ds-01 03/08OSE File Number:
NEW MEXICO OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT
TO CONSTRUCT AND OPERATE A DAM
1.NAME OF DAM:
2.DAM OWNER:
Name: Work Phone:
Title: Home Phone:
Address:
City:State: Zip:
3.PURPOSE:
4.HAZARD POTENTIAL CLASSIFICATION:
5.LOCATION:
A.1/4 1/4 1/4 Section: Township: Range: N.M.P.M.
in County.
or X = feet, Y = feet, N.M. State Plane Coordinate System
Zone Datum of in the Grant.
B.Latitude in decimal degrees:
Longitude in decimal degrees:
C.On land owned by:
D.Source of Water Supply:
a. Name of Surface Watercourse: Tributary of
b. Name of Groundwater Basin:
c. Name of Ditch or Spring (Off Channel Dams):
E.Distance to the nearest downstream City/Town (miles):
6.DRAINAGE AREA, PRECIPITATION DATA AND SPILLWAY DESIGN FLOOD RESULTS:
A.Drainage area: acres and square miles
B.100-year, hour precipitation: inches (indicate critical storm)
- Probable maximum precipitation (PMP), -hour storm: inches (indicate critical storm)
- Peak runoff into the reservoir from % of the -hour PMP: cfs
- Volume of runoff into the reservoirfrom % of the -hour PMP: acre-feet
- Maximum water surface elevation in the reservoir from % of the -hr PMP: ft.
- Routed peak outflow from the reservoir from % of the -hour PMP: cfs
OSE File Number:
NEW MEXICO OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT
TO CONSTRUCT AND OPERATE A DAM
7.PROPERTIES OF DAM AND RESERVOIR:
A.Dam length: feet
B.Crest width: feet
C.Base width: feet
D.Dam height: feet
E.Structural height: feet
F.Elevation of the dam crest: feet
G.Slope of upstream face: horizontal to 1 vertical
H.Slope of downstream face: horizontal to 1 vertical
I.Volume of dam: cubic yards
J.Type of dam:
K.Dead storage capacity: acre-feet
L.Reservoir storage capacity: acre-feet
M.Maximum storage capacity: acre-feet
N.Spillway design flood water level elevation: feet
O.Reservoir surface area at reservoir storage capacity: acres
P.Stage/Area/Storage capacity (elevations at the outlet invert, spillway and dam crest plus others):
Elevation or depthArea of WaterStorage Capacity
above outlet (Feet)Surface, (Acres)(Acre Feet)
8.PROPERTIES OF OUTLET CONDUIT:
A.Outlet conduit is: (give size and material)
B.Length of conduit: feet
C.Slope of conduit: percent
D.Manning coefficient:
E.Maximum discharge capacity (at dam crest): cubic feet/second
F.Elevation of upstream end of the invert of the outlet conduit: feet
G.Size, type and number of gates:
H.Time to empty the reservoir: hours or days
OSE File Number:
NEW MEXICO OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT
TO CONSTRUCT AND OPERATE A DAM
9.PROPERTIES OF SPILLWAY:
A. Spillway is: (give type and material)
B.Location:
C.Spillway crest elevation: feet
D.Freeboard: feet
E.Discharge coefficients: (dependent on type)
F.Effective length: feet
G.Discharge capacity (at the spillway design flood elevation): cubic feet/second
- Maximum discharge capacity (at the dam crest): cubic feet/second
- Residual freeboard: feet
10.ADDITIONAL STATEMENTS OR EXPLANATIONS:
11.CONSTRUCTION DATES:
Estimated date to begin construction:
Estimated date to complete construction:
12.Dam will be constructed under the supervision of:
EngineerLicense No.
13.ACKNOWLEDGEMENT FOR THE DAM OWNER
I, affirm that the foregoing statements are true to the best of my knowledge and belief. I fully understand the responsibility and liability related to dam ownership.
______
(Signature)(Date)
Subscribed and sworn to before me this ______day of ______, 20___.
______
Notary Public
My commission expires ______(SEAL)
OSE File Number:
NEW MEXICO OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT
TO CONSTRUCT AND OPERATE A DAM
ACTION OF STATE ENGINEER
This application to construct and operate a dam is approved provided it is not exercised to the detriment of any others having prior, valid and existing rights to the use of waters of this stream system or groundwater basin and further provided that:
Witness my hand and seal this ______day of ______, 20___.
State Engineer
By: ______
INSTRUCTIONS
This form shall be filed with original signatures and accompanied by construction drawings, specifications, design report, etc. and filing fee of $25.00 for the application and plan review fee of $2.00 per $1000 of construction cost for dam and appurtenances. This form and supporting documentation shall be delivered to the attention of the OSE Dam Safety Bureau, P.O. Box 25102, Santa Fe, New Mexico.
File Number provided by State Engineer. Hit “F1” key for additional instructions for each cell. Cell sizes are limited.
Section 1Dam name required.
Section 2All information is required.
Section 3Purpose is required.
Section 4Hazard potential classification is required. Refer to 19.25.12.10 NMAC.
Section 5Information for Items A through E required.
Section 6All information required if applicable.
Section 7All information required if applicable.
Section 8All information required if applicable. Item 8H: Flood control dams enter hours and storage dams enter days.
Section 9All information required if applicable.
Section 10Fill in blanks if additional information is necessary.
Section 11Information is required.
Section 12Information is required. Qualifications of the N.M. Professional Engineer with experience in dam design and construction are required (Subsection A of 19.25.12.13 NMAC).
Section 13Dam Owner’s printed name and notarized signature are required.