2012-11-02_REVISION - M1984094 ‎(3)‎

• Permit No: M1984094
• IBM Index Class Name: REVISION
• Doc Date: 11/2/2012
• Doc Name: Submittal
• From: Greg Lewicki And Associates, PLLC
• To: DRMS
• Type & Sequence: TR1
• Media Type: D
• Archive: No

Form No.
GWS -27
5/2012
COLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 Sherman St., Ste 821, Denver, Colorado 80203
Phone: [phone] Fax: [phone]
DWR Web: www water state co.us Email: dwr•ermitsonline • state co.us
For Office Use only
REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM
GRAVEL PIT WELL PERMIT APPLICATION
1.
TYPE OF PERMIT
n
•
NEW PIT(S)
PIT(S) EXIST, CONSTRUCTED AFTER DEC. 31, 1980
2.
APPLICANT INFORMATION
NAMES) Sanborn Sand and Gravel dba Golden Cross Aggregate
Mailing Address PO Box 1180
City, St. Zip Alma CO 80420
Phone (w/ area code) 970 389 -7056 Email: blackcrosstruckinginc @yahoo.cemt
3.
CONSULTANT /ATTORNEY /OPERATOR CONTACT (If different than #2)
PIT NAME Gloria Z Pit
NAME(S) Greg Lewicki
DRMS NO. M- 1984 -094
Mailing Address 11541 Warrington Court
City, St. Zip Parker CO
Phone (w\ area code)303 3 - Email: greg @lewicki.biz
4.
GENERAL LOCATION OF PIT(S): COUNTY Park
SE 1/4 SW 1/4, Sec. 22 Twp. 9 'l
N
S , Range 77
I
E
r
I
W. 6th P.M.
5.
Estimated maximum water surface to be exposed: 1.37 Acres. Number of Pits and ponds =3 ,
6.
Estimated depth of pit(s) 68 Ft. Estimated depth to groundwater 20 Ft.
7.
Estimated date to expose groundwater 10/31/2012 ; date to complete mining 10/31/2032
8.
ATTACHMENTS: (Check which have been attached.)
(a)
(b)
(c)
(d)
(e)
' -
.
❑
❑
❑
1 Scaled map of pit area with range, township, & section clearly identified (REQUIRED).
Copy of the reclamation permit, if applicable.
Copy of pre 1/15/89 water conservancy dist. or water user assoc. augmentation agreement, if applicable.
Copy of proposed substitute water plan or augmentation plan application, if applicable.
Copy of court approved augmentation plan, if applicable. Case No.
(f) ❑ Other
9.
Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of
diversion of any water withdrawn from the pond.
See attached sheet.
10.
Will dewatering occur within the DRMS permit boundary F Yes 7 No
11.
I (we) have read the statements made herein and know the contents thereof, and that they are true to my (our)
knowledge. [Pursuant to Section 24-4 -104 (13)(a) C.R.S., the making of false statements herein constitutes perjury
in the second degree and is punishable as a class 1 misdemeanor.]
Sign or enter arne(s) of s ter .
'
If signing print name & title
Greg Lewicki
Date (mm /dd /yyyy)
10/31/2012
For Office Use only
Court Case No. Div. Co. WD Basin MD Use