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Home My WebLink About1.16 Water Lease & Well Permit ApplicationsWEST DIVIDE WATER CONSERVANCY DISTRICT APPLICATION TO LEASE WATER 818 Taughenbaugh Blvd. #101, P. O. Box 1478, Rifle, CO 81650 970-625-5461 water@wdwcd.org 1. APPLICANT INFORMATION Name: _____________________________________________________ Mailing address: _____________________________________________ ___________________________________________________________ Telephone: _________________________________________________ Email: _____________________________________________________ Authorized agent:____________________________________________ 2.COURT CASE #s: Decree Case No. ________________________ Augmentation Plan Case No. ________________________________ 3. USE OF WATER RESIDENTIAL Number of main residences: _______ No. ADU’s _______ Subdivision: No. constructed units: No. vacant lots _____ Home garden/lawn irrigation of total sq. ft. Method of irrigation: flood____ sprinkler____ other____ Non-commercial animal watering of animals Fire Protection ____ Evaporation: Maximum water surface to be exposed: __________ 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use, other than evaporation, and method of diversion, rate of diversion, and annual amount of diversion of any water withdrawn from the pond: _________________________________ __________________________________________________________ ___________________________________________________________ Well Sharing Agreement for multiple owner wells must be submitted. If greater than two owners, application must be made under a homeowners association. COMMERCIAL Number of units: Total sq. ft. of commercial units: ________ Description of use: ___________________________________________ ___________________________________________________________ ___________________________________________________________ INDUSTRIAL Description of use: ___________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Evaporation: Maximum water surface to be exposed:________________ 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use, other than evaporation, and method of diversion, rate of diversion, and annual amount of diversion of any water withdrawn from the pond: _______________________________________________ ___________________________________________________________ DIRECT PUMPING Tributary: __________________________________________________ Location: ___________________________________________________ ___________________________________________________________ 4. SOURCE OF WATER Structure: Structure Name: ______________________ Source: surface____ storage____ ground water____ Current Permit # __________________________________ (attach copy) 5. LOCATION OF STRUCTURE ___________________________________________________________________ County Quarter/quarter Quarter ___________________________________________________________ Section Township Range P. M. Distance of well from section lines: ____________________________________________________________ __________________________________________________________ Elevation: _______________________ Well location address: _________________________________________ ___________________________________________________________ (Attach additional pages for multiple structures) 6. LAND ON WHICH WATER WILL BE USED (Legal description may be provided as an attachment.) ____________________________________________________________ __________________________________________________________ Number of acres in tract:____________________ Inclusion into the District, at Applicant's expense, may be required. 7.TYPE OF SEWAGE SYSTEM Septic tank/absorption leach field____ Central System____ Other___ District name: _______________________________________________ 8. VOLUME OF LEASED WATER NEEDED IN ACRE FEET: (minimum of 1 acre foot except augmentation from Alsbury Reservoir where a lesser amount is allowed) Provide engineering data to support volume of water requested. Commercial, municipal, and industrial users must provide diversion and consumptive data on a monthly basis. A totalizing flow meter with remote readout is required to be installed and usage reported to West Divide. Applicant expressly acknowledges it has had the opportunity to review the District's form Water Allotment Contract and agrees this application is made pursuant and subject to the terms and conditions contained therein. ___________________________________________________________ Applicant Signature ___________________________________________________________ Applicant Signature Application Date:____________________________ ISSUED AS AREA B CONTRACT _______YES ________NO Printed portions of this form, except differentiated additions or deletions, have been approved and adopted by the West Divide Water Conservancy District. Form : WDWCD 2014 APPLICATION 6th EXHIBIT A THE SURFACE ESTATE ONLY OF THE FOLLOWING DESCRIBED PARCELS: A tract of land situated in Section 18, Township 6 South, Range 92 West of the 6th P.M. being more particularly described as follows: Beginning at a point whence the Southeast Comer of said Section 18 bears South 18° 48' 43" East 2736.17 feet; thence North 73° 57' 56" West 84.78 feet; thence South 82° 36' 32" West 46.72 feet; thence South 58° 04' 05" West 135.69 feet; thence South 74° 39' 03" West 73.66 feet; thence North 80° 55' 21" West 78.00 feet; thence North 68° 38' 29" West 108.08 feet; thence North 68° 53' 03" West 71.82 feet; thence South 89° 30' 19" West 79.15 feet; thence South 72° 51' 07" West 70.62 feet; thence South 58° 03' 49" West 148.75 feet; thence South 46° 15' 00" West 56.32 feet; thence South 41° 58' 31" West 98.48 feet; thence South 54° 42' 50" West 125.13 feet; thence South 75° 59' 58" West 43.68 feet; thence South 81° 24' 12" West 39.30 feet to the North right of way of County Road 315; thence along said right of way and along a non- tangent curve to the right with an arc length of 307.60 feet, a radius of 783.33 feet, a central angle of 22° 29' 57'', a chord bearing of North 52° 16' 12" West, a chord length of 305.63 feet; thence North 41° 01' 13" West 536.04 feet; thence along a curve to the left with an arc length of 127.44 feet, a radius of 1789.03 feet, a central angle of 04° 04' 53", a chord bearing of North 43° 03' 40" West, a chord length of 127.41 feet to a point on the North-South centerline of said Section 18; thence North 00° 21' 29" West 902.06 feet to the Northwest Corner of the SW ¼ NE ¼ of said Section 18; thence North 89° 20' 17" East 447.79 feet along the North line of said SW ¼ NE ¼; thence South 46° 24' 49" East 1877.41 feet to the POINT OF BEGINNING, County of Garfield, State of Colorado, TOGETHER WITH WELL PARCEL A tract of land situated in Section 18, Township 6 South, Range 92 West of the 6th P.M. being more particularly described as follows: Beginning at a point whence the Southeast Comer of said Section 18 bears South 22° 24' 40" East 3116.54 feet said POINT OF BEGINNING; thence along said boundary line North 46° 24' 49" West 30.00 feet; thence departing said boundary line North 43° 35' 11" East 87.60 feet; thence South 46° 24' 49" East 30.00 feet; thence South 43° 35' 11" West 87.60 feet to the POINT OF BEGINNING, County of Garfield, State of Colorado. COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 821, DENVER, CO 80203 Main: (303) 866-3581 Fax: (303) 866-2223 dwrpermitsonline@state.co.us GENERAL PURPOSE Water Well Permit Application Review instructions on reverse side prior to completing form. The form must be computer generated, typed or in black or blue ink. 1. Applicant Information Name of applicant Mailing address City State Zip code Telephone # (area code & number) E-mail (online filing required) 2. Type Of Application (check applicable boxes) Construct new well Use existing well Replace existing well Change or increase use Change source (aquifer) Reapplication (expired permit) COGCC Well Other: ________________ 3. Refer To (if applicable) Well permit # Water Court case # Designated Basin Determination # Well name or # 4. Location Of Proposed Well County 1/4 of the 1/4 Section Township N or S Range E or W Principal Meridian Distance of well from section lines (section lines are typically not property lines) Ft. from N S Ft. from E W For replacement wells only – distance and direction from old well to new well feet direction Well location address (Include City, State, Zip) Check if well address is same as in Item 1. Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows: Format must be UTM Easting Northing Remember to set Datum to NAD83 Zone 12 or Zone 13 Units must be Meters Datum must be NAD83 Unit must be set to true north Was GPS unit checked for above? YES 5. Parcel On Which Well Will Be Located (PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description (may be provided as an attachment): B. # of acres in parcel C. Owner D. Will this be the only well on this parcel? YES NO (if no list other wells) E. State Parcel ID# (optional): Office Use Only 6. Use Of Well (check applicable boxes) Attach a detailed description of uses applied for. Industrial Municipal Irrigation Commercial Dewatering System Geothermal (production or reinjection Other (describe): ______________________ 7. Well Data (proposed) Maximum pumping rate gpm Annual amount to be withdrawn acre-feet Total depth feet Aquifer 8. Land On Which Ground Water Will Be Used Legal Description of Land (may be provided as an attachment): (If used for crop irrigation, attach a scaled map that shows irrigated area.) A. # Acres B. Owner C. List any other wells or water rights used on this land: 9. Proposed Well Driller License #(optional): 10. Sign or Entered Name Of Applicant(s) Or Authorized Agent The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Sign or enter name(s) of person(s) submitting application Date (mm/dd/yyyy) If signing print name and title Office Use Only USGS map name DWR map no. Surface elev. AQUAMAP Receipt area only WE WR CWCB TOPO MYLAR SB5 DIV _____ WD _____ BA _____ MD _____ Form GWS-45 (07/2013) COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST (07/2013) DEPARTMENT OF NATURAL RESOURCES GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS Applications must be computer generated on-line, typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned to the applicant for more information. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the original form. If filing online see online filing instructions! You may also save, print, scan and email the completed form to: dwrpermitsonline@state.co.us For further information please visit www.water.state.co.us FEES : This application must be submitted with a $100 filing fee. Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources. Visa, MasterCard or Discover are accepted by phone through our Records Section at 303.866.3581. Fees are nonrefundable. USES : This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot, geothermal (see Geothermal Rules for fee requirements), recovery wells, and other uses not otherwise noted in the following list: RESIDENTIAL use wells – Use of form GWS-44 is required LIVESTOCK watering on a farm, ranch, range or pasture (not feedlots) – Use form GWS-44 MONITORING/OBSERVATION wells – Use form GWS-46 GRAVEL PITS – Use form GWS-27 REGISTRATION of an existing well – Use form GWS-12 (must have been in use prior to May 8, 1972) GEOEXCHANGE SYSTEM LOOP FIELDS – Use form GWS-72 REPLACEMENTS OF WELLS FOR THE ABOVE USES ITEM INSTRUCTIONS : (numbers correspond with those on the front of this form) 1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be sent. 2. Check all boxes that apply. 3. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of water right, the case number or determination number must be indicated. If applying to replace or change the use of an existing well, the permit number of the existing well must be indicated. 4. The county, ¼ of the ¼ section designation, section #, township, range, principal meridian, and distances from section lines for the proposed well must be provided. (An option to providing distances from section lines and the ¼ of the ¼ section designation is to provide an accurate GPS location in UTM format. The required GPS unit settings must be as indicated on this form.) Colorado contains two (2) UTM zones. Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 108th Meridian (longitude). West of the 108th Meridian is UTM Zone 12 and east of the 108th Meridian is UTM Zone 13. The 108th Meridian is approximately 57 miles east of the Colorado-Utah state line. On most GPS units, the UTM zone is given as part of the Easting measurement, e.g. 12T0123456. Check the appropriate box for the zone. Provide the property address of the well location if one exists. If it is the same as the mailing address, check the box next to the well location address. 5. Please attach a current deed for the subject parcel. Complete all boxes and provide a complete legal description of the parcel of land on which the well will be located. If filing online please see online filing instructions for how to submit deed and or legal description attachments. 6. Check all boxes that apply and attach a detailed description of the uses applied for. 7. Complete all boxes. 8. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation is a proposed use, provide a map of the land area with proposed irrigated areas accurately drawn, including section numbers and section lines. A list of all other wells or water rights used on the described land must be provided. 9. The well must be constructed by a Colorado licensed well driller, an authorized individual in accordance with the Water Well Construction Rules, 2 CCR 402-2, or under the “private driller” provision as defined in CRS 37-91-102(12). A listing of licensed well drillers/pump installers is available at: http://water.state.co.us/groundwater/BOE/Pages/LicensedContractors.aspx 10. The individual signing the application or entering their name and title 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 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. If you filled the form out on-line you may save or print, sign, scan and email the form to the Division of Water Resources. Payment must be received via phone, fax or mail 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 Resources 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), or refer to our web site at http://www.water.state.co.us for general information, additional forms, and access to state rules or statutes. EXHIBIT A THE SURFACE ESTATE ONLY OF THE FOLLOWING DESCRIBED PARCELS: A tract of land situated in Section 18, Township 6 South, Range 92 West of the 6th P.M. being more particularly described as follows: Beginning at a point whence the Southeast Comer of said Section 18 bears South 18° 48' 43" East 2736.17 feet; thence North 73° 57' 56" West 84.78 feet; thence South 82° 36' 32" West 46.72 feet; thence South 58° 04' 05" West 135.69 feet; thence South 74° 39' 03" West 73.66 feet; thence North 80° 55' 21" West 78.00 feet; thence North 68° 38' 29" West 108.08 feet; thence North 68° 53' 03" West 71.82 feet; thence South 89° 30' 19" West 79.15 feet; thence South 72° 51' 07" West 70.62 feet; thence South 58° 03' 49" West 148.75 feet; thence South 46° 15' 00" West 56.32 feet; thence South 41° 58' 31" West 98.48 feet; thence South 54° 42' 50" West 125.13 feet; thence South 75° 59' 58" West 43.68 feet; thence South 81° 24' 12" West 39.30 feet to the North right of way of County Road 315; thence along said right of way and along a non- tangent curve to the right with an arc length of 307.60 feet, a radius of 783.33 feet, a central angle of 22° 29' 57'', a chord bearing of North 52° 16' 12" West, a chord length of 305.63 feet; thence North 41° 01' 13" West 536.04 feet; thence along a curve to the left with an arc length of 127.44 feet, a radius of 1789.03 feet, a central angle of 04° 04' 53", a chord bearing of North 43° 03' 40" West, a chord length of 127.41 feet to a point on the North-South centerline of said Section 18; thence North 00° 21' 29" West 902.06 feet to the Northwest Corner of the SW ¼ NE ¼ of said Section 18; thence North 89° 20' 17" East 447.79 feet along the North line of said SW ¼ NE ¼; thence South 46° 24' 49" East 1877.41 feet to the POINT OF BEGINNING, County of Garfield, State of Colorado, TOGETHER WITH WELL PARCEL A tract of land situated in Section 18, Township 6 South, Range 92 West of the 6th P.M. being more particularly described as follows: Beginning at a point whence the Southeast Comer of said Section 18 bears South 22° 24' 40" East 3116.54 feet said POINT OF BEGINNING; thence along said boundary line North 46° 24' 49" West 30.00 feet; thence departing said boundary line North 43° 35' 11" East 87.60 feet; thence South 46° 24' 49" East 30.00 feet; thence South 43° 35' 11" West 87.60 feet to the POINT OF BEGINNING, County of Garfield, State of Colorado.