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Form No. OFFICE OF THE STATE ENGINEER <br />Gw~-zs COLORADO DIVISION OF WATER RESOURCES <br />878 Centennial BtdB~. 1313 Sherman St., Denver, Coloratlc 80203 <br />Iin11 XR6 45N1 <br />APPLICANT <br />1279 <br />WELL PERMIT NUM9ER 250151 _ <br />DIV. 1 WD 2 DES. BASIN MD <br />LAFARGE WEST INC <br />°hT AXLEY @WATER & WASTE ENG <br />621 17TH ST STE 1020 <br />DENVER, CO 30293- <br />(303)292-3503 <br />APPROVED WELL LOCATION <br />WELD COUNTY <br />NE 1/4 NW 1/4 Section i2 <br />Township 1 N Range 67 W Sixth P.M <br />DISTANCES FROM SECTION LINES <br />1300 Ft. from North Section Line <br />1350 Ft. from West Section Line <br />UTM COORDINATES <br />rvorrntng: <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 material injury to existing water dghts. The issuance of this permit <br />does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested <br />water right from seeking relief in a civil coud action. <br />2) The wnstruction 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 Stale Board of Examiners of Water Well Construction and Pump Inslalla0on <br />Contractors in accordance with Rule 18. <br />3) Approved pursuant to CRS 37-92-602(3)(b)(I) for uses as described in CRS 37-92E02(1)(fJ. Use of this well is limited to <br />monitodng water levels and/or water quality sampling. <br />4) Approved for the use of an existing well acknowledged for construction under monitoring hole notice MHd1761, and <br />known as DS03 MW03. <br />5) This well must be equipped with a locking rap or seal to prevent well contamina0on or possible hazards as an open well. <br />The well must be kept capped and locked at all Omes except during sampling or measudng. <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 wnGusion of the monitodng program the well owner shall plug this well in accordance with Rule 16 of the Water <br />Well Constmc0on Rules. A Well Abandonment Report must be completed and submitted to the Division of Water <br />Resources within 80 days of plugging. <br />8) The owner shall mark the well in a conspicuous place with well permit number(s) and name of aqu'rfer as appropriate, <br />and shall take necessary means and precautions to preserve these markings. <br />9) This well must have been constructed by or under the supervision of a licensed well driller or other authorized indivitlual <br />according to the Water Well ConsWcdon Rules. <br />10) This well must be located not more than 200 feet from the location specified on this permit.~2/D3 <br />APPROVED r , ~ . ~ ~\(~~-- <br />RAB t1~0 1 <br />_ __ _______State Engin r _.______.__ __._____° By .._._._._.. _.__ __.____~ <br />