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2013-07-19_PERMIT FILE - C2010089A
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2013-07-19_PERMIT FILE - C2010089A
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Entry Properties
Last modified
8/24/2016 5:22:40 PM
Creation date
8/8/2013 2:02:47 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C2010089A
IBM Index Class Name
Permit File
Doc Date
7/19/2013
Doc Name
Approved Well Permits
Section_Exhibit Name
Appendix 2.05.6(3)-4
Media Type
D
Archive
Yes
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COLORADO DIVISION OF WATER RESOURCES <br />DEPARTMENT OF NATURAL RESOURCES <br />1313 SHERMAN ST, RM 821, DENVER, CO 80203 <br />Main: (303) 866 -3581 Fax: (303) 866 -2223 wrpermitsonline(cDstate Co t <br />GENERAL PURPOSE <br />Water Well Permit Application <br />Review instructions on reverse side prior to completing form. <br />The form must be computer generated, typed or in black or blue ink. <br />1. Applicant Information <br />Name of applicant <br />Western - Fuels- Colorado, LLC <br />Mailing address - <br />P.O. Box 33424 <br />City _._. State Zlp code — <br />Denver CO 180233 <br />Telephone # (area code 8 number) E -mail (online filing required) <br />(303) 255 -5800 <br />2. Type Of Application (check applicable boxes) <br />M1 Construct new well ❑ Use existing well <br />❑ Replace existing well ❑ Change or increase use <br />❑ Change source (aquifer) ❑ Reapplication (expired permit) <br />❑ COGCC Well Other: <br />3. Refer To (if applicable) <br />Well permit q Water Court case #- <br />N/A N/A <br />_..__ - -- <br />Designated Basin Dotemunalan # Well name or Al <br />DW12 -3 <br />4. Location Of Proposed Well <br />County <br />Montrose SW 1/4 of the SW 114 <br />Section Township -N or S — Range E or W T_kndpal Menckan <br />2547 I i"I 116 11 E j N.M. <br />Distance of well from section lne fines are typically ot <br />property lines) <br />1016 Ft. from F N J S 1312 Ft. from(❑ E LjW <br />_....._ - -- _ -- - -- <br />For replacement wells only - distance and direction from old well to new well —' - <br />feet direction <br />Well location address (Include Cily, State, Zip) F-1 Check if well address is same as in Item L <br />Optional., GPS well location information in UTM format You must check GPS unit for <br />required settings as follows: <br />T Zone 12 or[rj Zone 13 I Easting <br />Units must be Meters <br />Datum must be NAD83 Northing <br />Unit must be set to true north <br />Was GPS unit checked for above? ❑ YES Remember to set Datum to NAD83 <br />5. Parcel On Which Well Will Be Located <br />(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL <br />A. Legal Description (may be provided as an attachment) <br />West 1/2 of Section 25, Township 47 North, <br />Range 16 West of the N.M. P.M. <br />B. # of acres in parcel C. Owner <br />320 1 See Attachment A <br />D. Will this be the orgy well on this parcel? E] YES NO (If no list other wells) <br />Others wells operated under Case Nos. 10CW208 and <br />09CW171 and related SWSPs. <br />E. state Parcel ID# (optlarral): <br />Office Use Only I Form GWS -45 (0412012) <br />6. Use Of Well (check applicable boxes) <br />Attach a detailed description of uses applied for. <br />® Industrial © Dewatering System <br />❑ Municipal ❑ Geothermal (production or reinjection) <br />❑ Irrigation N Other (describe): Dust suppression <br />❑ Commercial <br />7. Well Data (proposed) <br />. _ m <br />Maximum pumping rare ; Annual aocnt to be withdrawn _.._ -___ -_ <br />(In combination w/ 9pm ; <br />DW12 -1 & DW12_2)__ 800 ; See Attachment B acre -feet <br />Total depth - . —.j- .Aquifer_..,...- .__.__._._... .. - <br />85 feet lBedrock /Coal <br />8. Land On Which Ground Water Will Be Used <br />Legal Description of Land (may be provided as an attachment): <br />West 1/2 of Section 25, Township 47 North, Range 16 West <br />of the N.M. P.M. <br />(If used for crop Irngabon, attach a- map that shows irrigated area.) <br />A. # Acres _ . B Owner <br />320 See Attachment A <br />C. List any other wells or water rights used on VU land: <br />Others wells and water rights operated under Case Nos. <br />10CW208 and 09CW171 and related SWSPs. <br />9. Proposed Well Driller License #(optional): <br />10. Sign or Entered Name Of Applicant(s) Or Authorized Agent <br />The making of false statements herein constitutes perjury in the second <br />degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. <br />24 -4 -104 (13)(a). I have read the statements herein, know the contents <br />there an state that they are true to my knowledge. _ <br />Sign a ems of perso submitting application Daie (exNddtyyyy) <br />If signing print n and title <br />e,-Iat 1+,,44 <br />map name I DWR map no. <br />Receipt area only <br />AQUAMAP <br />WE <br />WR <br />CWCB <br />TOPO <br />MYLAR <br />SB5 DN _ WD _ BA MD <br />
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