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OFFICE OF THE STATE ENGINEER -- <br />OMSION OF WATER RESOURCES <br />303-866 -3681 1 JUL 08 2010 <br />DAM NAME <br />NOTICE OF INTENT TO CONSTRUCT A NON-JURISDICTIONAL <br />WATER IMPOUNDMENT STRUCTURE' <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 45 days prior to construction. <br />(PLEASE PRINT OR TYPE NOTICE) <br />OWNER INFORMATION <br />Name: Da and Terri Andrews Telephone: ( 970 ) 3274504 <br />Address: P.O. Box 523 Norwood CO 81423 <br />Street / P.O. Box/ Rural Route CRY State Zip Code <br />Responsible Person: David Andrews <br />Telephone: ( 970 ) <br />327-4504 <br />Address: P.O. Box 523 <br />Norwood <br />CO <br />81423 <br />Street / P.O. Box/ Rural Route <br />City <br />State <br />Zip Code <br />Contractor: N/A Telephone: ( 1 WA <br />STRUCTURE INFORMATION <br />Name of Dam: Pond B Water Division 4 Water District: 60 <br />NE /. of [he NW Y. Sect. 33 , Township: 46N Range 15W N .M. P.M. <br />•LOcehgn 1 Distance o1 dam from Section lines 720 ft from v�N S, 1650 ft from E 'W <br />.Option 1 <br />OR Utilizing GPS: Set to UTM Datum. Measured on crest of dam above streamline /outlet. <br />.Option 2� Nothing �caai39' - rh.. Easting lloaso rn <br />Note GPS seliings must be NA083 CONUS. , <br />Dam Dimensions. Vertical Height 3 : 10 ft., Length. 160 ft., Slopes. U /S: 4 H:W, D/S 5 HAV <br />Reservoir: Surface Area': 1.0 acres, Capacity ': 8.5 acre feet, Drainage Area: 360 acres <br />Emergency Spillway: Width: 12 ft., Side Slopes: 2 HAV, Freeboard 2-5 ft <br />Outlet Drain: Type: PVC Pipe Size: 6 inches, Location: V above pond bottom <br />Stream Name or Water Source Unnamed drainage tributary to Naturita Creek <br />Proposed Water Use Stock Watedn Water o rt C N applicable) N/A <br />I-ZA C9. V)r ntt;l '/, l�_ <br />A - �uemaioal Sl—a enecram«e«imamwnar wana apvily a r a2o.uee «ror mw. camel"M <br />• Woo. 3) of m Iwl or I... <br />Pb ®a em evmWon me si&(or page 2) of Mrs form. <br />Yerwil n a tm .,g. Irom ggaevapm aIM b.ml ppM ft reWre lfurl«aaIlq O�.aM vMeie1M pas a«un �qNe bryNWrel ma«Cm atlp Ean <br />up w gn cm) )he emeroe«.r eWr«+r sue cram. <br />5 'Fte.Emrtl' b )M vernal aisfarce rmm nn Eollom a eplN,vey rotlro vul aue tlem. <br />rmf9noronInremrWriaemeplsg o&,m «,avtl pemWNmpuhed(wetl Pe�n�r apnk�em m'i!. rauMaxwx.walx.al0e.m.uY <br />puENan®.®pl <br /> J� <br />DMSION ENGINEER'S REQUIREMENTS, <br />