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Home My WebLink About978257I/NI:ULNI TWP IVIV RNG Dvn SEC NEY4 NWY SW% SE% TOTAL NEYa 1 NWYaI SW%I SEY4 NE% I NWY4I SWY4I SEV4 NEY4 I NWY4I SVY% I SE% NE% I NWY4I SWY4I SEY4 The water from this well is used for Miscellaneous Use (a bathroom) at the Scalehouse, contained within the following area: -incoln County Solid Waste Facility 34N 119W 36 X ,....-e FORM U.W.5 Rev. 9/09 Excel FILING FEE SCHEDULE ON REVERSE SIDE STATE OF WYOMIN OFFICE OF THE STATE ENGIN ER HERSCHLER BLDG., 4 -E CHEYENNE, WYOMI G 82 02 (307) 777 -6163 APPLICATION FOR PERMIT TO APPROPRI!ITE ROUND WATER APPLICATION FOR WELLS AND SPRINGS Note: Only springs flowing 25 gallons per minute or less, w ere th proposed use is Domestic and /or Stock Watering, will be considered as gro nd wa er appropriations. FOR OFFICE USE ONLY PERMIT NO. U.W. 202640 WATER DIVISION NO. 4 DISTRICT 12 U.W. DISTRICT Lincoln County NAME AND NUMBER OF WELL or SPRING Enl. Combustor Building #1 1. Name of applicant(s) Lincoln County Commissioners 2. Address of applicant(s) 925 Sage St. Kemmerer (MAILING ADDRESS) (CITY) 3. Name address of agent to receive correspondence and notices Lincoln Coun 925 Sage St. (MAILING ADDRESS) Kemmerer WY (CITY) (STATE) 4. Use to which the water will be applied: Domestic: Use of water in 3 single family dwellings or less, noncom totalling one acre or less. Number of houses served? n Stock Watering: Normal livestock use at four tanks or less within one mile and commercial feedlots are a Miscellaneous use. Numb Irrigation: Watering of any lands for agricultural purposes not scale lawn watering of golf courses, cemeteries, recreatio Municipal: Use of water in incorporated Towns and Cities Note: use divisions, improvement districts, mobile home parks, etc. a permit may be required by the Wyoming Depertnient of will be classified as a public water supply under the WDE 1 Monitor, Observation Note: a WDEQ permit may be required. 20.640 83101' Temporary Filing o. U.W. NOTE: o not TIold this form. Use typewriter or print neatly ith bla'Ck ink. ALL IT MS MUST BE COMPLETED BEFORE APPLICATION IS ACCEPTABLE E 1 U. (.t) I (Z•45 B o QOd I l'on eL( p0inds agl.A st' lot. V OjI.t IAtl:'I`r 1ru Phone (Z P) (STATE) Attn: Vlary Crosby ercial f wate re clas nviron 0 's rule Industrial: Long term use of water for the manufacture of a product or produ Book o. n 5. Location of the well or spring: (NOTE: Quarter quarter (40 acre subdivision) MUST .e sho 12, Township 14 North, Range 68 West.) 6:)S- 1'4.4-•BLtAGLO 8 -zo z.o Om. Lincoln County, NE 1/4 NE 1/4 of Sec. 36 T. 34 Wyoming. If located in a platted subdivision, also provide Lot/Tract —99 4+ :lock Subdivision (or Add'n) of Lincoln County Resurvey Lot ation: 6. Estimated depth of the well or spring is 200 feet. Estimated produ tion in 25 .pm U 7. (a) MAXIMUM instantaneous flow of water to be developed and beneficially used: NOTE: If for Domestic and or Stock watering use, this application will be processes for a spring, after approval of this application, some type of artificial diversion or improve ent m N/A U.W. 112 53 (b) MAXIMUM volumetric quantity of water to be developed and beneficially used p' r cale Circle appropriate units: r (Gallons, (Acre Feet) A four person family utilize appro or 325,000 gallons. 8. Mark the point(s) or area(s) of use in the tabulation box below. Note: Upper row ref rs to t refers to the quarter of the quarter section. WY 83101 1456 I T /7S 'Ud /a 4-3.5.4(13 (ZIP) Phone 307 877 -2095 atering of lawns and gardens f well •r spring. Stock watering pipelines r of sto''k tanks? d by th definition of domestic use (large areas etc., are Miscellaneous uses). in unincorporated towns, sub ified are miscellaneous uses. Note-- ental Quality (WDEQ) if the well and regulations. I tion of oil /gas or other minerals (oil field water flood operations, power plant water supply, etc.). (sescribe in REMARKS) I I Miscellaneous: Any use of water not defined under previous definitions s ch as -tock- watering pipelines, subdivisions, mine dewatering, mineral /oil exploration drilling, potable s pplies n office, etc. (Describe in REMARKS). Note: a permit may be required by the WDEQ if the well ill be classified as a public water supply under the WDEQ's rules and regulations. Coalbed Methane Water produced in the production of coal bed methane g s. Note used in the production of coal bed methane gas will require a permit from the Wyoming )iI and as Conservation Commision. erval is 150 ft. to 200 ft. W. 112453 25 gpm Total 0 This Enl. gallons per minute. dar year: imately one (1) acre -foot of water per year e quarter of the section. Next row m 0° D 0n m. CO G) C m r rn T o m n w 0 3« 2 (j 0 n no p m o z 0 CO G1I 0 N 0 a Test Well: (Describe in REMARKS) n. EXAMPLE: SE 1/4 NW 1/4 of Sec. R. 119 W. of the 6th P.M. (W.R.M,), of the -River--Berftl-Meadowatcl- ract (or Lot) g -20 -204 61 aximum of 25 gallons per minute. For a st be constructed to qualify for a water right. N/A Total 10,000 gallons This Enl. '9 0 01 9. If for Irrigatic... I ,f a. Describe MAXIMUM acreage to be irrigated in each 40 acre subdivision in the tabulation box aboVe.' b. n Land will be irrigated from this well only. c. Land is irrigated from existing water right(s) with water from this well to be additional supply. Describe existing water right(s) under REMARKS. 10. If for Irrigation use, describe method of irrigation, i.e. center pivot sprinkler, flood, etc.: N/A 11. The well or spring is to be constructed on lands owned by r K Co Li urz (The granting of a permit does not constitute the granting of a right -of -way. If any easement or right -of -way is necessary in connect on with this application, it should be understood that the responsibility is the applicant's. A copy of the agreement should accompany this application, if the land is privately owned and the owner is not the co- applicant.) 12. The water is to be used on lands owned by •Lt P,[n CO L [17 (If the landowner is not the applicant, a copy of the agreement relating to the usage of the appropriated water on the land I should be submitted to this office. If the landowner is included as co- applicant on the application, this procedure deed not be followed.) NOTE: Water rights attach to the area(s) and /or point(s) of use. REMARKS: This enlargement is necessary to cover additional points of use noted during a June 24, 2014 field inspection by George Moser. Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true, correct and complete. 4,0 Li Signature of Applicant or DOMESTIC AND /OR STOCK WATERING USES (Domestic use is defined as use of water in 3 single family dwellings or less, noncommerical watering of lawns and gardens totaling one acre or less.) COAL BED METHANE USE IRRIGATION, MUNICIPAL, INDUSTRIAL, AND MISCELLANEOUS USES MONITOR (For water level measurements or chemical quality sampling) or TEST WELL USES THE STATE OF WYOMING SS. STATE ENGINEER'S OFFICE This instrument was received and filed for r cord on the 20 14 at o'clock M. Permit No. U.W. 2 026 4 0 THIS IS TO CERTIFY that I have examined the foregoing application and do hereby grant the sav subject to the following limitations and conditions: This application is approved subject to the condition that the proposed use shall not interfere with any existing rights to ground water from the same source of supply and is subject to regulation and correlation with surface water rights, if the ground and surface waters are interconnected. The use of water hereunder is subject to the further provisions of Chapter 169, Session Laws of Wyoming, 1957, and any subsequent amendments thereto. Granting of a permit does not guarantee the right to have the water level or artesian pressure in the well maintained atl any specific level. The well should be constructed to a depth adequate to allow for the maximum development and beneficial use.of ground water in the source of supply. If the well is a flowing artesian well, it shall be so constructed and equipped that the flow may be shut off when not in Use without loss of water into sub surface formations or at the land surface. Coal Bed Methane wells have Additional Conditions and Limitations on attachment sheet. axe volse..ue,41 c. ptia.JiiYr Tr This permit serves to enlarge an existing well for additional points of use only and establish /alid water right for the same. STATEMENT OF COMPLETION WAIVED. ne limit for Completion of Beneficial Use are waived. Approval of thin application may be considered as authorization to proceed with construction of the proposed woll or spring. A Statement its of completion of construction, including pump installation. horizZd Agent IF WELL WILL SERVE MULTIPLE USES, SUBMIT ONLY ONE (THE HIGHER) FILING FEE. l Witness my hand this 7 7 1- 4_ day of D ate THE LEGALLY REQUIRED FILING FEE MUST ACCOMPANY THIS APPLICATION THIS SECTION IS NOT TO BE FILLED IN BY APPLICANT f day of er 20 )7 $50.00 $50.00 $75.00 No Fee Completion of construction and completion of the beneficial use of water for the purposes specified in Item 1 of this application ccmbcr 31, 20 The amount of appropriation shall be limited to the quantity to which permittee is entitled as determined at the time of proof of application of water to beneficial use. t A.D. 20 RRELL y. PATRICK T. T to Engineer vs f A.D. JRM U.W.8 ev: 1 -05 Excel /ATER DIVISION `1 2N ERMIT NO. U.W. AME OF WELL Enl. Combustor Building #1 Name of Claimant(s) Lincoln County Commissioners Address 925 Sage St. Kemmerer, WY For What Purpose(s) is Water Used? Use: Miscellaneous Use: If use is for irrigation, give date irrigation was completed on all lands under this Permit: NDUSTRIAL WELLS JIUNICIPAL WELLS Said Quadrangle map showing the well location and area(s) or point(s) of use mus licensed to practice within the State of Wyoming. 202640 STATE OF WYO OFFICE OF THE STATE ENGIN ER PART I Date First Used: Use: SEE RL,... SIDE U.W. DIS DATE 0 LOCATI EO PROOF OF APPROPRIATION AND BENEFICIAL U The owner is responsible for submitting Parts I and II of this form. Part III will be prepared b�y a Stat jEngineer Representative at time of inspection. Date PART II For Irrigation, Industrial, Municipal and Miscellaneous ells A plat which has been certified by a licensed professional engineer or land surveyor sha.1 be su e in accordance with W.S. 33 -29 -139 or Chapters V and VI, State Engineers Office Regulations and I be map shall be prepared with waterproof black ink on tracing linen or an acceptable equivalent and sh ie accurate location of the well or wells, storage facilities, main canals, streams, highways and o her imp ;town, if there is more than one owner under the permit. RRIGATION WELLS Acreage irrigated under terms of this permit will be clearly shown with a distinctive pat ern and laving an original supply and those provided an additional supply. Where use is for additional s ipply fo ze priority or permit number of the source, the source of supply and the name of the ditch, pipe line, or escribed. Indicate method of irrigation being used. NOTE: Do not fold this form. Use type writer or print neatly with black ink. I G GROUND WATER RICT None CLirtGo`vl acxkvlt PRIORITY A Iti IA51 t 2.0 t" N NE NE of Section 36 T. 34 N., R. 119 W. 31,4 zcoci Date First Used 20 2014 rst Used: Zip Code 83101 In addition to the information outlined above, industrial users will locate and describe conveya 'ce facilities to the point(s) of use, giving as .ccurately as possible the location of point(s) of use. Permits for other sources of water must be identifie The plat will show the area of use and show and describe the means of conveyance of ff e water from the well to the connection with the nunicipal water system distribution network. ;flitted to accompany this form. The plat shall tructions (Minimum scale shall b'e-2'.' 1 mile). 1 show on a suitablescale'the legal subdivisions, rtant cultural features. La ownership'shall,be r v^ a distinction clearly madeb lands with a right from `another source, indicate ther well. Conveyance system will be shown and VIISCELLANEOUS WELLS 1) The linen plat for wells where the use is described as miscellaneous and where the yield or flow oft `e well exceeds twenty -five (25) gallons per minute must show the area of use and describe and show the means of conveyance fiom the well to he distribution system and /or points of use. 2) The plat for wells where the use is described as miscellaneous and where the yield or flow is twenty 'five (25) gallons per minute or less may be a 7 1/2 minute United States Geological Survey Quadrangle snap in lieu of a linen tracing provided th.t the Quadrangle map is in compliance with the following conditions: The entire Quadrangle map must be submitted to the State Engineer's Office. The scale on said Quadrangle map must be one to twenty -four thousand. An identified section corner or quarter corner must be shown on said Quadrangle map aloe g with Section, Township and Range. The section in which the well is located and the section(s) where the area(s) or point(s) of se are located must be subdivided into forty (40) acre tracts and the well location and area(s) or point(s) of use clearly labeled and db scribe be cert fled by a professional engineer or land surveyor "CERTIFICATE OF OWNERSHIP" FROM THE COUNTY CLERIC'S OFFICE OR A COPY OF THE RECORDED PROPERTY DEED -JOWING OWNERSHIP OR CONTROL OF LAND(S) INVOLVED MUST ACCOMPANY THIS FORM. nder penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is true, correct, acid complete. Signature of Owner or Authorize Agen Date �l 1C G 18 2014 ate of Receipt: 20 20/V FORM UW: C &L, G Rev: 11 -17 -2000 PERMIT NO. U.V. 20264 T.F. No. U. W. 43 -5 -473 PERMIT STATUS Priority Date August 18, 2014 A August 18, 2014 Proof of Beneficial use on July 1, 2009 received. 0 pprovll DateAUG 2 5 21314