Primary Contact:

Date Submitted: 02/27/2021

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. 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
2. 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
3. Purpose of Use
Domestic 2 acres
Special Use Categories
C1. Are you using any water diverted under this right for the cultivation of cannabis? No
4. 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
5. 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
6. 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
7. Water Transfers
7a. Water transfered No
7b. Quantity transfered (Acre-Feet)
7c. Dates which transfer occurred / to /
7d. Transfer approved by
Water Supply Contracts
7e. Water supply contract No
7f. Contract with
7g. Other provider
7h. Contract number
7i. Source from which contract water was diverted
7j. Point of diversion same as identified water right
7k. Amount (Acre-Feet) authorized to divert under this contract
7l. Amount (Acre-Feet) authorized to be diverted in 2020
7m. Amount (Acre-Feet) projected for 2021
7n. Exchange or settlement of prior rights
7o. All monthly reported diversion claimed under the prior rights
7p. Amount (Acre-Feet) of reported diversion solely under contract
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
Credits Claimed
Conservation Reclaimed Water Use Conjunctive Groundwater Use
Claimed? (Yes/No) No No No
Conservation Supporting Information
Description of conservation methods
Description of baseline water use and time period
Description of conservation calculation methods
Conserved water used?
Additional Remarks
Currently not watering or maintaining pasture; watering only domestic lawn area. 
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 02/27/2021