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Form No. OFFICE OF THE STATE ENGINEER <br /> GWS-25 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg 1313 Sherman St,Denver Colorado 80203 <br /> (303)866-3581 LIC <br /> WELL PERMIT NUMBER 295654 - <br /> APPLICANT DIV. 2 WD 11 DES. BASIN MD <br /> APPROVED WELL LOCATION <br /> LAKE COUNTY <br /> SE 1/4 SE 1/4 Section 28 <br /> UNION MILLING COMPANY LLC Township 9 S Range 80 W Sixth P.M. <br /> PO BOX 620490 DISTANCES FROM SECTION LINES <br /> LITTLETON, CO 80162- 208 Ft. from South Section Line <br /> 791 Ft. from East Section Line <br /> (303)947-7837 UTM COORDINATES (Meters,Zone:13,NAD83) <br /> PERMIT TO CONSTRUCT A WELL Easting: 385067 Northing: 4343204 <br /> ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br /> CONDITIONS OF APPROVAL <br /> 1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit does not ensure that <br /> no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. <br /> 2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2. unless approval of a variance has <br /> been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18 <br /> 3) Approved pursuant to CRS 37-92-602(3)(b)(I)for uses as described in CRS 37-92-602(1)(f). Use of this well is limited to monitoring water levels <br /> and/or water quality sampling. <br /> 4) This well must be equipped with a locking cap or seal to prevent well contamination or possible hazards as an open well. The well must be <br /> 5) Records of water level measurements and water quality analyses shall be maintained by the well owner and submitted to the Division of <br /> Water Resources upon request. <br /> 6) Upon conclusion of the monitoring program the well owner shall plug this well in accordance with Rule 16 of the Water Well Construction <br /> Rules. A Well Abandonment Report must be completed and submitted to the Division of Water Resources within 60 days of plugging <br /> 7) The owner shall mark the well in a conspicuous place with the well permit number and name of aquifer as appropriate,and shall take <br /> necessary means and precautions to preserve these markings. <br /> 8) This well must be constructed by or under the supervision of a licensed well driller or other authorized individual according to the Water Well <br /> Construction Rules. If non-standard construction is anticipated,a variance request must be submitted in accordance with Rule 18 and approved <br /> prior to well construction. <br /> 9) A Well Construction and Test Report(Form GWS-31),including lithologic log must be submitted by the individual authorized to construct the <br /> well. For non-standard construction,the report must include an as-built drawing showing details such as depth,casing,perforated zones,and a <br /> description of the grouting type and interval. <br /> 10) This well shall be constructed not more than 200 feet from the location specified on this permit. <br /> NOTE: Issuance of this permit does not guarantee that this well can be converted to a production well under a future permit. Additionally, <br /> pursuant to Rule 14.2 of the Water Well Construction Rules(2 CCR 402-2),monitoring holes constructed pursuant to a monitoring hole notice <br /> shall not be converted to a production well. (Upon obtaining a permit from the State Engineer,a monitoring hole may be converted to a <br /> monitoring well, recovery well for remediation of the aquifer,or a dewatering system for dewatering the aquifer.) <br /> NOTE:This permit will expire on the expiration date unless the well is constructed by that date.A Well Construction and Test Report <br /> (GWS-31)must be submitted to the Division of Water Resources to verify the well has been constructed.An extension of the expiration date <br /> may be available.Contact the DWR for additional information or refer to the extension request form(GWS-64)available at: <br /> http://www.water.state.co.us <br /> NOTICE:This permit has been approved subject to the following changes:The distances from section lines,quarter/quarter,and quarter were <br /> determined from GPS coordinates provided by the applicant. You are hereby notified that you have the right to appeal the issuance of this <br /> permit,by filing a written request with this office within sixty(60)days of the date of issuance,pursuant to the State Administrative Procedures <br /> Act (See Section 24-4-104 through 106,C.R S.) <br /> APPROVED � <br /> CRF <br /> State Engineer By <br /> ,.Receipt No.3666028A DATE ISSUED 09-11-2014 EXPIRATI ATE 09-11-2016 <br />