2005-06-24_REVISION - M2000016 (13)

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Form fJo. OFFICE OF THE STATE ENGINEER Gws-zs COLORADO DIVISION OF WATER RESOURCES e18 Centennial Bldg., 1313 Sherman St., Denver, Cdorado 80203 (303) 8063581 APPLICANT 1279 WELL PERMIT NUMBER 250755 - DIV. 1 WD 2 DES. BASIN MD JI LAFARGE WEST INC %T AXLEY QWATER & WASTE ENG 621 17TH ST STE 1020 DENVER, CO 80293- (303)292-3503 APPROVED WELL LOCATION WELD COUNTY NE 1/4 SE 1/4 Section 12 Township 1 N Range 67 W Sixfh P.M. DISTANCES FROM SECTION LINES 1375 Ft. from South Section Line 275 Ft. from East Section Line t1TM COORDINATES ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDRIONS OF APPROVAL 1) This well shall be used in such a way as to cause no material injury b existing water rights. The issuance of this permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. 2) The wnsWction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a variance has been granted by the State Board of F~caminers of Water Well ConsWCtion and Pump Installation Contractors in accordance with Rule 18. 3) Approved pursuant to CRS 37-92-602(3)(b)(I) for uses as described in CRS 37-92-602(1)(1). Use of this well is limited to monitoring water levels andlor water quality sampling. 4) Approved for the use of an existing well acknowledged for construction untler monitoring hole notice MH-41765, and known as DS03 MWOB. 5) This well must be equipped with a locking cap or seal fo prevent well contamination or possible hazards as an open well. The well must he kept capped and locked at all times except during sampling or measuring. 6) Records of water level measurements and water quality analyses shall be maintained by the well owner and submitted to the Division of Water Resources upon request. 7) Upon cenclusion of the monitoring program the well owner shall plug this well in accordance with Rule 16 of the Water Well ConsWction Rules. A Well Abandonment Report must be completed and submitted to the Division of Water Resources within 60 days of plugging. 8) The owner shall mark the well in a conspicuous place with well permit number(s) and name of aquHer as appropriate. and shall take necessary means and precautions to preserve these markings. 9) This well must have been constructed by or under the supervision of a licensed well driller or other authorized individual according to Ne Water Web ConsWCtion Rules. 10) This well must be located not more than 200 feet from the location specified on this permit. s~12)'a3~ APPROVED RAB State