2018-12-26_HYDROLOGY - M1978039HR

• Permit No: M1978039HR
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/26/2018
• Doc Name Note: Groundwater Chemistry Data
• From: Western Water & Land, Inc.
• To: DRMS
• Email Name: LJW
• Media Type: D
• Archive: No

Form
No. GWS-7 EXEMPT PERMIT INFORMATION SHEET
10/2011 STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
1313 Sherman St., Ste 821, Denver, Colorado 80203
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-92-602
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully read the conditions of approval on your well permit. The conditions and the information on this
information sheet must be complied with in order for the permit to remain valid.
THE PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. The well must be constructed and
evidence of it's construction must be received by this office in the form of a Well Construction and Test report from
the well construction contractor confirming that the well was constructed prior to expiration of the well permit. The
well permit number is located in the upper right hand corner of the permit, and the expiration date is located in the
lower right hand corner. The expiration date of the permit may be extended one year at a time at the discretion of
the State Engineer for good cause shown. If an extension of time is necessary to construct the well,a written
request for the extension of time must be received by this office prior to the expiration date of the well
permit. In the request, you must provide the Weil`permit number,your dame and irimUng address and the
reasons why the well has not been constructed and approximately when it will be constructed.
Water well construction and pump installation contractors are specifically licensed in Colorado to perform these
specialized tasks. It is illegal for contractors who do not hold these licenses to construct wells and/or install pumping
equipment in or on wells. The well must be constructed and the pump installed by contractors with current
license(s) issued by the State of Colorado unless exempted as described on the reverse side. Please ask to see
their license(s). Backhoe Operators and Licensed Plumbers may or may not hold the respective Well Construction
and/or Pump Installation licenses. Please be aware of this when you contract to construct the well and install
purriping equipment. The well construction report including a test of the well yield must be submitted to the office of
the State Engineer within sixty (60) days of completion of the work or within seven days after expiration of the
permit, whichever is earlier. The pump installation report including a pumping system test must be submitted within
sixty (60)days of completion of the work. The contractor(s) must provide you with a copy of the work report(s)filed
with the State Engineer. The Well Construction and Test Report, Form Number GWS-31 and the Pump Installation
and Test Report, Form Number GWS-32 are available from the Division of Water Resources offices. Additional
information regarding well construction, pump installation, required testing and well plugging and sealing regulations
are found on the reverse side of this sheet.
You have been provided with at least two copies of the well permit. Keep a copy for your records. There is
also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller
license number on the application, or two additional copies have been enclosed. You may make additional
copies for the well construction contractor if you select one different from the one indicated in your application.
The•original permit is file in the Denver office Records Section. Copies may be obtained for a fee of 50 cents per
page. Statutes require that any change of mailing address or ownership be reported to the State Engineer. Form
number GWS-11 is used both by new owners to report ownership changes and current owners to report address
changes.
If you have questions, contact the Denver Office, or the Division Office in the area where your well is located.
Division 1 Division 2 Division 3 Division 4
810 9th St.2"d Floor 310 E.Abriendo Ave Ste B 301 Murphy Drive 1871 East Main St.
Greeley,CO 80631 Pueblo,CO 81004 Alamosa, CO 81101 Montrose, CO 81401
[phone] [phone] [phone] [phone]
Fax [phone] Fax [phone] Fax [phone] Fax [phone]
Division 5 Division 6 Division 7 Denver Office
Direct mail to Box 396 Direct mail to Box 773450 160 Rock Point Dr., Ste. E 1313 Sherman St. , Ste 821
Glenwood Spgs CO 81602 505 Anglers Dr. Suite 101 Durango, CO 81301 Denver, CO 80203
50633 U.S. Hwy 6 &24 Steamboat Spgs, CO [phone] [phone]
Glenwood Spgs., CO 81601 80477 Fax[phone] Fax[phone]
[phone] [phone]
Fax[phone] Call first Fax[phone]