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Form No. OFFICE OF THE STATE ENGINEER <br />GWS25 COLORADO DIVISION OF WATER RESOURCES <br />816 CentenMal Bldg., 1313 Sherman St., Denver, Cdomdo 80203 <br />Hn31 RFS ~5R1 <br />APPLICANT <br />1'179 <br />WELL PERMIT NUMBER 250139 _ <br />DIV.1 WD2 DES. BASIN MD <br />LAFARGE WESTING <br />%T AXLEY @WATER & WASTE ENG <br />621 17TH ST STE 1020 <br />DENVER, CU 80293- <br />(303)292-3503 <br />APPROVED WELL LOCATION <br />WELD COUNTY <br />NW 1/4 SE 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 Line <br />1525 Ft. from East 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 no matedal injury to existing water dghts. The issuance of this permit <br />does not assure the applicant Nat no injury wig occur to another vested water dght or preclude another owner of a vested <br />water right from seeking relies in a civil court ac8on. <br />2) The construction of this well shall be incompliance with the Water Well Construction Rules 2 CCR 402-2, unless approval <br />of a vadance has been granted by the State Board of Examiners of Water Well Construcion and Pump Installation <br />Contractors 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)(f). 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 consWction under monitoring hole notice MH-41766, and <br />known as MF03 MW02. <br />5) This well must be equipped with a locking cap or seal to prevent well contaminagon or possible hazards as an open well. <br />The well must be kept capped and locked at all times except during sampling or measuring. <br />6) Records of water level measurements and water quality analyses shall be maintained by fhe well owner and submitted to <br />the Division of Water Resources upon request. <br />7) Upon conclusion of the monitodng progrem the well owner shall plug this well in accordance with Rule 16 of the Water <br />Weg Construction Rules. A Well Abandonment Report must he completed and submitted to the Division of Water <br />Resources within 60 days of plugging. <br />8) The owner shall mark the welt in a conspicuous place with weg perng number(s) and name of aquifer as appropriate, <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 well ddller or other authorized individual <br />according to the Water Well Construction Rules. <br />10) This well must bo located not more than 200 feet trom the location specified on this permit. S~/ 2~t'3 Q~ <br />APPROVED ,,~~ r <br />RAe .U~D Z1. ~A ~.•_9.~ <br />Sfas~eer By <br />