2023-01-10_PERMIT FILE - M2023001 ‎(12)‎

• Permit No: M2023001
• IBM Index Class Name: Permit File
• Doc Date: 1/10/2023
• Doc Name Note: Exhibit G - Water Information
• Doc Name: Application
• From: J-2 Contracting Company
• To: DRMS
• Email Name: PSH
• Email Name: JLE
• Media Type: D
• Archive: No

RCVD DWR
GWS-51 NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) 08/30/2022
02/2017 Please type or print legibly in black or blue ink or file online,[e-mail]
State of Colorado,Office of the State Engineer 1313 Sherman St,Room 821,
Denver,CO 80203 Phone [phone] www.water.state.co.us
Well Owner Name(s):
Sunset Industrial, LLC. Location: Section 3
Address: 1050 Coronado Ct, Unit A-101, Ft. Collins, 80525 Township 5 MN QS,Range 65 pE QW, 6 PM
Phone; [phone] County: Weld
Email: Subdivision: n/a
Lot: Block: Filing:
Landowner's Name.. Sunset Industrial, LLC. Site/Property Address Highway 263. Greeley
Please check one and complete as indicated including contact info:
GPS Location in UTM format if known:
❑Water Well Driller Licensed In Colorado-Lic.No. Set GPS unit to true north,datum NAD83,and use meters for
❑Professional Engineer Registered in Colorado-Reg. No. the distance units,(3Zone 12 or OZone 13.
0 Professional Geologist per C.R.S.23-41-208(b) Easting 529454 Northing 4475088
0 Other — anyone directly employed by or under the supervision of a licensed #of Monitoring Holes to be constructed in Section: 5
driller,registered professional engineer or professional geologist Estimated Depth 80 Ft.,Aquifer n/a
Contact/Company Jay Edwards / Cesare, Inc.
Address 7108 S.Alton Way, Bldg B Purpose of Monitoring Holes) Groundwater
City,State a zip Centennial CO 80112 Monitoring
Phone [phone]
Email [e-mail] Anticipated Date of Construction: 09/08/2022
Print Name:Jay Edwards
Date Notice Submitted: 08/30/2022
Signature or enter full name here: 1sY B. Edwards (Must be at least 3 days prior to construction)
ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE
FOR OFFICE USE ONLY
63811 MH PROCESSED BY
Div. 1 WD—3 BAs MD DATE ACKNOWLEDGED 08131/2022
CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT
A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING SITE.
1) Notice was provided to the State Engineer at least 72 hours prior to construction of monitoring Et observation hole(s).
2) Construction of the hole(s)must be completed within 90 days of the date notice was given to the State Engineer. Testing and/or
pumping shall not exceed a total of 200 hours unless prior written approval is obtained from the State Engineer. Water diverted during
testing must not be used for beneficial purposes. The owner of the hole(s)is responsible for obtaining permit(s)and complying with all rules
and regulations pertaining to the discharge of fluids produced during testing.
3) All work must comply with the Water Well Construction Rules,2 CCR 402-2. Standard permit application and work report forms are
found of the DWR website at http://www.water.state.co.us. Well Construction and Yield Estimate Reports(GWS-31)must be
completed for each hole drilled. The licensed coitractor or authorized individual must submit the completed forms to this office within 60
days of monitoring hole completion. Aquifer testing information must be submitted on Well Yield Test Report(GWS-39).
4) Unless a well permit Is obtained or variance approved,the hole(s)must be plugged and sealed within eighteen(18)months after
construction. An Abandonment Report(GWS-09)must be submitted within 60 days of plugging&sealing. The above MH
acknowledgement number,owner's structure name,and owners name and address must be provided on all well permit application(s),well
construction and abandonment reports.
5) A MONITORING HOLE CANNOT BE CONVERTED TO A PRODUCTION WATER WELL,except for purposes of remediation(recovery)or as a
permanent dewatering system,if constructed in accordance with the Water Well Construction Rules and policies of the State Engineer.
6) IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS,PLEASE WRITE"NO HOLES CONSTRUCTED"ON A COPY OF
THE ACKNOWLEDGED NOTICE WiTH THE FILE NUMBER AND EMAIL TO THE DIVISION OF WATER RESOURCES AT
[e-mail].
THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMIT(S)CAN BE APPROVED.
Incomplete forms or Notice provided less than 72 hours prior to well construction wit(not be acknowledged