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 [e-mail] RCVD
DWR
MONITORING/OBSERVATION
Water 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 State Zip code Total depth Aquifer
Craig CO 81626 430 feet Un-Named
Telephone# E•Mail(if filing online itIsrequired) 8. Consultant Information (if applicable)
970-826-6143 [e-mail] Name of contact person
2. Type Of Application (check applicable boxes)
9 Use existing well ❑ Replacement for existing monitoring well: Company name
I]Construct new well Permit no.:
❑Other: Mailing address
3. Refer To (if applicable)
Monitoring hole acknowledgment Well name or# city State Zip code
MH- 60895 CY_3
4. Location Of Proposed Well (important! See Instructions Telephone
County
Moffat SW 114ofthe NW 114 9. Proposed Well Driller License# optional :
Section Township NarS Range EorW Prinepal Meridian 10. Name of Well Owner or Authorized Agent
28 6 91 ❑ N 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(section lines are typically not property lines) thereof and state that they are true to my knowled e.
2518 Ft.froml$l N[]S 670 Ft.from❑ E Lx W SEgn or enter full name here Date(mmlddlyyyy)
For replacement wells only—distance and cilrection from cld well to new wO Graham Roberts 109/23/2020
feet direction If signing print name. Print title if other than land owner.
Well location address(Include City,State,Zip) ❑Check if well address is same asIMm1, 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 no. Surface efev,
Format must be UTM
❑Zone 12 or lR Zone 13 Fasting 278118 Receipt area only
Units must be Meters
Datum must be NAD83 Northing 4480857
Unit most be set to true north
Remember to set Datum to NAD83
Was GPS unit checked for above? ©YES
5. Property Owner Information 10006469
Name of property owner
State of Colorado Land Board
Malmi;address
1127 Sherman Street, Suite 300
city State Zip codo
Denver CO 80203
Telephone#
303-866-3454 DIV WD BA MD