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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 1258 <br /> WELL PERMIT NUMBER 282680 <br /> APPLICANT DIV. 8 WD 49 DES. BASIN 1 MD 3 <br /> APPROVED WELL LOCATION <br /> LINCOLN COUNTY <br /> NW 1/4 SW 1/4 Section 10 <br /> JIM SMITHBURG Township 9 S Range 52 W Sixth P.M. <br /> 53580 CR 46 DISTANCES FROM SECTION LINES <br /> ARRIBA, CO 80804- Ft. from Section Line <br /> Ft. from Section Line <br /> (719) 768-3429 UTM COORDINATES (Meters,Zone:13,NAD83) <br /> PERMIT TO CONSTRUCT A WELL Easting: Northing: <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 <br /> does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from <br /> 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 <br /> of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation <br /> Contractors in accordance with Rule 18. <br /> 3) Approved pursuant to CRS 37-90-105. <br /> 4) Water from this well may be used for domestic purposes inside 1 single family dwelling(s),and the watering of the <br /> owner's own large non-commercial domestic animals. <br /> 5) The pumping rate of this well shall not exceed 15 GPM, <br /> 6) The annual withdrawal of ground water from this well shall not exceed 3 acre-feet. <br /> 7) The irrigated area shall not exceed 1 acre of lawn and garden. <br /> 8) Water from this well may be used for the watering of livestock on range and pasture. <br /> 9) Pursuant to Rule 6.2.3 of the Water Well Construction Rules,the well construction contractor shall submit the as-built well <br /> location on work reports required by Rule 17.3 within 60 days of completion of the well. The measured location must be <br /> accurate to 200 feet of the actual location. The location information must include a GPS location(UTM coordinates) <br /> pursuant to the Division of Water Resources'guidelines. <br /> 10) Production is limited to the Ogallala aquifer. Plain casing must be installed and grouted to prevent diversion of water from <br /> other zones. <br /> APPROVED <br /> SMJ <br /> State EnP#rr By <br /> Recei t No. 3644532 DATE ISSUED 02-18-2010 EXPIRAT N A E 02-18-2012 <br />