2020-12-21_PERMIT FILE - C1981010 ‎(17)‎

• Permit No: C1981010
• IBM Index Class Name: Permit File
• Doc Date: 12/21/2020
• Doc Name: Design & Construction for GW Monitoring Wells
• Section_Exhibit Name: APPENDIX V PART C
• Media Type: D
• Archive: No

COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-46(01/2020)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST.,Ste 821,DENVER CO 80203
Phone: [phone] dwr ermitsanline state.co.us RCVD
DWR
MONITORING/OBSERVATION
Wafter Well Permit Application
Review instructions on reverse side prior to completing form. 09/23/2020
The form must be typed,completed online or in black or blue ink.
1.Well Owner Information
Name of well owner 6. Use Of Well
Trapper Mining Inc. Use of this well is limited to monitoring water levels
Mailing address and/or water quality sampling
PO Box 187 7.Well Data(proposed)
City slate Zip code Total depth Aquifer
Craig CO 81626
35 feet Un-Named
Telephone# FE-Madfilingonlineitisrequired) 8. Consultant Information (if applicable)
970-826-6143 [e-mail] Name of contact person
2.Type of Application (check applicable boxes)
© Use existing well El Replacement for existing monitoring well: Company name
❑Construct new well Permit no.:
❑Other: Mailing address
3. Refer To (if applicable)
Monitoring hole acknowledgment Well name or# City Stale Zlp Cade
MH- 60895 CY-A
4. Location Of Proposed Well (important! see Instructions Telephcneil
County
Moffat SW 114of1he NW 114 9. Proposed Well Driller License# optional :
Section Township NorS Range I Eorw I PrincipalMeddlan 10. Name of Well Owner or Authorized Agent
28 6 R] ❑ 91 ❑ 9 6th The making of false statements herein constitutes perjury in the second
degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
24-4-104(13)(a). I have read the statements herein,know the contents
Distance of well from section lines(sectionlines are typically n6l property Fries) thereof and state that the are true tom knowledge.
2518 Ft.from! r N t..I S 670 Ft.from❑ E IJ W Sign or enter full name here Date(mmlddtyyyy)
For replacement wells only—distance and directlon from old well to now wait Graham Roberts 09/23/2020
feet direction If sign[ng print name. Print[ilia if other than land owner.
Walt location address(Include City,state,Zip) ❑Checkifwell address is same as Siam 1, Graham Roberts, Environmental Eng.Trapper Mining Inc.
6.5 Miles SW Craig CO Office Use Only
Optional: GPS well location information in UTM format
You must check GPS unit for required settings as follows: USGS map name DwR map nc. surface elev.
Format must be UTM
❑Zone 12 or 9 Zone 13 Easting 278127 Receipt area only
Units must be Meters
Datum must be NAD83 Northing 4480850
Unit must be set to true north
Remember to set datum to NAD83
Was GPS unit checked For above? ©YES 10006470
5. Property Owner Information
Name of properly owner
State of Colorado Land Board
Mailing address
1127 Sherman Street, Suite 300
City Stale Zip Code
Denver CO 80203
Telephone#
Dlv wD ea MD
303-866-3454