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Home My WebLink About20223494.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 Office Use Only Form GWS-45 (01/2020) Vicki Knudson 6. Use Of Well (check applicable boxes) Mailing address 14971 Vine St City Thornton State CO Zip code 80602 Attach a detailed description of uses applied for. ■❑ Industrial ❑ Municipal ■❑ Irrigation ■❑ Commercial ❑ Dewatering System ❑ Geothermal (production or reinjection ❑ Other (describe): Telephone # (area code & number) 720-841-7275 E-mail (online filing required) Michael.dente@kw.com 7. Well Data (proposed) Maximum pumping rate 150 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Well ❑ Use existing well ❑ Change or increase use ❑ Reapplication (expired permit) ❑ Other: gpm Annual amount to be withdrawn Maximum -Allowed acre-feet Total depth TBD feet Aquifer Laramie -Fox Hills 8. Land On Which Ground Water Will Be Used 3. Refer To (if applicable) Well permit # Water Court case # Designated Basin Determination # Well name or # 4. Location Of Proposed Well County Weld SE 1/4 of the SE 1/4 Legal Description of Land (may be provided as an attachment): PT SE4 33-1-67 LOT A REC EXEMPT RECX16-0028 (If used for crop irrigation, attach a scaled map that shows irrigated area.) A. # Acres 19.97 Section 33 Township 1 Nor S IXIfl Range E or W 67 i Ei Principal Meridian 6th B. Owner Vicki Knudson Distance of well from section lines (section lines are typically not property lines) 425 Ft. from fl N (x S 1,037 Ft. fromMX E ❑W C. List any other wells or water rights used on this land: For replacement wells only— distance and direction from old well to new well feet direction 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 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 rl Zone 12 orEl 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 509414 Northing 4427931 Remember to set Datum to NAD83 Vicki Knudson, Kennard Kundson Date (mm/dd/yyyy) 08/04/2022 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) USGS map name DWR map no. Surface elev. A. Legal Description (may be provided as an attachment): PT SE4 33-1-67 LOT A REC EXEMPT RECX16-0028 B. # of acres in parcel 19.97 C. Owner Vicki Knudson, Kennard knudson D. Will this be the only well on this parcel? xM YESE NO (if no list other wells) E. State Parcel ID# (optional): AQUAMAP WE WR CWCB TOPO MYLAR SB5 Receipt area only DIV WD BA MD 146933400039 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 Forfurther information please visit dwr.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 14 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. TO ODD CREEK -VILLAGE September 19, 2022 RE: Conditional Will Serve Letter for Parcel Number 146933400039 Weld County, Colorado — Dear Ken & Vicki Knudson, Mr. Bob Demaree has indicated that he is the owner's representative of Parcel Number 146933400039 Weld County, Colorado (the "Property"). The listed property owners are KENNARD M KNUDSON and VICKI J KNUDSON so this will -serve letter is being sent to you. The Property is located on the North side of WCR 2 between WCR 17 and WCR 19 in Weld County, Colorado. The Property is located within the service area of Todd Creek Village Metropolitan District ("TCVMD"). It is the understanding of TCVMD that you may develop the site (the "Site"). Therefore, this Site is the subject of this conditional will serve letter from TCVMD. TCVMD is willing and able to provide potable and non -potable water service and sanitary sewer service to the Site (the "Service") for either residential or commercial uses subject to the following conditions, which shall be conditions precedent to any obligation on the part of TCVMD to provide such Service: 1. You shall pay TCVMD's then current water tap fees and all other fees, rates, tolls and charges imposed pursuant to TCVMD's then current rules and regulations. 2. You shall design, construct, acquire easements and install any and all infrastructure required or deemed necessary by TCVMD to provide Service to your Property (including but not limited to: service taps, service lines, mainlines or any other improvements and facilities required, including any permits or improvements required by Weld County for work within County R.0.W.). You shall design all such infrastructure according TCVMD's design standards and in accordance with TCVMD's rules and regulations. Further, you shall reimburse TCVMD for any and all costs it incurs related to its review of the infrastructure design, construction and installation, including reimbursement of its engineers and consultants. 3. This Conditional Will -Serve Letter, as it relates to sewer service availability, is subject to the District receiving approval of its pending application with Metro Water Recovery to be deemed a "Special Connector" that is allowed to utilize Metro Water Recovery's sewer services. TCVMD will provide you with non -monetary assistance in your acquisition of easements necessary to provide for offsite infrastructure to allow TCVMD to provide Service to the Property. In addition, TCVMD will provide the terms of, and administer, reimbursement or L TODD CREEK VILLAG:E cost recovery agreements related to the installation or upsizing of offsite facilities or infrastructure designed and constructed by you benefiting future development receiving Service from TVCMD. The standard life span of such reimbursement agreements is ten years. Potable and non -potable water service will be provided to the Site subject to and conditioned upon the terms of the TCVMD's rules and regulations as they may be amended from time to time and the payment of all fees, rates and charges imposed thereunder. This commitment shall run only to the Site and shall not be transferrable or assignable in any manner whatsoever. This conditional will serve commitment shall not be effective until you purchase a tap from TCVMD indicating your willingness to be bound by the terms set forth herein. If you have any follow-up questions or concerns, please do not hesitate to contact me. Very truly yours, Todd Creek Village Metropolitan District Don Summers General Manager, Todd Creek Village Metropolitan District cc: Blair Dickhoner, District Counsel Todd Creek Village Metropolitan District - Board of Directors Hello