HYDRO25195

• Permit No: M1980244
• IBM Index Class Name: Hydrology
• Doc Date: 7/11/2007
• Doc Name: NOI To Construct Monitoring Well
• From: CC & V
• To: DRMS
• Media Type: D
• Archive: No

cws.s, NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S)
osros
Please type or print legibly in blade or blue ink
Colorado Division of Water Resources 1313 Sherman St-Room 621 Denver CO 80203
Phone [phone] Fax [phone]
AUTHORIZED INDNIDUAL OR DRILLER
Contad__ imi~ rnrtarr ~C'hr<Ffi/7rurronrvrrnlcl ~oo,-d~.+~fz~r
Company ~~f l~ ~-to~ yYlrra iN4 (ca~LVla /rV
Address ~ 1~oX 14/
City, State. Zip /J'ir~a~. Cv/orurJo fS086c7
Phone -714~(~E9-,197'7 FazNo. 714~4~89' 32s`/
(iF applicebk;)
Well Owner (Client) Information S. le. ~A ' C'~
Name CCi/ CT.,I~L /1'lrnioy ~Mp,„y GSRBN- I
Address ~Cr ~u /ill
/[x~ ~/ i~ 3r°r 51rr~ f
c1«,zr, r~%.-a~l~ S~~~o
WellOwnersPhone ~17~[v&~'- a`' ~7
Landowners Name: r~3+°r CCr/C~o/cl!/1lrnrnG [brvr~nir
Hole(s) to be consWded: Number /
Estimated depth'- 5o Ft. Aquifer
Purpose of Monitodng Hole(s)
a~ / ~ o ~
Approximate Date of ConsWdion U/terc ~f J4/ i zca
6/ 1MnAte~ ka~ a nays ptarm conwucbon)
//i~~/ ~~~_ --
Authorized Signature
ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE
FOR OFFICE USE ONLY
MH- PROCESSED BY
DN. WD BAS__ MD
DATE ACKNONIL.F~GFD
CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT
A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRIW NG SITE.
Notice was provided to the State Engineer at least 3 days prior to construction of monitoring 8 observation hole(s). CansWdron
of the hole(s) must be completed within !30 davs of the date noEoe was given to the State Engineer. Testing andlor pumping shall not
exceed a total of 200 hours unless prior written approval is otNained from the State Engineer. Water diverted during testing shall not be
used for benefidal purposes. The owner of the hole(s) is responsible for obtaining permit(s) and complying with all rules and regulations
pertaining to the disdtarge of fluids produced during testing.
All work must comply wffh the Water Well Corrstructlon Rules, 2 CCR 402-2. Minimum consWction standards must be met or a
variance obtained. Starxlard permit appricafion and work report famrs are found on the DWR website at htM://www.waterstate.co.us.
Well Corrstruetlon and Test Reports (GWS37) must ba completed for each hole drilled. The licensed confrador or authored individual
must submd the completed forms to this office within 60 days of ddllirg.
Unless a well pemrft is obtained, the hole(s) must be plugged and sealed within one (t) year after constrrction.
An Abandonment Report (form GWS~) must be submitted for each hole plugged within 60 days of plugging 3 sealing. The
monitoring hole acknowledgement number, owners sWdure name, and hole owners name and address must be provided on all well
permR applicetion(s), well consWdion and abardonmeM reports.
TFre owner of the hole(s) should maintain records of water quality testing and sutxnit this data to the State Engineer upon request
A mondortrg hole cannot be converted to a production water well, except for purposes of remediation (recovery) or as a permanent
dewaterirrg system, if consWded in accorclance with the Water Well Construction Rules and polities of the State Engineer.
THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMR(S) CAN BE APPROVED.
IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WRHIN 90 DAYS, PLEASE WRtfE, "NO HOLES CONSTRUCTED" ON A
COPY OF THE ACKNOWLEDGED NOTICE WITH THE FlLE NUMBER AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES.
Location: ~l~'/,, SF '/.,Section ~7
Township 15 N ~ Range ~_ E ~ PM t~+'`
County TU~r
Subdivision N/A
Lot .uJn Blk. ~//r4 Flg. N//~
Site/Property Address Te (I~r Cn,., ~./ ~~~ 83
Additional Conditions