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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 SL, Denver,Colorado SOM <br /> (303)888-3581 <br /> LIC <br /> WELL PERMIT NUMBER 1(;3755 -_ <br /> APPLICANT DIV. 1 CNTy. 30 WD 7 DES. BASIN MD <br /> Lot: Block: Filing: Subdiv: <br /> APPROVED WELL LOCATION <br /> COUNTY JEFFERSON <br /> COTTER CORD NW 1/4 SE 1/4 Section 25 <br /> 12596 W BAYAUD AVE #3 5 0 Twp 2 S Range 71 w SzthP.M. <br /> LAKEWOOD, CO 8022$ <br /> DISTANCES FROM SECTION LINES <br /> 303/980-1292 2165 Ft. from South Section Line <br /> PERMIT TO CONSTRUCT MONITORING WELL MW 1 1773 Ft. from Fast Section Line <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 the <br /> permit does not assure the applicant that no Injury will occur to another vested water right or preclude another <br /> 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 and Pump Installation Rules <br /> 2 CCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well <br /> Construction and Pump Installation Contractors in accordance with Rule 17. <br /> 3) Approved pursuant to CRS 37-92-602(3)(b)(1) for uses as described in CRS 37-92-602(1)0). Use of this well is <br /> limited to monitoring water levels 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 <br /> well. The well must be kept locked at all times except during sampling or measuring. <br /> 5) Records of water level measurements and water quality analyses shall be maintained by the well owner and <br /> submitted to the Division of Water Resources upon request. <br /> 6) Upon conclusion of the monitoring program the well owner shall plug and abandon this well In accordance with the <br /> Water Well Construction and Pump installation Rules. <br /> 7) The owner shall mark the well in a conspicuous place with well permit number and name of aquifer as appropriate. <br /> He shall take 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 <br /> according to the Water Well Construction and Pump Installation Rules. <br /> 9) A well completion report including lithologic log must be submitted by the individual authorized to construct the well. <br /> For non-standard construction the report must include an as built drawing showing details;such as depth,casing, <br /> perforated zones, and a 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 /> AFML VED: State <br /> Receipt No. 0336089 Engineer <br /> A DATE ISSUED APR 2 0 1992 EXPIRATION oATE APR 2 0 1994 <br />