INSPEC32881

• Permit No: M1983141
• IBM Index Class Name: Inspection
• Doc Date: 3/24/1992
• Doc Name: LIST OF EXHIBITS FOR CORRECTIONS TO SYNOPSIS OF EVENTS
• Media Type: D
• Archive: No

~__;:
1
1
hRJ. S.Pev. _
COLOR,ayDO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
PERMIT APPLICATION FORM
Application :rust
be complete where
applicable. Type or
print in BLACK
INK. No overstrikes
or erasures unless
initialed.
(1)
1 A PERMIT TO USE GROUND WATER
(~ A PERMIT TO CONSTRUCT A WELL
FOR: 1 1 A PERMIT TO INSTALL A PUMP
1 1 REPLACEM1tENT FOR N0.
( (OTHER
WATER COURT CASE N0.
RECEIVED

ri-~'0-F~ h..~' ~h'.,~~~
~_:l~ r ~~y

03'x7' S0.0J
•p~+lnc_ F'001'
ice- SO.OJ
C%'=_.U_ 50,00
mailing address
NAME Gold Hill Ventures
' STREET PO Sox 1523
CITY Lon mont, CO 80501
ISt.te) (Ziol
' TELEPHONE NO. 449-
(2) LOCATION OF PROPOSED WELL
' County Boulder
SE '/. of the I'tt~ L, Section 12
' Twp. 1 N, Rng. 72 i7, 6t)1 P,M,
ir:.51 iE.Wi
,3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm) SdmDles Only
' Average annual amount of ground water
to be appropriated lacre~feetl: D
' Number of acres to be irrigated: D
Proposed total depth (teed: 60
' Aquifer ground water is to be obtained from:
t Owner's well designation ' 1
GROUND WATER TO BE USED FOR:
1 )HOUSEHOLD USE ONLY ~ no irrigation 101
' ( 1 DOMESTIC 111 1 )INDUSTRIAL 151
i )LIVESTOCK 121 1 )IRRIGATION I61
( 1 COMMERCIAL 141 1 I MUNICIPAL 181
I XI OTHER 191 MOn~ f'OPi ng
DETAIL THE USE ON BACK IN (11)
14) DRILLER
.ame GRODA'D [4P.^E3 SYSTEMS, INC.
'Street 4599 N. Broadway
'C,ty Boulder, CO 80501
ISUUI IZ~oI
_ "'- nc-
FOR OFFICE USE ON LYS~rDO NOT WR17E~)
IT'f ''
-,~
Receipt No. /
Basin Dist.
CONDITIONS OF APPROVAL
This well shall 5e used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
1) APPROVED PURSUANT TO C.R.S. 37-90-137(2) TO
SATISFY THE PERIdIT I3EOUT13EMENTS OF C.R.S.
37-90-138(3)_ USE OF THIS WELL IS LIMITED TO
MONITORING WATER LEVELS AND/OR WATER QUALITY
SAMPLING.
2) THIS WELL MUST BE EQUIPPED WITH A LOCKING
CAP OR SEAL TO PREVENT WELL CONTAMINATION OR
POSSIBLE HAZARDS AS AN OPEN WELL. THE WELL
MUST BE KEPT LOCKED AT ALL TIMES EXCEPT DURING
SAMPLING OR MEASURING.
3) RECORDS OF WATER LEVEL MEASUREMENTS AND
WATER 9UALITY ANALYSES SHALL BE MAINTAINED BY
THE WELL OWNER AND SUBMITTED TO THE DIVISION OF
WATER RESOURCES UPON REQUEST.
4) UPON CONCLUSION OF THE MONITORING PROGRAM
THE APPLICANT SHALL PLUG AND ABANDON THIS WE~.L
IN ACCORDANCE WITH THE RULES AND REGULATIONS
FOR WATER WELL CONSTRUCTION AND PUMP INSTALLA-
TION CONTRACTORS.
5) THE OWNER SHALL MARK THE WELL IN A CONSPICU-
OUS PLACE WITH APPROPRIATE WELL PERMIT NUMBER
AND NAME OF THE AQUIFER. HE SHALL TAKE
NECESSARY MEANS AND PRECAUTIONS TO PRESERVF,
THESE MARKINGS.
K~1 h f ~vJ~ -~
APPLICATION APPROVED
PERA1IT NUMBER Q R3~J166Q3 ~~ I
DATE ISSUED ^~" 22 1987
EXPIRATION DATE //A''ffPR,(2-319/88
rc Tc cNfa+acc o~
eY

fH15 COLUMN
i, ~