2018-05-18_HYDROLOGY - P2017008

• Permit No: P2017008
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/18/2018
• Doc Name Note: FINAL
• Doc Name: Abandonment Report
• From: Brandon Heser
• To: DRMS
• Email Name: TC1
• Media Type: D
• Archive: No

GWS-51 NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) JUL 2 8 20I7
02/2017 Please type or print legibly in black or blue ink or file online,dwmermitsonlinegstate.co.us
State of Colorado,Office of the State Engineer 1313 Sherman St,Room 821, W%JER RMOURC
SS
Denver,CO 80203 Phone [phone] www.water.state.co.us STATE ENGNNEEt
COLD
Well owner Name(s): Transit Mix Concrete Co.
Location: Section 16
Address: 444 E. Costilla, Colorado Springs, CO 80903 Township 16 QN ES,Range 67 t3E OW, 6th PM
Phone: [phone] County: El Paso
Email: [e-mail] Subdivision:
Lot: Block: Filing:
Landowner's Name: RMBC Group LLC Site/Property Address
Please check one and complete as indicated including contact info:
1510 GPS Location in UTM format if known:
'I Water Well Driller Licensed in Colorado-Lic. No. Set GPS unit to true north,datum NAD83,and use meters for
❑Professional Engineer Registered in Colorado-Reg.No. the distance units,QZone 12 or OZone 13.
0 Professional Geologist per C.R.S.23-41.208(b) Easting 509974 Northing 4278625
❑ Other — anyone directly employed by or under the supervision of a licensed is of Monitoring Holes to be constructed in Section: 6
driller,registered professional engineer or professional geologist Estimated Depth 100 Ft.,Aquifer Fountain SST
Contact/Company Authentic Drilling
Address 201 Perry Park Ave. #105 Purpose of Monitoring Hole(s) To determine
City,State a Zip Larkspur, CO 80118 ground water depth and flow near the
Phone [phone] Ute Pass fault and in the Fountain Formation.
Email [e-mail] Anticipated Date of Construction: 07/31/2017
Print Name:Marc Haes
Date Notice Submitted: 07/27/2017
Signature or enter full name here: Brandon Heser (Must be at least 3 days prior to construction)
ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE
FOR OFFICE USE ONLY
5 Gg -7 7 - MH PROCESSED BY
Div. Z WD BAs MD DATE ACKNOWLEDGED
CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT
A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING SITE.
1) Notice was provided to the State Engineer at least 72 hours prior to construction of monitoring&observation hole(s).
2) Construction of the hole(s)must be completed within 90 days of the date notice was given to the State Engineer. Testing and/or
pumping shall not exceed a total of 200 hours unless prior written approval is obtained from the State Engineer. Water diverted during
testing must not be used for beneficial purposes. The owner of the hole(s)is responsible for obtaining permit(s)and complying with all rules
and regulations pertaining to the discharge of fluids produced during testing.
3) All work must comply with the Water Well Construction Rules, 2 CCR 402-2. Standard permit application and work report forms are
found on the DWR website at htto://www.water.state.co.us. Well Construction and Yield Estimate Reports(GWS-31)must be
completed for each hole drilled. The licensed contractor or authorized individual must submit the completed forms to this office within 60
days of monitoring hole completion. Aquifer testing information must be submitted on Well Yield Test Report(GWS-39).
4) Unless a well permit is obtained or variance approved,the holes)must be plugged and sealed within eighteen(IS)months after
construction. An Abandonment Report(GWS-09)must be submitted within 60 days of plugging&sealing. The above MH
acknowledgement number,owner's structure name,and owners name and address must be provided on all well permit application(s),well
construction and abandonment reports.
5) A MONITORING HOLE CANNOT BE CONVERTED TO A PRODUCTION WATER WELL,except for purposes of remediation(recovery)or as a
permanent dewatering system,if constructed in accordance with the Water Well Construction Rules and policies of the State Engineer.
6) IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS,PLEASE WRITE"NO HOLES CONSTRUCTED"ON A COPY OF
THE ACKNOWLEDGED NOTICE WITH THE FILE NUMBER AND EMAIL TO THE DIVISION OF WATER RESOURCES AT
[e-mail].
THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMIT(S)CAN BE APPROVED.
Incomplete forms or Notice provided less than 72 hours prior to welt construction will not be acknowledged