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Form No. OFFICE OF THE STATE ENGINEER #13 <br /> GWS-25 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203 <br /> (303)866-3581 <br /> 894 <br /> WELL PERMIT NUMBER 269503 - - <br /> APPLICANT DIV. 2 WD 11 DES. BASIN MD <br /> SMITH APPROVED WELL LOCATION <br /> LAKE COUNTY <br /> NE 114 SW 114 Section 28 <br /> BRAD & DIANE SMITH Township 9 S Range 80 W Sixth P.M. <br /> 2005 N HANCOCK DISTANCES FROM SECTION LINES <br /> ARLINGTON,VA 22201- 2611 Ft. from South Section Line <br /> 2027 Ft. from West Section Line <br /> (703)528-4334 UTM COORDINATES (Meters,Zone:13,NAD83) <br /> PERMIT TO CONSTRUCT A WELL Easting: Northing: <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 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 37-92-602(3)(b)(11)(A)as the only well on a tract of land of 39.71 acres described as the NE 114 <br /> of the SW 114,Sec.28,Twp.9 S, Ring.80 W,Sixth P.M., Lake County. <br /> 4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than <br /> three(3)single family dwellings,the watering of poultry,domestic animals and livestock on a farm or ranch and the <br /> irrigation of not more than one(1)acre of home gardens and lawns. <br /> 5) The pumping rate of this well shall not exceed 15 GPM. <br /> 6) The return flow from the use of this well must be through an individual waste water disposal system of the <br /> non-evaporative type where the water is returned to the same stream system in which the well is located. <br /> 7) This well shall be constructed not more than 200 feet from the location specified on this permit. <br /> NOTE:This section is short in the east-west and north-south directions. LAW bl t z ru6 <br /> a <br /> APPROVED F; - .t AL ILZ <br /> CDK <br /> State Engineer By <br /> Recei t No.3605378 DATE ISSUED 06-22-2006 EXPIRATION DATE 06-22-2008 <br />