Primary Contact:

Date Submitted: 04/15/2019

Application Number: A018080
License Number: 007000

Source(s) of Water POD Parcel Number County
HAYFORK CREEK 160-160-50 Trinity

MAX Direct Diversion Rate: 0.14 CFS
MAX Collection to Storage: 0 AC-FT
Face Value: 34.4 AC-FT

Permitted Use(s) Acres Direct Diversion Season Storage Season
Irrigation 20 05/01 to 09/01
1. Project Abandoned
The project has been abandoned and I request revocation of my water right license No
2. Compliance with License Terms and Conditions
I have currently reviewed my water right license and I am complying with all terms and conditions Yes
Description of noncompliance with terms and conditions
3. Changes to the Project
Intake location has been changed
Description of intake location changes
Type of use has changed
Description of type of use changes
Place of use has changed
Description of place of use changes
Other changes
Description of other changes
4. Purpose of Use
Domestic 2
Special Use Categories
C1. Are you using any water diverted under this right for the cultivation of cannabis? No
5. Maximum Rate of Diversion
Month Rate of Diversion (Gallons Per Minute)
January 0
February 0
March 0
April 0
May 0.0920
June 0.0920
July 0.0920
August 0.0920
September 0.0920
October 0
November 0
December 0
6. Amount of Water Diverted and Used
Month Amount directly diverted
Amount diverted or
collected to storage
Amount used
January 0 0 0
February 0 0 0
March 0 0 0
April 0 0 0
May 0.092 0 0.092
June 0.092 0 0.092
July 0.092 0 0.092
August 0.092 0 0.092
September    0.092 0 0.092
October 0 0 0
November 0 0 0
December 0 0 0
Total 0.46 0 0.46
Type of Diversion Direct Diversion Only
Water Transfers
6d. Water transfered No
6e. Quantity transfered (Acre-Feet)
6f. Dates which transfer occurred / to /
6g. Transfer approved by
Water Supply Contracts
6h. Water supply contract No
6i. Contract with
6j. Other provider
6k. Contract number
6l. Source from which contract water was diverted
6m. Point of diversion same as identified water right
6n. Amount (Acre-Feet) authorized to divert under this contract
6o. Amount (Acre-Feet) authorized to be diverted in 2018
6p. Amount (Acre-Feet) projected for 2019
6q. Exchange or settlement of prior rights
6r. All monthly reported diversion claimed under the prior rights
6s. Amount (Acre-Feet) of reported diversion solely under contract
7. Water Diversion Measurement
a. Required to measure as of the date this report is submitted No
b. Is diversion measured? No
c. An alternative compliance plan was submitted to the division of water rights on
d. A request for additional time was submitted to the division of water rights on
Measurement Attachments
Measurement ID Number File Name Description Size
No attachments
Measurement Data Files
Measurement ID Number File Name Description Size
No data files
8. Storage
Reservoir name Spilled this year Feet below spillway at maximum storage Completely emptied Feet below spillway at minimum storage Method used to measure water level
Conservation of Water
9. Are you now employing water conservation efforts? Yes
Description of water conservation efforts Did not water additional pasture.
10. Amount of water conserved
11. I have data to support use reductions under this water right due to conservation efforts No
Water Quality and Wastewater Reclamation
12. During the period covered by this Report, did you use reclaimed water from a wastewater treatment facility, water from a desalination facility, or water polluted by waste to a degree which unreasonably affects the water for other beneficial uses? No
13. Amount of reclaimed, desalinated, or polluted water used
Conjuctive Use of Groundwater and Surface Water
14. During the period covered by this Report, were you using groundwater in lieu of available surface water authorized under your license? No
15. Amounts of groundwater used
Additional Remarks
At this time additional acreage is not being cultivated but may be in the future. 
File Name Description Size
No Attachments
Contact Information of the Person Submitting the Form
First Name Betty
Last Name Felch
Relation to Water Right Primary Owner of Record
Information on Certification and Signatory
Name of Person Signing and Certifying the Report Betty Felch
Date of Signature 04/15/2019