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Form No. OFFICE OF THE STATE ENGINEER <br />Gws=z5 COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldg.. 7373 Sherman St., Denver, Colorado 80203 <br />tanvt aaa.zca~ <br />APPLICANT <br />1279 <br />WELL PERMIT NUMBER 250146 _ <br />DIV. 1 WD 2 DES. BASIN MD <br />LAFARGE WEST INC <br />%T AXLEY QWATER & WASTE ENG <br />821 17TH ST STE 1020 <br />DENVER, CO 80293- <br />(303)292-3503 <br />APPROVED WELL LOCATION <br />WELD COUNTY <br />SW i!4 NW 1!4 Section 18 <br />Township 1 N Range 66 W Sixth P.M <br />DISTANCES FROM SECTION LINES <br />2t75 Ft. from North Section Line <br />830 Ft. from West Section line <br />UTM COORDINATES <br />easting: <br />ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />CONDITIONS OF APPROVAL <br />1) This well shall bo used in such a way as to cause no material injury to existing water rights. The issuance of this permit <br />does not assure the applicant that no injury will occur to anoNer vested water right or preclude another owner of a vested <br />water right from seeking relief in a civil court ac8on. <br />2) The construction of this well shall be in compliance w8h the Water Well Constriction Rules 2 CCR 402-2, unless approval <br />of a variance has been granted by the State Boartl of Examiners of Water Well Constroc0on and Pump Installation <br />Contractors in accordance with Rule 78. <br />3) Approved pursuant to CRS 37-92-602(3)(6)(1) for uses as described in CRS 37-92-602(1 )(f). Use of this wall is limited to <br />monitoring water levels andlor water quality sampling. <br />4) Approved for the use of an exisOng well acknowledged for construction under monitoring hole notice MH-01774, and <br />known as CH03 MW04. <br />5) This well must be equipped with a lacking cap or seal to prevent well contamina8on or possible hazards as an open well. <br />The well must be kept capped and locked at all 8mes except during sampling or measuring. <br />6) 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 we81n accordance with Rule 16 of the Water <br />Well ConsWction 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 conspicuous place with well permit number(s) and name of aquifer as appropriate, <br />and shall take necessary means and precau8ons to preserve these markings. <br />9) This well must have been conshucted by or under the supervision of a licensed well driller or other authorized individual <br />according fo the Water Well ConsWction Rules. / ~p <br />10) This well must be located not more than 200 feet from the low8on specified on this permit. S~ ~/Q3 ~t-"~ <br />RAB <br />State <br />~ A~ <br />