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Form No. OFFICE OF THE STATE ENGINEER <br />Gws-2s. COLORADO DIVISION OF WATER RESOURCES <br />618 Centennial 81tlg., 7313 Sherman 51., Denver, Colorado 80203 <br />(303) 86G3581 <br /> <br />APPLICANT <br />1279 <br />WELL PERMIT NUMBER 250150 - <br />DIV. t WD 2 DES. BASIN MD J <br />LAFARGE WEST INC <br />%T AXLEY (WATER & WASTE ENG <br />621 17TH ST STE 1020 <br />DENVER. CO 60293- <br />(303)292-3503 <br />APPROVED WELL LOCATION <br />WELD COUNTY <br />NE 114 NW 1/4 Section 12 <br />Township 1 N Range 67 W Sixth P.M. <br />75 Ft. from North Section Line <br />1425 Ft. from West Section Line <br />UTM COORDINATES <br />^asnng: <br />CONDITIONS OF APPROVAL <br />1) This well shall be used in such a way as to cause no material injury to exisgng water rights. The issuance of this permit <br />does not assure the applicant that no injury will occur to another vested water right or preGUde another owner of a vested <br />water right from seeking relief in a civil court action. <br />2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval <br />of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation <br />Contracbrs in accordance with Rule 18. <br />3) Approved pursuant to CRS 37-92-602(3)(b)(I) for uses as described in CRS 37-92-602(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 exisgng well acknowledged for consWCtion under nonitoring hole notice MH-01761, and <br />known as OS03 MW02. <br />5) This well must be equipped with a locking cap ar seal to prevent well contamination ar possible hazards as an open well. <br />The well must be kept cappetl and locked at all times except tluring sampling or measuring. <br />6) Records of water level measurements and water quality analyses shall be maintained by the well owner and submi0ed 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 ConsWcOon Rules. A Well Abandonment Report must be completed and submitted to the Division of Water <br />Resources within 60 days of plugging. <br />B) The owner shall mark the well in a conspicuous place with well permit number(s) and name of aquifer as appropdate, <br />and shall take necessary means and precau0ons to preserve these markings. <br />9) This well must have been consWCted by or under the supervision of a licensed well driller or other authorized individual <br />according to the Water Well Construction Rules. <br />10) This well must be located not more than 200 feet from the location specified on this permit. ~~2 fp3~ <br />RAB <br />ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />state <br />