HomeMy WebLinkAbout20130565.tiffCOLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 821, DENVER, CO 80203
Main: (303) 866-3581 Fax: (303) 866-2223 dwrpermitsonlineestate.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
Office Use Only
Form GWS-45 (04/2012)
Plains Marketing, L.P.
Mailing address
333 Clay Street, Suite 1600
City
Houston
6. Use Of Well (check applicable boxes)
Attach a detailed description of uses applied for.
State
TX
Zip code
77002
Telephone # (area code & number)
(713) 646-4383
2. Type Of Application (check applicable boxes)
E-mail (online filing required)
emolivier@paalp.com
❑ Industrial
El Municipal
❑ Irrigation
El Commercial
❑ Dewatering System
❑ Geothermal (production or reinjection)
❑ Other (describe):
7. Well Data (proposed)
Maximum pumping rate
0.4
Annual amount to be withdrawn
gpm .4787
acre-feet
O Construct new well
El Replace existing well
El Change source (aquifer)
❑ COGCC Well
El Use existing well
El Change or increase use
❑ Reapplication (expired permit)
❑ Other:
Total depth
750 feet
Aquifer
Laramie Fox Hills
8. Land On Which Ground Water Will Be Used
3. Refer To (if applicable)
Well permit #
Water Cowl case #
Designated Basin Determination #
Well name or #
4. Location Of Proposed Well
County
Weld
1/4 of the 1/4
Legal Description of Land (may be provided as an attachment):
All that part of Section 17, T2N, R63W of the 6th PM lying
southerly of the Chicago, Burlington,& Quincy RR ROW,
County of Weld, State of Colorado
(If used for crop irrigation, attach a scaled map that shows irrigated area.)
Section
17
Township N or S Range E or W Principal Meridian
2 fx:l ❑l 63 O l0 6th
Distance of well from section lines (section lines are typically not properly lines)
Ft. fromEN N ❑ s Ft. frorr❑E IOW
For replacement wells only — distance and direction from old well to new well
feet
direction
Welt location address (Include City. State. Zip) El Check if well address is same as in Item 1.
31636 CR 398, Keenesburg, CO 80643
Optional: GPS well location information in UTM format You must check GPS unit for
required settings as follows:
A. # Acres
356.753
B. Owner
Plains Marketing, L.P.
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
Format must be UTM
nIZone 12 oru Zone 13
Units must be Meters
Datum must be NAD83
Unit must be set to true north
Was GPS unit checked for above? ❑ YES
Easting
Northing
Remember to set Datum to NAD83
Emmanuel M Olivier, Project Engineer
Date (mm/dd/yyyy)
11/19/2012
If signing print name and title
Office Use Only
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):
All that part of Section 17, T2N, R63W of the 6th PM lying
southerly of the Chicago, Burlington,& Quincy RR ROW,
County of Weld, State of Colorado
USGS map name
DWR map no.
Surface elev.
B. # of acres in parcel
356.753
C. Owner
Plains Marketing, L.P.
D. Will this be the only well on this parcel? IIJ! YES] NO (if no list other wells)
E. State Parcel ID# (optional):
AOUAMAP
WE
WR
CWCB
TOPO
MYLAR
SB5
Receipt area only
DIV WD BA MD
COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST (04/2012)
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 Forfurtherinformation please visitwww.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, 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)
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.
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.
The county, V. of the '/. 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 '/. of the V. 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 108''' Meridian (longitude). West of the 1081h Meridian is UTM Zone 12 and east of the 108`'
Meridian is UTM Zone 13. The 108'h 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. 1270123456. 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
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.
Colorado Division of Water Resources
1313 Sherman St. Rm. 818
Denver. CO 80203
(303) 866-3581
httpalwater state.co us/default.htm
Application Receipt No.
Applicant's Name
COMMERCIAL SMALL CAPACITY WELL WATER USE BREAKDOWN WORKSHEET
(For Wells Located Within Designated Groundwater Basins)
Name and Type of
Business Plains Tampa Loading Facility
1. Is this application for a new well?
X Yes
No If no, is this application for a change of use for an existing permitted well?
Yes Permit Number of well (if applicable)
No For wells used prior to May 8, 1972 see form GWS-12 Registration of Existing Well for
further information.
2. Type of disposal system:
X
Septic tank/absorption leach field
Central System (district name:)
Vault (location sewage hauled to: )
Other (attach copy of engineering design)
3. Water Demand Calculations (for average factors for water demand see below)
Employees
Number of Employees
X
Number of Gallons per
Employee per Day
X
Number of Days Employee
Works per Year
=
Gallons per Year
40
X
15
X
260
=
156,000
Customers
Number of
Customers per Day
X
Number of Gallons per
Customer
X
Number of Days Business
is Open per Year
=
Gallons per Year
N/A
x
x
=
Outside
Square Feet of
Irrigated Landscape
X
Number of Gallons per
square foot per day
X
Number of Days landscape
is irrigated
=
Gallons per Year
N/A
x
x
=
Other Uses - Provide breakdowns for all other substantial water usage (i.e. veterinary clinic, green houses, etc.)
Type of Use
X
Gallons per Use per
Day
X
Days per Year
=
Gallons per Year
N/A
X
X
=
Total amount of water required:
A
B
C
D
156,000 gallons per year
(A+B+C+D)
0.4787 acre -ft per year
(1 acre -ft = 325,851 gallons)
For all small capacity commercial wells:
1. The pumping rate shall not exceed 50 gallons per minute and may be further limited by Water Management District
Rules.
General Guidelines for Water Demand in Gallons per Day
Day Workers at Offices — 15 gallons/person/day
Food Service Establishments (with toilet and kitchen wastes) — 10 gallons/patron/day
Churches (does not include food service) — 5 gallons/seat/day
Overnight Lodging — 50 gallons/customer/day
Landscape Irrigation —45 gallons/1,000 square feet/day
On -Site Proprietor of Overnight Lodging (i.e. on -site owner of a Bed & Breakfast) — 80 gallons/person/day
Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject. GWS-61
03/03
COLORADO DIVISION OF WATER RESOURCES GWS-61
DEPARTMENT OF NATURAL RESOURCES 03/03
GUIDELINES FOR DETERMINING SMALL CAPACITY COMMERICAL WATER CONSUMPTION INSIDE A
DESIGNATED GROUNDWATER BASIN
2. The amount of ground water diverted shall not exceed 5 acre-feet annually except where Ground Water Management
District Rules allow up to 80 acre-foot annually.
3. The return flow from the use of the water must be discharged to the same stream system in a location so as to not injure
any vested water right.
4. The well must be the only commercial well serving this business and may only serve this business.
5. The parcel on which the well would be located, must be:
(a) Thirty-five (35) acres or more in size (A legal description, in the form of a metes and bounds description or a
surveyor's map of the parcel must accompany the permit application);
(b) If less than 35 acres, the parcel must have been established prior to June 1, 1972, if less than 35 acres, or must
be exempt from the definition of a subdivision pursuant to Section 30-28-101(10)(c) and (d), C.R.S. (A copy of a
deed describing the parcel and dated before June 1, 1972, or a copy of the signed county resolution exempting
the parcel, must accompany the permit application); or
(c) Located in a subdivision approved on and after June 1, 1972. (The recommendations made by this office in the
water supply review process of that subdivision will be honored.)
6. A totalizing flow meter must be installed on the well. Permanent annual diversion records must be maintained by the
well owner and submitted to the Division of Water Resources and the local Ground Water Management District (if
applicable) upon request.
CONDITIONS STATEWIDE VARY - MEETING THE ABOVE CONDITIONS DOES NOT GUARANTEE THE ISSUANCE OF A PERMIT
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