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Form Na— OFFICE OF THE STATE ENGINEER <br /> GVYS-25 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg.,1313 Sherman St,Denver, Worado 80M <br /> (303)8883581 <br /> LIC <br /> WELL PERMIT NUMBER 16.3756 <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 CORP —NW 1/4 SE-1/4 Section 29 <br /> 12596 W BAYAUD AVE #3 5 0 Twp 2 S Range 71 W _6_thP.M. <br /> LAKEWOOD, CO 80228 DISTANCES FROM SECTION LINES <br /> 303/980-1292 1982 Ft. from South Section Line <br /> PERMIT TO CONSTRUCT MONITORING WELL MW-2 1531 Ft. from East 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 Constriction and Pump Installation Rules <br /> 2 CCR 402-Z 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)(t). 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 /> APFFPjROVED: <br /> State Engineer <br /> Receipt No. 033608 B9 DATE ISSUED APR 2 0 1992 EXPIRATION DATE APR 2 0 199 <br />