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Form No. <br />GWS -27 <br />6/2006 <br />COLORADO DIVISION OF WATER RESOURCES <br />DEPARTMENT OF NATURAL RESOURCES <br />1313 Sherman St., Rm 818, Denver, Colorado 80203 <br />Phone: (303) 866 -3581 <br />For Office Use only <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />GRAVEL PIT WELL PERMIT APPLICATION <br />1. <br />TYPE OF PERMIT <br />❑ <br />✓ <br />NEW PIT(S) <br />PIT(S) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 <br />2. <br />APPLICANT INFORMATION <br />NAME(S) Climax Molybdenum Company - Henderson Operations (c/o Bryce Romig) <br />Mailing Address 19302 County Road 3 <br />City, St. Zip Parshall CO 80468 <br />Phone ( 303 ) 569 -3221 <br />3. <br />CONSULTANT /ATTORNEY /OPERATOR CONTACT (If different than #2) <br />PIT NAME Henderson Mill Gravel Pit <br />NAME(S) Steven M. Maly, W. W. Wheeler & Associates, Inc. <br />DMG NO M -77 -342 <br />Mailing Address 3700 South Inca Street <br />City, St. Zip Englewood CO 80110 <br />Phone ( 303 ) 7614130 <br />4. <br />GENERAL LOCATION OF PIT(S): COUNTY Grand <br />NW 1/4 SE 1/4, Sec. 14 Twp. 2 ❑ N. <br />✓ <br />S., Range 78 ❑ E. <br />✓ <br />W. 6 P.M. <br />5. <br />Estimated maximum water surface to be exposed: 3 Acres. Number of Pits 1 . <br />6. <br />Estimated depth of pit(s) 28 Ft. Estimated depth to groundwater 23 Ft. <br />7. <br />Estimated date to expose groundwater Already Exposed • to complete mining unknown <br />8. <br />ATTACHMENTS: (Check which have been attached.) <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />✓ <br />✓ <br />❑ <br />❑ <br />❑ <br />Scaled map of pit area with range, township, & section clearly identified (REQUIRED). <br />Copy of the reclamation permit, if applicable. <br />Copy of pre 1/15/89 water conservancy dist. or water user assoc. augmentation agreement, if applicable. <br />Copy of proposed substitute water plan or augmentation plan application, if applicable. <br />Copy of court approved augmentation plan, if applicable. Case No. <br />(f) <br />✓ <br />Other Owner letter authorizing undersigned. Pre - 1981 map of the pit area. , <br />9. <br />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diversion of any water withdrawn from the pond.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 />There am no plans to davalnp the pit halnw the water tahlejn tha firtura <br />10. <br />I (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/Title (Please type or print) <br />Steven M. Maly/ Consultant <br />Signature <br />Date <br />9/30/a <br />For Office Use only <br />Court Case No. Div. Co. WD Basin MD Use <br />_ _ <br />