HomeMy WebLinkAbout20231415.tiffCOLORADO 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
TJ Gill
Mailing address
917 Mulberry Ln
City
Bellaire
Telephone # (area code & number)
1-403-874-7180
State Zip code
TX 77401
E-mail (online filing required)
tj.gill@voltagrid.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:
15
Total depth
850
7. Well Data (proposed)
Maximum pumping rate Annual amount to be withdrawn
gpm
1.53 acre-feet
Aquifer
feet Laramie -Fox Hills
3. Refer To (if applicable)
Well permit #
N/A
Designated Basin Determination #
N/A
Water Court case #
N/A
Well name or #
N/A
4. Location Of Proposed Well
County
Weld
Section Township
20 2
NW 1/4 of the SW 1/4
N or S Range E or W Principal Meridian
rl rl 64 ri El 6th
Distance of well from section lines (section lines are typically not property lines)
274 Ft. from [ N fl s 413 Ft. from E ❑W
For replacement wells only — distance and direction from old well to new well
N/A feet N/A
Well location address (Include City, State, Zip) ❑ Check if well address is same as in Item 1.
direction
Currently no address for property. (See location above)
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)
Lot B, Recorded Exemption RE -3024
SW 1/4 of Section 20, Township 2N, Range 64W, 6th P.M.
Water to be used for drinking, sanitary, and truck washing
(If used for crop irrigation, attach a scaled map that shows irrigated area.)
A. # Acres B. Owner
7.00 Voltagrid, LLC
C. List any other wells or water rights used on this land:
N/A
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)
TJ Gill 01/12/2023
If signing print name and title
Director Facilities and Natural Gas Processing
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)
Lot B, Recorded Exemption RE -3024
Being a part of the SW 1/4 of Section 20, Township 2 North,
Range 64 West of the 6th Principal Meridian
B. # of acres in parcel C. Owner
7.00 Voltagrid, LLC
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
USGS map name
AQUAMAP
WE
WR
CWCB
TOPO
MYLAR
SB5
DWR map no. Surface elev.
Receipt area only
DIV WD BA MD
130520000013
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