and is punishable as a class 1 misdemeanors CHECK <br />Narne/Titie (Please type or p" Signature 1. UU2579 <br />Fred Duckels, President as Amount: $100.00 <br />office use only- Z-- <br />Court Case No. Div. Co. WD Basin MD Use