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Form No. OFFICE OF THE STATE ENGINEER #16 <br /> GWS-25 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg„ 1313 Sherman St.,Denver,Colorado 80203 <br /> (303)866-3581 <br /> 1455 <br /> WELL PERMIT NUMBER 283678 <br /> APPLICANT DIV. 2 WD 11 DES. BASIN MD <br /> FRITZ APPROVED WELL LOCATION <br /> EST. EL 9,775 FT LAKE COUNTY <br /> NW 1/4 SE 1/4 Section 28 <br /> ROBERT FRITZ Township 9 S Range 80 W Sixth P.M. <br /> 500 E 7TH ST DISTANCES FROM SECTION LINES <br /> LEADVILLE, CO 80461- Ft. from Section Line <br /> Ft. from Section Line <br /> (321) 794-9857 UTM COORDINATES (Meters,Zone:13,NAD83) <br /> PERMIT TO CONSTRUCT A WELL Easting: 384677 Northing: 4343755 <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 39.60 acres described as the NW 1/4 <br /> of the SE 1/4, Sec. 28,Twp.9 S, Rng. 80 W, Sixth P.M., Lake County. j <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) Pursuant to Rule 6.2.3 of the Water Well Construction Rules,the well construction contractor shall submit the as-built well <br /> location on work reports required by Rule 17.3 within 60 days of completion of the well. The measured location must be <br /> accurate to 200 feet of the actual location. The location information must include a GPS location (UTM coordinates) <br /> pursuant to the Division of Water Resources'guidelines. <br /> NOTE:This permit will expire on the expiration date unless the well is constructed by that date.A Well Construction and <br /> Test Report(GWS-31)must be submitted to the Division of Water Resources to verify the well has been constructed.An <br /> extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension <br /> request form (GWS-64)available at:http://www.water.state.co.us/pubs/forms.asp <br /> I <br /> t APPROVED I <br /> SMJ <br /> 'Receipt NO.3646375 State Engi DATE ISSUED 08-02-2010 B EXPIRATIO T 08-02-2012 <br /> i <br />