HomeMy WebLinkAboutWell Permit ApplicationCOLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., Ste 821, DENVER, CO 80203
Main: (303) 866-3581 Fax: (303) 866-2223 dwrpermitsonline(astate.co.us
RESIDENTIAL Note: Also use this form to apply for livestock watering
Water Well Permit Application
Review form instructions prior to completing form.
Hand completed forms must be completed in black or blue ink or typed.
1. Applicant Information
Name(s)
7W Guest Ranch, LLC / Brian Widhalm
Mailing address
1121 Sweetwater Road
City
Gypsum
Telephone (w/area code)
970-524-9328
State
CO
E-mail
Zip code
;81637
Office Use Only
Form GWS -44 (7/2012)
2. Type Of Application (check applicable boxes)
❑ Construct new well ❑ Change source (aquifer)
❑ Replace existing well ❑ Reapplication (expired permit)
• Use existing well ❑ Rooftop precip. collection
❑ Change or increase use ❑ Other:
6. Use Of Well (check applicable boxes)
See instructions to determine use(s) for which you may qualify
D A. Ordinary household use in one single-family dwelling
(no outside use)
• B. Ordinary household use in 1 to 3 single-family dwellings:
Number of dwellings: 3
VIII Home garden/lawn irrigation, not to exceed one acre:
area irrigated 1 C sq. ft. id acre
NI Domestic animal watering — (non-commercial)
❑ C. Livestock watering (on farm/ranch/range/pasture)
3. Refer To (if applicable)
Well permit #
289432
Designated Basin Determination #
Water Court case
Well name or #
7. Well Data (proposed)
Maximum pumping rate
15 gpm
Total depth
110
feet
Annual amount to be withdrawn
1
•................. ...................
Aquifer
acre-feet
4. Location Of Proposed Well (Important! See Instructions
County
Garfield SE 1/4 of the SE 1/4
Section I Township N or S 1 Range E or W I Principal Meridian
21 13 IT * 87 C IXi 'Sixth
Distance of well from section lines (section lines are typically not property lines)
894 Ft. from N X S 199 Ft from LK_ E ❑ W
For replacement wells only — distance and direction from old well to new well
feet Direction
Well location address (Include City State, Zip) AI Check if well address is same as in Item 1.
Optional: GPS well location information in UTM format. GPS unit settings are as follows:
Format must be UTM
Zone 12 orr Zone 13 Easting: 315164
Units must be Meters
Datum must be NAD83
Unit must be set to true north
Was GPS unit checked for above? ❑ YES
Northing: 4404886
Remember to set Datum to NAD83
8. Water Supplier
Is this parcel within boundaries of a water service area?I YES g.1 NO
If yes, provide name of supplier:
9. Type Of Sewage System
El Septic tank / absorption leach field
❑ Central system: District name:
❑ Vault: Location sewage to be hauled to:
❑ Other (explain)
10. Proposed Well Driller License #(optional):
5. Parcel On Which Well Will Be Located
(You must attach a current deed for the subject parcel)
A. You must check and complete one of the following:
❑ Subdivision: Name
Lot Block Filing/Unit
❑ County exemption (attach copy of county approval & survey)
Name/# Lot #
❑ Parcel less than 35 acres, not in a subdivision attach a deed with metes
& bounds description recorded prior to June 1, 1972, and current deed
❑ Mining claim (attach copy of deed or survey) Name/#:
❑ Square 40 acre parcel as described in Item 4
❑ Parcel of 35 or more acres (attach metes & bounds description or survey)
❑ Other: (attach metes & bounds description or survey)
B. # of acres in parcel C. Are you the owner of this parcel?
35 IN YES (_l NO
D. Will this be the only well on this parcel? I"1 YES[ I NO (if no — list other wells)
E. State Parcel ID# (optional):
11. Sign or Enter 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
th-reof and state that they are true to my knowledge.
Sig i or enter name(s) of person(ssubmit tf g application 1 Date- mm/dd/yyyy)
If signing print name and title
I.
14, 1
Office Use Only
USGS map name
I DWR map no. i Surface elev.
Receipt area only
AQUAMAP
WE
WR
CWCB
TOPO
MYLAR
SB5 DIV WD BA MD
GRAPHIC SCALE
200 0 100 200 400
NORTH
800
ID
ID
4
( IN FEET )
1 inch = 200 ft.
W
W
c
0
0
z
J
OWNER
WATTERS, DARRELL & JACQ
PARCEL NO. 1863-223-0
W 1/4 CORNER
15' RIGHT-OF-WAY EASEMENT TO
EAGLE VALLEY TELEPHONE COMPANY
BOOK 501 PAGE 958
RECEPTION NO. 281373
7W GUEST RANCH MINOR SUBDIVISON
A PARCEL OF LAND SITUATED IN THE SE1/4 OF SECTION 21,
SW 1 /4 OF SECTION 22 AND THE /NE 1 /4 OF SECTION 28
TOWNSHIP 3 SOUTH, RANGE 87 WEST OF THE 6TH P.M.
COUNTY OF GARFIELD, STATE OF COLORADO
ELYN R.
-092
SW1 /4
(SEC. 22)
SECTION 22
2-1/2" GLO BRASS CAP
(FND)
COUNTY
ROAD 151
(40' R.O.W.)
EXISTING
GRAVEL
ROADWAY
FOUND NO. 5 REBAR
AND ALUMINUM CAP
LS NO 26598
R
FOUND NO. 5 REBAR
/
AND YELLOW PLASTIC CAP
MARKED PROP CORNER
HCE LS 19598
ALONG THIS LINE
L8
OWNER
WATTERS, DARRELL Sc JACQUELYN R.
PARCEL NO. 1863-223-00-092
<9
FOUND REFERENCE
MONUMENT
2" ALUMINUM CAP
LS19598
7W GUEST RANC -0 FOOT
ACCESS RIGHT-OF-WAY MENT
RECEPTION NO. 341704 AND 4 0
PARCEL B OF RECEPTION NO. 61470
L11
FOUND NO. 5 REBAR
AND YELLOW PLASTIC CAP
MARKED PROP CORNER
HCE LS 19598 /
S00°52'24"W 1255.08'
LOT 2
RANCH MANAGER'S
PARCEL
3.000± Ac.
BOUNDARY AGREEMENT
RECEPTION NO. 498777
UTILITY & ACCESS
EASEMENT FOR LOT 2
655.15'
POINT OF BEGININNG
NE CORNER
SECTION 28
3" GLO BRASS
CAP (FND)
599.93'
OWNER
TESTWUIDE, PAUL ANDERSON & JANET MARIE
PARCEL NO. 1863-214-00-098
®WELL
SEE DETAIL
SET NO. 5 REBAR
& YELLOW PLASTIC CAP
MARKED PROP CORNER
HCE LS 19598
(TYPICAL)
0)
EXISTING
GRAVEL
ROADWAY
20' HOLY CROSS
EASEMENT
FOR LOT 2
sz-
OWNER
BURKE, SHANNON & MARCY, RODNEY
PARCEL NO. 1863-272-00-122
Il
//
//
//
//
//
//
//
//
//
//
//
/i
30 FOOT O.
ACCESS EASEMENT
RECEPTION NO. 745889
FOUND NO. 5 REBAR
AND YELLOW PLASTIC CAP
MARKED PROP CORNER
HCE LS 19598
ALONG THIS LINE
OWNER
BURNT PARK TRAIL, LLC
PARCEL NO. 1863-214-00-117
0
L5
L6
CREEK
OVERHEAD
POWERLINE
(TYPICAL)
•
x
x
EXISTING WIRE FENCE
N W1 /4
(SE -3. 27)
OWNER
GREEN, SCOTT & CAPPIE
600 COTTONWOOD PASS ROAD
GYPSUM, CO 81637
PARCEL NO. 1863-272-00-121
(BASIS OF BEARINGS)
SO1 °53'58' E 2752.96'
POWER POLE
(TYPICAL)
1317.42'
EXISTING
GRAVEL
ROADWAY
X
x
L3
L18
L17
2J
L20
//
//
//
//
//
//
//
//
1/
//
1/
1/
11
POND
LINE DATA
LINE
BEARING
LENGTH
L1
S6T10'18"W
58.38'
L2
S28°59'33"W
14.90'
L3
S06'31'16"E
11.68'
L4
S2816'15"E
85.84'
L5
SO7°02'30"E
54.02'
L6
S12°05'14"W
55.18'
L7
S22°47'35"W
177.66'
L8
S11'15'30"W
186.81'
L9
S29°55'39"W
257.98'
L10
S45°48'41 "W
214.13'
L11
S36°23'47"W
3.22'
L12
N36'23'47"E
191.53'
L13
N45°49'11"E
211.28'
L14
N29'55'39"E
242.58'
L15
N11'15'30"E
183.64'
L16
N22'47'35"E
178.02'
L17
N12'05'14"E
42.07'
L18
NOTO2'30"W
36.22'
L20
N28°16'15"W
86.07'
L21
N28'59'33"E
44.01'
L22
N54'54'50"E
212.19'
L23
N46°37'11"E
221.70'
L24
N36°23'51"E
188.66'
20' HOLY CROSS EASEMENT
RECEPTION NO. 251098
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CREEK
CURVE DATA
CURVE
RADIUS
DELTA
LENGTH
TANGENT
CHORD BEARING
CHORD
65.83'
01
420.00'
08'59'23"
65.90'
33.02'
S 82°01'42" E
C2
148.83'
10'08'03"
26.32'
13.20'
S 81'27'21" E
26.29'
ELIMINA
10/30/14
__-&VI
NOTICE: ACCORDING TO COLORADO LAW YOU MUST COMMENCE ANY LEGAL
ACTION BASED UPON ANY DEFECT IN THIS SURVEY WITHIN THREE YEARS
AFTER YOU FIRST DISCOVER SUCH DEFECT. IN NO EVENT MAY ANY ACTION
BASED UPON ANY DEFECT IN THIS SURVEY BE COMMENCED MORE THAN
TEN YEARS FROM THE DATE OF CERTIFICATION SHOWN HEREON.
S0018'53"W 550.69'
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NORTH 1/4 CORNER
SECTION 28
3" GLO BRASS CAP (FND)
NO018'53"E 809.71'
S -C 1/16 CORNER
SECTION 21
REBAR & CAP
L.S. NO. 16842 (FND)
INNIMM
0
20' HOLY CROSS EASEMENT
RECEPTION NO. 414199
EXISTING STRUCTURES
LOT 1
GUEST RANCH PARCEL
215.254± Ac.
EXISTING DITCH
OWNER
WHITE RIVER NATIONAL FOREST
PARCEL NO. 1869-202-00-951
EXISTING TRAIL
EXISTING WIRE FENCE-\
N00°20'36"W 2729.57'
EAST 1/4 CORNER
SECTION 28
3" GLO BRASS CAP (FND)
4
EXISTING DITCH
CENTER 1/4 CORNER
SECTION 28
3" ALUMINUM CAP
LS NO 19598 (FND)
WEST 1/4 CORNER
SECTION 28
GLO BRASS CAP (FND)
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SOUTH 1/4 CORNER -
SECTION 28
GLO BRASS CAP (FND)
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PROJECT NO.
2111662
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