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Home My WebLink About191209-KnutsonWaterRightsAppnFill inthe form online byclicking in the appropriate field and typing, Print the completed application and mail in one signed copy of the form with fees and supporting documents. You will not be able to save your data entry online, so print an extra copy for yourself. DIVISION OF MINING, LAND AND WATER Alaska Department of WATER RESOURCES SECTION NATURAL RESOURCES Anchorage Office 5bOWest 7mAvenue, Suite 1O20 Anchorage, AK0S501-3SS2 (907)269-8600 Fax: (SU7)2GQ-88O4 Juneau Office POBox 111O20 Juneau, AKSS811-1O20 4OUWilloughby, #4UO (087)465-3400 F For ADNR Use Only 300Airpo Way Fairbanks, AKAQ7OQ (907)451-2705 For ADNR Use Only QatelTimeStanp INSTRUCTIONS ,-/1 Complete one application for each water source. Incomplete applications will not be accepted. ,,-2. Attach a copy of an executed deed, lease agreement, or other possessory interest document for property where water will be used (applicant must own, lease, or obtain written authorization to use water on property). ,e3. Attach copy of legal access document (i.e. right-of-way, easement, permit) or application for legal access to water withdrawal point and transport route, if applicable, or copy of request or application for legal access to water withdrawal point. ,,<4. Attach driller's well log for drilled wells (if already drilled and available). v-5. Attach sketch, photos, plans of water system, or project description (if applicable). 6. Attach legible map that includes Meridian, Township, Range, and Section lines such as a subdivision Plat, USGS topographical quadrangle, or borough tax map. Indicate location of water withdrawal, route of water transmission, water use area boundary, points of water use within boundary, and point of water return flow (if applicable). �7. Attach copy of approved ADEC Water and Wastewater system certificate (if applicable). -8. Attach copy of ADF&G Fish Habitat Permit (if applicable). 'S. Attach completed and notarized Statement of Beneficial Use of Water form and associated fee if water system and water use are fully developed. A0. Submit the non-refundable fee (see page 4) APPLICANT INFORMATION PEDRO BAY VILLAGE COUNCIL JOEL GROVES / POLARCONSULT ALASKA, INC. Organization Name (if applicable) ]��A�J ��| ��\�|N|�T��T�l�\ --. .. ' _- - --' __ (ADMINISTRATOR) . . ~ `. .~. ./ Individual Applicant Name (if applicable) PO BOX 47020 9O7-85 Daytime Phone Number 907-850-2221 Fax Number (if available Agent orConsultant Name (if applicable) Individual Co -applicant Name (if applicable) PEDRO BAY AK 99647 City State Zip Code � ��-�7�_^_1~-� �^~ Alternate Phone Number ¢phnmaU J.BAALKE@PEOROBAY.COk8.JDEL@POLARCONSUL[NET E-Mail Address (optional) 102-102 (Rev.an8) Page 1m4 PROPERTY DESCRIPTIONS Location of Water Use Subdivision Name or Survey Number Lot, Block, or Tract Meridian Township Range Section Quarter Sections UNSUBDIVIDED SECTION SEWARD T4S R28W 20 QQ Q 1/4 Location of Water Source Subdivision Name or Survey Number Lot, Block, or Tract Meridian Township Range Section Quarter Sections UNSUBDIVIDED SECTION SEWARD T4S R28W 16 Z YQ Location of Water Return Flow or Discharge if applicabi Geographic Name of Water Body or Well Depth Meridian Township Range Section Quarter Sections KNUTSON CREEK AT RM 1.29 SEWARD T4S R28W 20 QQ Q 1/4 WATER SOURCE DESCRIPTION Ground Water Type (e.g. drilled, d epth (in feet) Static Water Level in feet) Date Completed Well Yield (in gpm) N/A 77 Surface Water Type (e.g. stream, lake, spring) Geographic Name (if named) STREAM K NUT S 0" N C R E E K" METHOD OF TAKING WATER (IF KNOWN) Pump Pump Intake Inches Pump Output GPM Hours Working Length of Pipe Hours/Day Feet (from pump to point of use) Gravity Pipe Diameter 24 Inches Head 200 Feet Length of Pipe 61300 Diversion Rate . 20 Feet (take point to point of use) [:]GPM orNCFS Ditch L D W Feet Diversion Rate DGPM orCFS F-1 Reservoir L D IN Feet Water Storage AF Dam L (95-D H f W Feet Water Storage t AF (AT DESttlf-j 102-102 (Rev. 6118) Page 2 of 4 AMOUNT OF WATER Common dater Uses and Standard Amounts Type of Use How Many Standard Total Amount Months of Use Amounts Requested Begin End Fully Plumbed Single-family Home (includes irrigation of 10,000 sq. ft.) # Homes X 500 GPD = Partially Plumbed Single-family Home (no hot water heater) # Homes X 250 GPD = Unplumbed Single-family Home (hand carry water) # Homes X 75 GPD _ Duplex or Triplex # Bldgs. X 1000 GPD = Four-plex and Larger Housing # Units X 250 GPD = Motel or Resort # Rooms X 150 GPD = Work Camps ` # People X 50 GPD = Domestic Irrigation 250 GPD per # Sq. ft. X 10,000 Sq. ft. _ Non -domestic Irrigation � # Acres X 0.5 AFY = Other Water Uses Type of Use How Amount Total Amount Months of Use Many Requested Begin End HYDROELECTRIC GENERATION 1 X 20 CFS = 20 CFS JAN DEC X = Type of Use Total Amount Months of Use Requested Begin End Expected date for water system and water use to be fully developed or date when existing use started OCT. 2022 Note: Pursuant to AS 46.15.180(a)(1). Crimes, a person may not construct works for an appropriation, or divert, impound, withdraw, or use a significant amount of water from any source without a permit, certificate of appropriation, or authorization issued under this chapter. 11 AAC 93.040 sets out the required information on an application for a water right. AS 38.05.035(a) authorizes the director to decide what information is needed to process an application for the sale or use of state land and resources. This information is made a part of the state public land records and becomes public information under AS 40.25.110 and 40.25.120 (unless the information qualifies for confidentiality under AS 38.05.035(a)(8) and confidentiality is requested, AS 43.05.230, or AS 45.48). Public information is open to inspection by you or any member of the public. A person who is the subject of the information may challenge its accuracy or completeness under AS 44.99.310, by giving a written description of the challenged information, the changes needed to correct it, and a name and address where the person can be reached. False statements made in an application for a benefit are punishable under AS 11.56.210. In submitting this form, the applicant agrees with the Department to use "electronic" means to conduct "transactions" (as those terms are used in the Uniform Electronic Transactions Act, AS 09.80.010 — AS 09.80,195) that relate to this form and that the Department need not retain the original paper form of this record: the department may retain this record as an electronic record and destroy the original. 102-102 (Rev. 6/18) Page 3 of 4 SIGNATURE The information presented inthis application istrue and correct tothe best of my knowledge.|understand that per 11/V\C 93.040 and 11 AAC 93.050 additional information may be required by the department to adjudicate this application. Failure to provide requested information could result in this file being closed. Signature |(��/ D. ��(�\/�� ' GROVES ° �� Make checks payable to"Alaska Department ofNatural Reeourcea"- ��(��N�� O1� ��^_^^`_.°.`^�_. ~ °' °-° .~, Date �� / ��J/�|�� AGENT . , ^_.~��."^_^_. ^ Title (if applicable) " $100 for one single-family residence or duplex, or for water use associated with one single-family residence or duplex. " $1,600 for up to 60 hours of staff time, for activities related to oil and gas and associated substances. ° $j,5DRfor up&o0O hours Ofstaff time, for activities related tolocatable mining. 6'_$1,500 for up to 60 hours of staff time, for hydroelectric power generation capacity greater than 100 kilowatts. ° $1.5nDfor upto OO hours ofstaff tinne, for water removal out of8 hydrologic unit under A84O.15.O35 or 46.15.037. ~ $26Ofor 5.00OGF`Dorless for ause not listed above. ~ $565 for greater than 5,000 GPD and no more than 30,000 GPD for a use not listed above. " $GSOfor greater than 3O.O0OGPOand nomore than 1OO.00OGPDfor ause not listed above. " $1,i25for greater than 1OO.00OGPOfor 8use not listed above. REFERENCES Measurement Units GPD gallons per day CFS cubic feet per second GPM gallons per minute AFY = acre-feet per year (325,851 gallons/year) AFD = acre-feet per day (325,851 gallons/day) MGD = million gallons per day Conversion Table 102-102 (Rev.sn8) Page *of+