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COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-46(01/2020) <br /> DEPARTMENT OF NATURAL RESOURCES <br /> 1313 SHERMAN ST.,Ste 821,DENVER CO 80203 <br /> Phone: (303)866-3581 dwrpermitsonlineAstate.co.us Rcvd <br /> MONITORING/OBSERVATION 11/10/2021 <br /> Water Well Permit Application <br /> Review instructions on reverse side prior to completing form. <br /> The form must be typed,completed online or in black or blue ink. <br /> 1. Well Owner Information <br /> Name of wet owner 6. Use Of Well <br /> Monarch Mountain Minerals and Aggregates Use of this well is limited to monitoring water levels <br /> Marling address and/or water quality sampling <br /> 5 Concourse Pkwy, Suite 1900 7.Well Data (proposed) <br /> City State Zip code Total depth Aquifer <br /> Atlanta GA 30328 <br /> 50 feet S. Platte Alluvium <br /> Telephone# E-Mail(If filing online it is required) 8. Consultant Information (if applicable) <br /> 720-289-5584 eric.leigh@quikrete.com Name of contact person <br /> 2. Type Of Application (check applicable boxes) Kyle Regan <br /> Company name <br /> 0 Use existing well 0 Replacement for existing monitoring well: <br /> Construct new well Civil Resources, LLC <br /> Permit no.: <br /> 0 Other: Mailing address <br /> 3. Refer To (if applicable) 8108 Colorado Blvd; Suite 200 <br /> Monitoring hole acknowledgment Well name or# City State Zip Code <br /> MH- 62487 PZ-01 Firestone CO 80504 <br /> 4. Location Of Proposed Well (Important! See Instructions) Telephone# <br /> County 408.930.2544 <br /> Weld County se 1/4 of the Se 1/4 9. Proposed Well Driller License#(optional): <br /> Section Township N or S Range E or W Principal Meridian 10. Name of Well Owner or Authorized Agent <br /> r r The making of false statements herein constitutes perjury in the second <br /> 18 4 66 6 degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. <br /> 24-4-104(13)(a). I have read the statements herein,know the contents <br /> Distance 01 well from section lines(section lines are typically not property lines) thereof and state that they are true to my knowledge. <br /> 1033 Ft fromE N[x S 189 Ft from REW Sign or enter full name here Date(mm/dd/yyyy) <br /> For replacement wells only—distance and direction from old well to new well Kyle Scott Regan 11/10/2021 <br /> feet direction If signing print name Print title if other than land owner <br /> Wet location address(Include City.State,Zip) 0 Check if well address is same as Item 1 Kyle Scott Regan <br /> 21421 HIGHWAY 60, Weld County <br /> Office Use Only <br /> Optional: GPS well location Information in UTM format <br /> You must check GPS unit for required settings as follows' USGS map name DWR map no Surface elev <br /> Format must be UTM <br /> FT Zone 12 or[Y Zone 13 Easting Receipt area only 10 016 821 <br /> Units must be Meters <br /> Datum must be NAD83 Northing <br /> Unit must be set to true north <br /> Remember to set Datum to NAD83 <br /> Was GPS unit checked for abov0 0 YES <br /> 5. Property Owner Information <br /> Name of property owner <br /> HS Land and Cattle <br /> Mailing address <br /> PO Box 366 <br /> City State Zip Code <br /> Gilcrest CO 80623-0366 <br /> Telephone# <br /> DIV 1 WD 2 BA MD <br />