__ MU or QM:
|
[] will complete construction within 20 years |
|
[] Fujii reviewed recomendations:_________________________________________ |
__ Is the application complete? [] No [] Yes
__ Prohibited by ORS 538? [] No [] Yes If so, do not do an IR; return
the application & fees to the applicant.
__ DIV 9 [] will likely be available... [] will not likely be available...[]
will, if properly conditioned...
[] classify as surface water well ___________________ has PSI with _________________________ (include basin map if true) well __________ is within [] 1N 3E 20,21,28,29 [] GWLA [] CGWA _____________ GW conditions: _________________________________________________________________________ Ground Water Restricted Area(s):
Groundwater Mitigation - Upper Deschutes
__ Division 33 [] NA [] No
[] allowed 4/15 ~ 9/30
[] Division 33 Area(s):Statewide, Upper Columbia
__ SW Availability [] NA [] 80% live [] 50% storage _________________________________________________
WID(s):
<a href="http://apps.wrd.state.or.us/apps/wars/wars_display_wa_tables/display_wa_table.asp?ws_id=0&exlevel=80" target="_blank"> (0)</a> <a href="http://apps.wrd.state.or.us/apps/wars/wars_display_wa_tables/display_wa_table.asp?ws_id=30530643&exlevel=80" target="_blank">DESCHUTES R > COLUMBIA R - AB SHITIKE CR (30530643)</a> <a href="http://apps.wrd.state.or.us/apps/wars/wars_display_wa_tables/display_wa_table.asp?ws_id=70753&exlevel=80" target="_blank">WHYCHUS CR > DESCHUTES R - AT MOUTH (70753)</a>
[] Use DWF's nonstandard W/A memo if the source is a Drews Reservoir tributary;
the Snake River; the Columbia River; the North Umpqua River below Rock Creek; or
within the drainages of the Lost River, Chehalem Creek, or Champoeg Creek (including
Mission & Case Creeks)
__ POU Conflict? [] NA [] No, different sources [] No, make up a deficiency in rate [] No, existing not at max rate
[] Yes _____________________________________________________________________________
__ Use is supplemental, checked for primary rights [] NA
[] Yes limits ________________________________
__ Use is [] allowed [] not allowed [] limited
[] OAR [] Compact __________________________________
__ |
Requested Use/Rate Season |
__________________________________________________________________________ |
|
Allowed Use/Rate/Duty |
__________________________________________ |
Limit |
_____________ |
Duty
| _____________ |
__ Land use : []approved [] not approved []
being pursued [] county notified [] NA
__ Storage Contracts: [] NA [] BOR [] Doug County []
Corp of Eng [] needed [] obtained __________________
__ Authorized agent specified: [] NA [] needed []
Yes ________________________________________
__
Conditions: _______________________________________________________________
[] Small ≤ 0.1 CFS, ≤ 9.2 AF, [] Medium > 0.1 and < 1.5 CFS, > 9.2 and < 100AF, [] Large ≥ 1.5 CFS, ≥ 100 AF Use “Medium” when the source is Siltcoos Lake, Sandy Basin ground water, or stored water with a contract. Use “Large” when permit has temp control (including NU) or HC above a SWW, Tenmile Lake, or when the applicant is a government entity Use “Large-7g” or “Large-7i” if GW recommends 7g or 7i Use “Large with totalizing flow meter” for IR permits in South Salem Hills or IR over 10 Ac. in Stage Gulch CGWA
__ Stream withdrawn [] NA [] No [] Yes, allows
use/season
Area(s):
__ Basin Maps have been checked [] NA [] Yes limits
________________________________________________________
__ SWW [] ABOVE [] WITHIN [] NA (If above or within, notify Parks.) Name
Scenic Water Way(s): , ABOVE The Deschutes Scenic Waterway, WITHIN The Deschutes Scenic Waterway
__ Use is within a high priority area for streamflow restoration? [] NA
[] No [] Yes
Priority WAB(s): DESCHUTES R ab SHITIKE CR (OWRD: Good, ODFW: Moderate) (30530643) SQUAW CR @ mouth (OWRD: Very good, ODFW: High) (70753)
__ Letter format [] Good [] Limited [] Bad [] Bad w/ rate
reduction opportunity [] Bad w/ HC opportunity
__ POD is within North Umpqua settlement reach and the spreadsheet was updated ? [] NA [] Yes
__ Forms [] NA [] DIV 33 [] basin map [] HC except
[] spring description [] other _______________________________
__ Copy to |
[] NWR
|
[] WM# ___ |
[] ODFW |
[] CRIFC |
|
[] NCR
|
[] Agent |
[] DEQ |
[] US Fish & Wildlife |
|
[] ER |
[] CWRE |
[] DOA |
[] NW Planning Council |
|
[] SWR
|
|
[] State Parks |
[] CTUIR |
|
[] DOA Food Safety Division (bottled water) |
[] City ______________________ (w/in 5-mile muni wells) |
|
___________________________________________________________________________________ |
|
___________________________________________________________________________________ |
__ Any affected land owners? _________________________________________________________
__ Prior to permit, applicant must submit [] NA [] storage contract
[] easement [] plans/specs [] evidence of well repair
__ App and map meet min. requirements | [] Yes [] No _________________________________________ |
| (If not, send IR certified.) |
__ Fees
_________ CFS |
|
Base |
|
|
|
__________ |
_________ AF |
|
Up to 1 CFS |
|
|
|
__________ |
|
|
__________ |
Add'l CFS @
|
____________ |
|
__________ |
|
|
Up to 20 AF |
|
|
|
__________ |
|
|
__________ |
Add'l AF @ |
__________ |
|
__________ |
|
|
Add'l |
[] POD/POA |
[] Use |
+ |
__________ |
|
|
|
|
Exam Fee Required |
= |
__________ |
|
|
|
|
Exam Fee Payed |
|
__________ |
|
|
|
|
Still Owed |
|
__________ |
Name: | ______________________________________ |
Date: | _________ |
Peer Reviewer: | ___________________ |
The purpose of this checklist is to be used as a working
document by Department staff to aid in the production of the related Initial Review,
Proposed Final Order, or Final Order. It is not intended to be a complete record
of all factors which were considered to produce the document, nor is it intended
to serve any purpose other than that stated above. The related Initial Review, Proposed
Final Order, or Final Order is intended to stand alone as the record of factors
considered in its production. |
|