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DNR
COLORADO
Division of Water Resources
Department of Natural Resources
WELL PERMIT NUMBER 89154-F
RECEIPT NUMBER 10035889
ORIGINAL PERMIT APPLICANT(S)
NGL WATER SOLUTIONS DJ LLC (JAMES WINTER)
PERMIT TO CONSTRUCT A NEW WELL
APPROVED WELL LOCATION
Water Division: 1 Water District: 2
Designated Basin: N/A
Management District: N/A
County: WELD
Parcel Name: REC EXMPT RECX17-0182
Lot: B Block: Filing:
Physical Address: N/A
NW 1/4 NE 1/4 Section 28 Township 1.0 N Range 66.0 W Sixth P.M.
UTM COORDINATES (Meters, Zone:13, NAD83)
Easting: 518784.6 Northing: 4430849.8
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This well shad be used in such a way as to cause no material injury to existing water rights. The issuance of this permit does not
ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking
relief in a civil court action.
2) The construction of this well shad be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a
variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in
accordance with Rule 18.
3) Approved pursuant to CRS 37-90-137(4) and the findings of the State Engineer dated May 29, 2024.
4) The use of groundwater from this well is limited to industrial, irrigation, and commercial.
5) The pumping rate of this well shad not exceed 150 GPM.
6) The average annual amount of groundwater to be withdrawn shad not exceed 8.16 acre-feet and the total volume of
groundwater to be withdrawn shad not exceed 816 acre-feet.
7) Production from this well is limited to the Laramie -Fox Hills aquifer which is located approximately 815 feet below ground
surface and extends to a depth of approximately 1,160 feet. Wells completed in the Laramie -Fox Hills aquifer must be
constructed with solid steel casing and grouted in accordance with Well Construction Rule 10.4.8 (2 CCR 402-2). If coals and/or
carbonaceous shales are encountered in the borehole, plain casing and grout should be installed through these intervals to
exclude poor quality water from entering the well, in accordance with BOE Bulletin 2021-1.
8) The entire length of the hole shad be geophysically logged as required by Rule 9 of the Statewide Nontributary Ground Water
Rules prior to installing casing.
9) The owner shad mark the well in a conspicuous location with well permit number(s), name of the aquifer, and court case
number(s) as appropriate. The owner shad take necessary means and precautions to preserve these markings.
10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions
must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request.
11) This well shad be constructed more than 600 feet from any existing well, completed in the same aquifer, that is not owned by
the applicant.
12) This well shad be constructed not more than 200 feet from the location specified on this permit.
13) Pursuant to CRS 37-90-137(9)(b) and the Denver Basin Rules, no more than 98% of the nontributary groundwater withdrawn
annually shad be consumed and the well owner shad demonstrate to the reasonable satisfaction of the State Engineer that no
more than 98% of the water withdrawn will be consumed.
14) This well is subject to administration by the Division Engineer in accordance with applicable decrees, statutes, rules, and
regulations.
Printed 05-29-2024
For questions about this permit call 303.866.3581 or go to https://dwr.colorado.gov Page 1 of 2
WELL PERMIT NUMBER 89154-F
RECEIPT NUMBER 10035889
15) ADVANCE NOTICE REQUIRED - Pursuant to Construction Rule 6.2.2.1 (2 CCR 402-2), licensed or private drillers and pump
installers must provide advance notification (by 11:59 pm the day before) to the State Engineer prior to each of the following
for this well: the start of well construction, the initial installation of the first permanent pump, and the initial installation of a
cistern connected to the water well supply system. Any change in the date of construction/installation must be re -noticed prior
to the activity (by 11:59 pm the day before). Information regarding the notification process and a link to the electronic
notification form can be found on the Division of Water Resources website at dwr.colorado.gov
NOTE: This well is withdrawing water from a non-renewable aquifer. While the withdrawals from this aquifer are administered
based on a 100 year aquifer life, water level declines may prevent this well from diverting the permitted amounts for that 100
years.
NOTE: To ensure a maximum productive life of this well, perforated casing should be set through the entire producing interval
of the approved zone or aquifer indicated above.
NOTE: A hydrogeologic aquifer evaluation has been completed for this permit and the details of the evaluation can be viewed in
the hydrogeologic aquifer evaluation imaged document located in the well permit file.
NOTE: This permit will expire on the expiration date unless the well is constructed and a pump is installed by that date. A Well
Construction and Yield Estimate Report (GWS-31) and Pump Installation and Production Equipment Test Report (GWS-32) must
be submitted to the Division of Water Resources to verify the well has been constructed and the pump has been installed. A
one-time extension of the expiration date may be available. Contact the DWR for additional information or refer to the
extension request form (GWS-64) available at: dwr.colorado.gov
Issued By WENLI DICKINSON
Date Issued: 5/29/2024
Expiration Date: 5/29/2025
Printed 05-29-2024
For questions about this permit call 303.866.3581 or go to https://dwr.colorado.gov Page 2 of 2
Form no. DIVISION OF WATER RESOURCES
GWS-1 DEPARTMENT OF NATURAL RESOURCES
(7/2023) 1313 Sherman St, Room 821, Denver, CO 80203
(303) 866-3581, www.colorado.gov/water, dwrpermitsonline@state.co.us
NONTRIBUTARY GROUNDWATER LANDOWNERSHIP STATEMENT
This form is to be submitted with applications for the following, when the applicant is the owner of the overlying land.
1) A well permit to withdraw groundwater from the Dawson, Denver, Arapahoe or Laramie -Fox Hills aquifers, or other aquifer the
applicant claims contains nontributary groundwater, outside of a Designated Groundwater Basin subject to section 37-90-137(4),
C.R.S., except when the right to withdraw the groundwater has been determined by a valid decree; OR
2) A determination of water right in the Dawson, Denver, Arapahoe or Laramie -Fox Hills aquifers, or a well permit to withdraw
groundwater from those aquifers that are subject to Designated Basin Rule 5.4, within a Designated Groundwater Basin.
NOTE: Form submittal instructions can be found on our website Colorado.gov/water. See instructions on the reverse of this form.
Type or print in black or blue ink.
1. APPLICANT INFORMATION
Name of Applicant
James Winter
Mailing Address City State Zip Code
865 North Albion Street, Suite 500 Denver CO 80220
Telephone Number (include area code)
303-638-1940
Email
Jim.Winter@nglep.com
2. AQUIFER
Laramie -Fox Hills
3. CLAIM OF OWNERSHIP — I hereby claim that I am the owner of the following described property, as evidenced by
the attached copy of a deed recorded in the county in which the property is located.
Number of acres: 29.42 in the county of: Weld County
described as follows (type the legal description below or type "see attached" and attach a legal description).
PT N2 28-1-66 LOT B REC EXEMPT RECX17-0182
- I further claim that the right to withdraw the groundwater in the aquifer underlying the above described
property has not been reserved by another, nor has consent been given to another for the right to its withdrawal.
4. THE APPLICANT MUST PROVIDE — a Verification of Notice of Application (form no. GWS-43) (see instructions for
exceptions).
5. SIGNATURE - Sign or enter name(s) 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.
Signature: Jim Winter Date: 5/28/2024
Print name and title: Jim Winter, Vice President
COLORADO GROUND WATER COMMISSION GWS-1 (7/2023)
DIVISION OF WATER RESOURCES - DEPARTMENT OF NATURAL RESOURCES
INSTRUCTIONS - NONTRIBUTARY GROUNDWATER LANDOWNERSHIP STATEMENT
ITEM 1 - APPLICANT INFORMATION - Provide the applicant's name, telephone number, mailing address and
email where all correspondence will be sent.
ITEM 2 — AQUIFER - Indicate the aquifer that is the subject of the application for a well permit or Determination of
Water Right. A separate statement must be submitted for each aquifer.
ITEM 3 - THE APPLICANT MUST PROVIDE — Pursuant to C.R.S. 37-90-137(4)(b.5)(I) and Designated Basin
Rules 5.3.2.2 and 5.4.2.2 the applicant shall provide evidence that the applicant has given notice of the
application by registered or certified mail, return receipt requested, no less than ten days prior to the making of
the application, to every record owner of, and to every person who has a lien or mortgage upon, or deed of
trust to, the overlying land recorded in the county in which the overlying land is located, unless the applicant is
a political subdivision of the state of Colorado, special district, municipality, or quasi -municipal district that
obtained the right to the underlying water by deed, assignment, or other written evidence of express or implied
consent where, at the time of application, the overlying land is within the water service area of such entity.
Evidence that the notice has been given is to be provided by submitting a Verification of Notice of Application
(form no. GWS-043), which is available for downloading on the Division of Water Resources website at
www.water.state.co.us
ITEM 4 - CLAIM OF OWNERSHIP —
• This statement must be accompanied by a deed recorded with the county showing that the claimant is the
owner of the described property. The name of the claimant must be the same as the name of the owner of
the described property as shown on the deed.
• Indicate the number of acres being claimed as owned.
• Identify the county in which the property is located.
• Provide a legal description of the property.
o For descriptions of irregularly shaped parcels (where the boundaries do not follow or parallel section
lines), or where there are exclusions of land within the total parcel, the applicant must submit a map
having a scale of 1:24,000 or larger (e.g. 1:10,000) which accurately depicts the described land.
o If the legal description is too lengthy for the space provided, you may refer to an attached legal
description and attach the complete legal description.
o If the copy of the deed being provided contains an adequate legal description, that deed may be
referenced.
o The legal description and map must be complete and legible. Descriptions that are illegible or
incomplete (e.g. that reference exclusions without legal descriptions) may be returned.
• Affirm the right to withdraw the groundwater in the aquifer underlying the above described property has not
been reserved by another, nor has consent been given to another for the right to its withdrawal.
ITEM 5 - SIGNATURE — The form must be signed. If the applicant is a company, corporation, organization,
etc., the statement must be signed by responsible person in the company who must indicate his/her title. The
application may be signed by the attorney who is acting on behalf of the applicant. An applicant's authorized
agent may sign the form if a letter signed by the applicant is submitted with the application authorizing the
person to act as agent for the specific purpose of applying for the application.
ADDITIONAL INFORMATION:
• The Designated Basin Rules are available for viewing and downloading on the Division of Water Resources
website at www.colorado.gov/water
• A map of the Designated Basins can be accessed on the Designated Basins page of the Division of Water
Resources website at www.colorado.gov/water
• This form may be reproduced by photocopying or computer means.
IF YOU HAVE ANY QUESTIONS - call the Division of Water Resources - Groundwater Information Desk - at
303-866-3587
Form no. DIVISION OF WATER RESOURCES
GWS-43 DEPARTMENT OF NATURAL RESOURCES
(1/2020) 1313 Sherman St, Room 821, Denver, CO 80203
(303) 866-3581, www.colorado.qov/water, dwrpermitsonline@state.co.us
VERIFICATION OF NOTICE OF APPLICATION
This form is to be submitted with applications for the following.
1) A well permit to withdraw groundwater from the Dawson, Denver, Arapahoe or Laramie -Fox Hills aquifers, or other aquifer the
applicant claims contains nontributary groundwater, outside of a Designated Groundwater Basin subject to section 37-90-137(4),
C.R.S., except when the right to withdraw the groundwater has been determined by a valid decree; OR
2) A determination of water right in the Dawson, Denver, Arapahoe or Laramie -Fox Hills aquifers, or a well permit to withdraw
groundwater from those aquifers that are subject to Designated Basin Rule 5.4, within a Designated Groundwater Basin
NOTE: Form submittal instructions can be found on our website Colorado.gov/water. See instructions on the reverse of this form
for exceptions to the above list. Type or print in black or blue ink.
1. APPLICANT INFORMATION
Name of Applicant
NGL Water Solutions DJ, LLC
Mailing Address City State Zip Code
865 North Albion Street, Suite 400, Denver, CO 80220
Telephone Number (include area code)
(720) 213-1521
Email
Jim.Winter@nglep.com
2. AQUIFER
Laramie -Fox Hills
3. NOTICE OF APPLICATION — I hereby claim that I have given notice pursuant to section 37-90-137(4)(b.5), C.R.S., or
Designated Basin Rule 5.3.2.2, or Designated Basin Rule 5.4.2.2, as applicable, of application for a well permit or determination
of water right by registered or certified mail, return receipt requested, no less than ten days prior to the making of the application,
to every record owner of the overlying land and to every person who has a lien or mortgage upon, or deed of trust to, the
overlying land recorded in the county in which the overlying land is located.
The names of the persons that were given notice are listed below:
N/A
4. SIGNATURE - Sign or enter name(s) 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.
Signature: Jim Winter Date: 5/28/2024
Print name and title: Jim Winter, Vice President
DIVISION OF WATER RESOURCES - DEPARTMENT OF NATURAL RESOURCES GWS-43 (1/2020)
INSTRUCTIONS — VERIFICATION OF NOTICE APPLICATION
ITEM 1 - APPLICANT INFORMATION - Provide the applicant's name, telephone number, mailing address and
email where all correspondence will be sent.
ITEM 2 — AQUIFER - Indicate the aquifer that is the subject of the application for a well permit or Determination of
Water Right. A separate form must be submitted for each aquifer.
ITEM 3 — NOTICE OF APPLICATION — Section 37-90-137(4)(b.5), C.R.S., Designated Basin Rule 5.3.2.2, and
Designated Basin Rule 5.4.2.2 require that an applicant for a well permit or determination of water right furnish
evidence that the applicant has given notice of the application by registered or certified mail, return receipt
requested, no less than ten days prior to the making of the application, to every record owner of the overlying
land and to every person who has a lien or mortgage upon, or deed of trust to, the overlying land recorded in
the county in which the overlying land is located, except for the following applicants.
1. Applicants for applications for well permits to withdraw groundwater from the Dawson, Denver,
Arapahoe or Laramie -Fox Hills aquifers outside of a Designated Groundwater Basin subject to section
37-90-137(4), C.R.S., whose right to withdraw the groundwater has been determined by a valid decree;
OR
2. Applicants that are a political subdivision of the state of Colorado, special districts, municipalities, or
quasi -municipal districts that have obtained consent to withdraw the groundwater by deed, assignment,
or other written evidence of consent where, at the time of application, the overlying land is within the
water service area of such entity.
ITEM 4 - SIGNATURE OF APPLICANT — The form must be signed. If the applicant is a company, corporation,
organization, etc., the statement must be signed by responsible person in the company who must indicate
his/her title. The application may be signed by the attorney who is acting on behalf of the applicant. An
applicant's authorized agent may sign the form if a letter signed by the applicant is submitted with the
application authorizing the person to act as agent for the specific purpose of applying for the application.
ADDITIONAL INFORMATION:
• Pursuant to section 37-90-137(4)(b.5)(II), C.R.S., for the purposes of paragraph (b.5), "person" means any
individual, partnership, association, or corporation authorized to do business in the state of Colorado, or any
political subdivision or public agency thereof, or any agency of the United States.
• The Designated Basin Rules are available for viewing and downloading on the Division of Water Resources
website at www.colorado.gov/water
• A map of the Designated Basins can be accessed on the Designated Basins page of the Division of Water
Resources website at www.colorado.gov/water
• This form may be reproduced by photocopying or computer means.
IF YOU HAVE ANY QUESTIONS - call the Division of Water Resources - Groundwater Information Desk - at
303-866-3587
COLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 821, DENVER, CO 80203
Main: (303) 866-3581 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
NGL WATER SOLUTIONS DJ, LLC
Mailing address
865 North Albion Street Suite 500
City State
Denver CO
Telephone # (area code & number)
303-638-1940
Zip code
80220
E-mail (online filing required)
Jim.Winter@nglep.com
Office Use Only
Form GWS-45 (01/2020)
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):
2. Type Of Application (check applicable boxes)
❑ Construct new well
❑ Replace existing well
❑ Change source (aquifer)
❑ COGCC Well
❑ Use existing well
❑ Change or increase use
❑ Reapplication (expired permit)
❑ Other:
7. Well Data (proposed)
Maximum pumping rate
150
gpm
Annual amount to be withdrawn
Maximum Allowed acre-feet
Total depth Aquifer
TBD feet Laramie -Fox Hills
3. Refer To (if applicable)
Well permit #
Designated Basin Determination #
Water Court case #
Well name or #
4. Location Of Proposed Well
County
Weld County NW
Section
28
1/4 of the NE 1/4
Township N or S Range E or W Principal Meridian
01 � ri 66
El 6
Distance of well from section lines (section lines are typically not property lines)
679 Ft. from I ^ N I S 1,568 Ft. fromn E ❑W
For replacement wells only — distance and direction from old well to new well
feet
Well location address (Include City, State, Zip)
direction
❑ Check if well address is same as in Item 1.
Unincorporated Weld County, CO, 80621
Optional: GPS well location information in UTM format You must check GPS unit for
required settings as follows:
Format must be UTM
rl Zone 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? EYES
Easting
Northing
Remember to set Datum to NAD83
8. Land On Which Ground Water Will Be Used
Legal Description of Land (may be provided as an attachment)
PT N2 28-1-66 LOT B REC EXEMPT RECX17-0182
(If used for crop irrigation, attach a scaled map that shows irrigated area.)
A. # Acres B. Owner
29.53 NGL Water Solutions DJ, LLC
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)
James Winter 03/21/2024
If signing print name and title
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)
PT N2 28-1-66 LOT B REC EXEMPT RECX17-0182
B. # of acres in parcel C. Owner
29.53 NGL Water Solutions DJ, LLC
D. Will this be the only well on this parcel? M YES EI NO (if no list other wells)
E. State Parcel ID# (optional):
Office Use Only
USGS map name
AQUAMAP
WE
WR
CWCB
TOPO
MYLAR
SB5
DWR map no. Surface elev.
Receipt area only
DIV WD BA MD
147128100013
COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST (01/2020)
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 pleasevisitdwr.colorado.gov
FEES: This application requires a nonrefundable $100.00 filling fee. Please visit DWR's Online Form Submittal web page for
acceptable payment information or contact DWR at (303) 866-3581.
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, 1/4 of the 1/4 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 1/4 of the 1/4 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
here.
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
dwr.colorado.gov for general information, additional forms, and access to state rules or statutes.
COLORADO
DEPARTMENT
1313
Main:
Website:
Email
DIVISION OF WATER RESOURCES
OF NATURAL RESOURCES
SHERMAN ST., STE 821, DENVER,
(303) 866-3581
dwr.colorado.gov
CO 80203
Form GWS-57 (12/2023)
Application
Applicant's
Receipt No.
Name:
to: dwrpermitsonline@state.co.us
COMMERCIAL DRINKING AND SANITARY WELL WORKSHEET
Review instructions on reverse side prior to completing form. The form must be completed in black or blue ink or typed.
1. Name and Type of Business: Biochar Processing CR 6 LLC
2.
Is this application for a new well?
for a change
of well (if applicable)
for drinking and
may be required.
of use for an existing well?
• Yes
• No If no, is this application
• Yes Permit Number
• No For wells used
sanitary purposes prior to May 8, 1972, a field inspection
See form GWS-12 Registration of Existing Well
of the well to verify
for further information.
historical uses
3.
Is the parcel the well is located
municipality, water company, etc.)
on (or will be located
or is water
other source is
on) within the boundaries of a water service area (water district,
available from another source (such as a well)?
• Yes If yes, indicate what this
® No
(name of water district/supplier, or well permit number)
4.
Proposed type of disposal system to
be used:
tank / absorption leach
System (district name:)
(location sewage hauled
(attach copy of engineering
field
MI Septic
• Central
• Vault
to:)
• Other
design)
5.
Water Demand Calculations (for average factors for water demand see below)
Employees
A
B
C
Number of
Employees
X
Number of Gallons
per Employee per Day
X
Number of Days Employee
Works per Year
=
Gallons per Year
20
X
15
X
350
=
105000
Customers
Number of
Customers per Day
X
Number of Gallons
per Customer
X
Number of Days Business
is Open per Year
=
Gallons per Year
0
X
0
X
0
=
0
Other Uses (Note: No uses outside of the building would be permitted for this type of well.)
Type of Use
X
Gallons per Use per Day
X
Days per Year
=
Gallons per Year
MISC.
X
5
X
350
=
1.750
Total amount
of water required:
=
Gallons per Year
(A + B + C)
=
106750
For wells used for commercial drinking and sanitary purposes
108,600 gallons (1/3 of an acre-foot) per year.
For wells used for commercial drinking and sanitary purposes
gallons (1 acre-foot) per year.
General Guidelines for Water Demand in Gallons per
on or after May
8, 1972, the total water demand cannot exceed
1972, the total water demand cannot exceed 325,900
— 80 gallons/person/day
or from a technical reference on this subject.
prior to May
8,
consultant
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
On -Site Proprietor of Overnight Lodging (i.e. on -site owner of a Bed & Breakfast)
Additional water demand figures may be obtained from a private water
COLORADO DIVISION OF WATER RESOURCES GWS-57 (12/2023)
DEPARTMENT OF NATURAL RESOURCES
INSTRUCTIONS FOR EXEMPT COMMERCIAL DRINKING AND SANITARY WELLS
OUTSIDE A DESIGNATED GROUNDWATER BASIN
This form is to be completed when applying for an exempt well permit for commercial drinking and sanitary uses
as described in section 37-92-602(1)(c), C.R.S.
For all commercial drinking and sanitary wells:
• The use of the water diverted is limited to inside drinking and sanitary facilities in an individual
commercial business. No uses outside of the building are permitted.
• The pumping rate shall not exceed 15 gallons per minute.
In addition:
For a well permit to construct a new well, or for a well permit to use an existing well for commercial
drinking and sanitary purposes where the well was not put to such beneficial use prior to May 8,
1972, refer to State Engineer Policy 1985-1 for further qualifying requirements. When completing
this form, it is important to note the following:
• The amount of groundwater diverted shall not exceed 1/3 acre-foot annually (108,600 gallons). The
applicant must support the well permit application with evidence that the proposed use will not create
a demand greater than 1/3 acre-foot/year.
• 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 annually or upon
request.
• This form is to be submitted in conjunction with a General Purpose Application form GWS-45.
For a well permit for an existing commercial well put to beneficial use for drinking and sanitary
purposes prior to May 8, 1972, refer to State Engineer Policy 1990-1 for further qualifying
requirements. When completing this form, it is important to note the following:
• The amount of ground water diverted shall not exceed one (1) acre-foot annually (325,900 gallons).
The applicant must support the well permit application with evidence that the proposed use will not
create a demand greater than one (1) acre-foot/year.
• 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 annually or upon
request.
• This form is to be submitted in conjunction with a Registration of Existing Well form GWS-12.
CONDITIONS VARY STATEWIDE
MEETING THE ABOVE CONDITIONS DOES NOT GUARANTEE THE ISSUANCE OF A PERMIT
If you have questions, contact the Denver Office or the Division Office where the well is located or submit a
question at: AskDWR - Exempt Commercial for assistance. Contact information is available from our website at:
https://dwr.colorado.gov/about-us/contact-us.
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