Free OFFICE OF THE STATE ENGINEER - Colorado

OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES 303-866-3581

FOR OFFICE USE ONLY DAM NAME _________________________________ NO.____________ WATER DIV: ______ DIST:_______

NOTICE OF INTENT TO CONSTRUCT A NON-JURISDICTIONAL WATER IMPOUNDMENT STRUCTURE1
This notice is required per Section 37-87-125, C.R.S. (1998). This notice must be submitted to the Division Engineer's Office a minimum of 45 days prior to construction.
(PLEASE PRINT OR TYPE NOTICE)

OWNER INFORMATION Name: _________________________________________________________Telephone: (_________)______________ Address: _________________________________________________________________________________________ Street / P.O. Box/ Rural Route City State Zip Code Responsible Person: _____________________________________________Telephone: (________)_______________ Address: _________________________________________________________________________________________ Street / P.O. Box/ Rural Route City State Zip Code Contractor: ____________________________________________________ Telephone: (________)_______________ STRUCTURE INFORMATION Name of Dam: _________________________________________ Water Division: __________ Water District:________ Location : Option 1 OR Option 2
2

¼ / ¼ Sect: ________ ¼ of the ________ ¼; Sect: _____, Township: _____, Range: _______, ___ P.M. Distance of dam from Section lines ____________ft from N S, ____________ft from E W Utilizing GPS: Set to UTM Datum. Measured on crest of dam above streamline/outlet. Northing __________________m. Easting _____________________m. Note: GPS settings must be NAD83 CONUS.
3

Dam Dimensions: Vertical Height : ________ft., Length: ___________ ft., Slopes: U/S: ____ H:1V, D/S _____ H:1V Reservoir: Surface Area : ___________acres, Capacity : _____________acre feet, Drainage Area: __________acres Emergency Spillway: Width: ___________ ft., Side Slopes: ___________ H:1V, Freeboard :_______ft Outlet Drain: Type: ___________________________, Size:______inches, Location: ____________________________ Stream Name or Water Source : _____________________________________________________________________ Proposed Water Use: __________________________________ Water Court Case No. (If applicable) _______________ ___________________________________________________ Signature of Owner Date DIVISION ENGINEER'S REQUIREMENTS: ___________________________________________________________________
5 4 1 1

DWR (03/07)
1 2 3 4 5

Signature of Division Engineer
Please see example on reverse side (or page 2) of this form.

Date

A "Non-Jurisdictional Structure" is a dam creating a reservoir with a capacity of 100 acre-feet or less and a surface area of 20 acres or less and a vertical height (see footnote 3) of 10 feet or less. "Vertical Height" is measured from the elevation of the lowest point of the natural surface of the ground where that point occurs along the longitudinal centerline of the dam up to the crest of the emergency spillway of the dam. "Freeboard" is the vertical distance from the bottom of spillway to the crest of the dam. If construction in reservoir intercepts groundwater, a well permit is required. (Well permit applications can be found at www.water.state.co.us/pubs/forms.asp)

LOCATION SPECIFYING EXAMPLE 26 25 30

NW

NE

35
SW

36
NW

31
NE¼ of the SE¼

SW

SE
1,500 ft.

1,000 ft.

T2N T1N

Dam Location

2

1
R67W R66W

6

Section 36, Township 2 North, Range 67 West, 6th PM (S36 T2N R67W)
Dam is located in the SE¼ of the SE¼ of Section 36 1,000 feet North of the South Section Line 1,500 feet West of the East Section Line