GENERAL31155

• Permit No: M2001001
• IBM Index Class Name: General Documents
• Doc Date: 8/28/2002
• Doc Name: OSE Compliance
• From: Four States Aggregates LLC
• To: DMG
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

Form
No. GWS-2 NON-EXEMPT
O6/00 STATE OF COLORADO
DIVISION OF WATER RESOURCES
OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
[phone] Fax [phone]
WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37-90-137(2)
Carefully read the conditions of approval on your well permit. The conditions and the information on
this information sheet must be complied with in order for the permit to remain valid.
THE ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
The well permit is located in the upper right corner of the permit, and the expiration date is located in the
lower right corner.
THE WELL PERMIT EXPIRATION DATE IS ONE YEAR FROM THE DATE ISSUED. Evidence of the use
must be received in the form of a Statement of Beneficial Use (Form No. GWS-10) PRIOR TO THE
EXPIRATION DATE OF THE PERMIT. The well must be constructed, the pump installed and water from the well
must be used for the approved purposes prior to the expiration date of the permit. There are penalties if the
evidence of use (Statement of Beneficial Use) is not received prior to the expiration date. The well owner is
responsible for the Statement of Beneficial Use completion and submittal to the Division of Water Resources.
The expiration date of the permit may be extended for a maximum time of one year at the discretion of the
State Engineer for good quse shown. If an extension of time is necessary to construct and aut water from the
and fee must be received by the State Engineer orior to the expiration date. The request must state why the well
has not been completed, must inGude an estimate of time required to complete the well, and put the water to
beneficial use
Water well and pump installation contractors are licensed in Colorado to perform these specialized
tasks. It is illegal for contractors who do not hold these licenses to construct wells and install pumping
equipment in or on wells. The well must be constructed and the pump installed by contractors with
current license(s) issued by the State of Colorado unless exempted as described on the reverse side. The
well construction and pump installation reports including testing of well yields and pumping systems must be
submitted to the office of the State Engineer by the respective contractors within sixty (60) days of completion of
the work or within seven days after expiration of the permit, whichever is earlier. The contractor(s) must provide
you with a copy of the work report(s) filed with the State Engineer. The Well Construction and Test Report, Form
Number GWS-31 and the Pump Installation and Test Report, Form Number GWS-32 are available from the
Division of Water Resources offices. Additional information regarding well construction, pump installation,
required testing and well plugging and sealing regulations are found on the reverse side of this sheet.
You have been provided with at least two copies of the well permit. Keep a copy for your records. There
is also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller
license number on the application, or two additional copies have been enclosed. You may make additional
copies for the well construction contractor if you select one different from the one indicated in your application.
The original permit is on file in our Denver office Records Section. Copies may be obtained for a fee of 50 cents
per page. Statutes require that any change of mailing address or ownership be reported to the State Engineer.
Form number GWS-11 is used to report ownership changes and current owners to report address changes.
If you have questions, contact the Denver Office, or the Division Office in the area where your well is located.
Division 1 Division 2 Division 3 Division 4
810 9`" St. 2n° Floor 310 E. Abriendo Ave Ste B 422 4`" St 1540 E. Niagara
Greeley, CO 80631 Pueblo, CO 81004 Alamosa, CO 81101 Montrose, CO 81402
[phone] [phone] [phone] [phone]
Fax [phone] Fax [phone] Fax [phone] Fax [phone]
Division 5 Division 6 Division 7 Denver Office
50633 U.S. Hwy 6 8 24 Suite 101 701 Camino Del Rio Ste. 1313 Sherman St. Rm. 818
Glenwood Spgs., CO 1120 S. Lincoln Ave. 205 Denver, CO 80203
81601 Steamlwat Spgs, CO 80477 Durango, CO 81301 [phone]
[phone] [phone] [phone] Fax [phone]
Fax [phone] Fax [phone] -Fax [phone]