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Form No. OFFICE OF THE STATE ENGINEER <br />cws2s COLORADO DIVISION OF WATER RESOURCES <br />,. 81B Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />3 966-3 <br />(30 I 581 <br />APPLICANT <br />1279 <br />WELL PERMR NUMBER 250738 _ <br />DIV. 1 WD 2 DES. BASIN MD <br />LAFARGE WEST INC <br />%T AXLEY QWATER & WASTE ENG <br />621 17TH ST STE 1020 <br />DENVER, CO 80293- <br />(303)292-3503 <br />APPROVED WELL LOCATION <br />WELD COUNTY <br />NE 1/4 SW 1/4 Section 12 <br />Township 1 N Range 67 W Sixth P.M. <br />DISTANCES FROM SECTION LINES <br />2600 Ft. from South Section Lime <br />1675 Ft. from West Section Line <br />UTM COORDINATES <br />.........y. ~..., ..y. <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 na material injury to existing water rights. The issuance of this permit <br />does not assure the applicant that no injury will occur to another vested water dght or preGude another owner of a vested <br />water right from seeking relief in a civil couA acgon. <br />2) The construction of this well shall be in compliance with the Water Well ConsWction Rules 2 CCR 402-2, unless approval <br />of a variance has been granted by the State Bcarcl of Examiners of Water Well Construction and Pump Installation <br />ConUactors in accordance with Rule 18. <br />3) Approved pursuant to CRS 37.92-602(3)(b)(I) for uses as descdbed in CRS 37-92-602(1)(1). Use of this well is limited to <br />monitoring water levels and/or water quality sampling. <br />4) Approved for the use of an existing well acknowledged for construction under monitodng hole notice MH-41762, and <br />known as MF03-MW01. <br />5) This well must be equipped with a ticking cap or seal to prevent well centaminalion or possible hazards as an open well. <br />The well must be kept capped and locked at all Gmes except dudng sampling or measuring. <br />fi) Records of water level measurements and water quality analyses shall be maintained by the well owner and submitted to <br />the Division of Water Resources upon request. <br />7) Upon conclusion of the monitoring program the well owner shall plug this well in accordance with Rule 16 of the Water <br />Well Construction Rules. A Well Abandonment Report must be completed and submitted to the Division of Water <br />Resources within 60 days of plugging. <br />8) The owner shall mark the well in a censpicucus place with well permit number(s) and name of aqu6er as appropdate, <br />and shall take necessary means and precau0ons to preserve these markings. <br />9) This well must have been constructed by or under the supervision of a licensed web driller or other authorized individual <br />according to fie Water Well Construction Rules. <br />10) This well must be located not more than 200 feet from the location specified on this permit. $ ~2.~C''S <br />RAB <br /> <br />State Engineer <br />