ds-01 03/08
OSE 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
in
1/4
1/4 Section:
Township:
Range:
N.M.P.M.
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:
B. 100-year,
acres and
hour precipitation:
square miles
inches (indicate critical storm)
C. Probable maximum precipitation (PMP),
D. Peak runoff into the reservoir from
-hour storm:
% of the
E. Volume of runoff into the reservoir from
-hour PMP:
% of the
F. Maximum water surface elevation in the reservoir from
G. Routed peak outflow from the reservoir from
inches (indicate critical storm)
% of the
cfs
-hour PMP:
% of the
acre-feet
-hr PMP:
-hour PMP:
ft.
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:
I.
Volume of dam:
J.
Type of dam:
horizontal to 1 vertical
cubic yards
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 depth
above outlet (Feet)
Area of Water
Surface, (Acres)
Storage Capacity
(Acre Feet)
8. PROPERTIES OF OUTLET CONDUIT:
A. Outlet conduit is:
B. Length of conduit:
C. Slope of conduit:
(give size and material)
feet
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:
G. Size, type and number of gates:
H. Time to empty the reservoir:
hours or
days
feet
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:
D. Freeboard:
feet
feet
E. Discharge coefficients:
F. Effective length:
(dependent on type)
feet
G. Discharge capacity (at the spillway design flood elevation):
H. Maximum discharge capacity (at the dam crest):
I.
Residual freeboard:
cubic feet/second
cubic feet/second
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:
Engineer
License 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 1
Section 2
Section 3
Section 4
Section 5
Section 6
Section 7
Section 8
Section 9
Section 10
Section 11
Section 12
Section 13
Dam name required.
All information is required.
Purpose is required.
Hazard potential classification is required. Refer to 19.25.12.10 NMAC.
Information for Items A through E required.
All information required if applicable.
All information required if applicable.
All information required if applicable. Item 8H: Flood control dams enter hours and storage
dams enter days.
All information required if applicable.
Fill in blanks if additional information is necessary.
Information is required.
Information 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).
Dam Owner’s printed name and notarized signature are required.