2012-11-02_REVISION - M1984094 (3)

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COLORADO DIVISION OF WATER RESOURCES GWS -27 INST (5/2012) DEPARTMENT OF NATURAL RESOURCES GRAVEL PIT WELL PERMIT APPLICATION - INSTRUCTIONS Applications must be computer generated online, typewritten, or printed in BLACK or BLUE INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned for more information. Attach additional sheets if more space is needed. If filinq online see online filinq instructions! You may also print, scan and email the completed form to: dwrpermitsonlineAstate.co.us This applications is for use in applying for a well permit for a gravel pit that exposes groundwater to evaporation as required under the provision of 37 -90- 107(6) or 37 -90- 137(11), C.R.S. If this is not such a gravel pit, use General Purpose Application Form GWS -45. A permit is not required if the pit was constructed prior to December 31, 1980 and has not been operated or reactivated after that date. FEES A $100 non - refundable filing fee is required. One application is required for each DRMS permit area. Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources. Payment by Visa, MasterCard or Discover cards can be accepted by phone through the Records Office at 303.866.3581. A substitute supply plan or augmentation plan may be required for approval where groundwater was exposed after December 31, 1980. These plans are submitted separately and a filing fee of $1,593.00 is required. These plans may not be needed in areas where water is available and all other water rights are satisfied. ITEM 1 ITEM 2 ITEM 3 ITEM 4 ITEM 5 ITEM 6 ITEM 7 ITEM 8 ITEM 9 ITEM 10 TYPE OF PERMIT - Check the appropriate box. APPLICANT INFORMATION - This is the applicants name and the mailing address where all correspondence will be sent. Include the phone number. CONSULTANT /ATTORNEY /OPERATOR CONTACT - If there is someone different than the applicant to be contacted for additional information, then complete this item. Indicate the name of the gravel pit and the assigned DRMS number (include any prior DRMS /MLRD permit numbers that may be assoicated with this pit. LOCATION OF WELL - The general location of the well (pit) must be indicated and include a quarter /quarter, Section, Township, Range and Principal Meridian. An outline of the pit(s) on a USGS 7 1/2 minute quadrangle map is desirable. Indicate the maximum number of acres of groundwater to be exposed to the atmosphere and the total number of excavated areas (pits) covered within the DRMS permit. Indicate the estimated proposed or actual depth of the pit(s), and estimated depth to groundwater. Indicate the estimated dates of beginning to expose groundwater and completing the mining. ATTACHMENTS - The list of attachments to this application provides information which is necessary to the evaluation. A scaled map of the pit area tied to a section corner is required. USE - Complete this item if water is to be used for any purpose other than evaporation, those uses must be detailed. The information required includes but is not limited to the volume of gravel mined, the method of diversion of water from the pit, the pumping rate in gallon per minute, the average annual amount of water diverted or used in acre -feet, and the proposed use. DEWATERING — Specify whether dewatering will occur within the DRMS permit boundary. ITEM 11 SIGNATURE - The individual signing the application or entering their name (and title if applicable) must be the applicant or an officer of the corporation /company /agency identified as the applicant or their attorney. An authorized agent may also sign or enter their name on the application if a letter signed by the applicant or their attorney is submitted with the application authorizing that agent to sign or enter their name on the applicant's behalf. Payment must be received via phone if filing online at 303.866.3581 (Records Office) prior to processing the application. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk (303- 866 - 3587), or the nearest Division of Water Resource Field Office located in Greeley (970- 352 - 8712), Pueblo (719- 542 - 3368), Alamosa (719- 589 - 6683), Montrose (970- 249 - 6622), Glenwood Springs (970 -945- 5665), Steamboat Springs (970- 879 - 0272), or Durango (970- 247 - 1845). COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, STE 821, DENVER, CO 80203 (Main) 303 - 866 -3581, (Fax) 303 -866 -2223