Free GWS-27, GRAVEL PIT WELL PERMIT APPLICATION - Colorado

Form No. GWS-27 6/2006

COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES
1313 Sherman St., Rm 818, Denver, Colorado 80203 Phone: (303) 866-3581

For Office Use only

REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM

GRAVEL PIT WELL PERMIT APPLICATION
1. TYPE OF PERMIT NEW PIT(S) PIT(S) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 2. APPLICANT INFORMATION NAME(S) ________________________________________________________ Mailing Address ___________________________________________________ City, St. Zip ______________________________________________________ Phone (_________)________________________________________________ 3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (If different than #2) NAME(S) ________________________________________________________ Mailing Address ___________________________________________________ City, St. Zip ______________________________________________________ Phone (_________)________________________________________________ 4. GENERAL LOCATION OF PIT(S): COUNTY____________________________ _______1/4 _______1/4, Sec._______ Twp.________ 5. 6. 7. 8. N. S., Range________ E. W. ______P.M.

PIT NAME ___________________ DMG NO. ____________________

Estimated maximum water surface to be exposed: ______________ Acres.

Number of Pits _____________.

Estimated depth of pit(s)___________Ft. Estimated depth to groundwater _____________Ft. Estimated date to expose groundwater ________________________; to complete mining _________________________. ATTACHMENTS: (Check which have been attached.) (a) (b) (c) (d) (e) (f) 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. ______________________ 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use, other than evaporation, and method of diversion, rate of diversion, and annual amount of diversion of any water withdrawn from the pond. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

10.

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.] Name/Title (Please type or print) Signature Date

For Office Use only

Court Case No.

Div.

Co.

WD

Basin

MD

Use ______

COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES

GWS-27 INST (6/2006)

GRAVEL PIT WELL PERMIT APPLICATION - INSTRUCTIONS
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 DMG permit area. Checks should be payable to the COLORADO DIVISION OF WATER RESOURCES. 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. Applications must be completed clearly, and legibly in BLACK INK or typed. ALL ITEMS in the application must be completed. Incomplete applications may be returned for more information. Do not change or alter the application in any way. Attach additional sheets if more space is needed. ITEM 1 ITEM 2 TYPE OF PERMIT - Check the appropriate box. APPLICANT INFORMATION - This is the applicant's 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 DMG number (include any prior DMG/MLRD permit numbers that may be assoicated with this pit. ITEM 4 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 DMG 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. SIGNATURE - An ORIGINAL signature must be on each application. The individual signing the application must be the applicant, or an officer of the company identified as the applicant. Clearly print the name, and title, of the person signing the application and include the date. The applicant's authorized agent may sign the application, if a letter signed by the applicant is submitted with the application authorizing them to act as agent for the purpose of obtaining a well permit.

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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 (970-9455665), Steamboat Springs (970-879-0272), or Durango (970-247-1845). COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, ROOM 821, DENVER, CO 80203
PHONE 303-866-3587 (Information), 303-866-3581 (Main), 303-866-3447 (Well & Water Rights Records), 303-866-3589 (Fax)