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cws=_; NOTICE OF INTEiNT TO CONSTRUCT MONITORING HOLE{S) <br />03N5 <br />Please type ar pont legioy in black or blue ink <br />Colorado Division of Water Resources 1313 Sherman St-Room 821 Denver CO 80203 <br />Phone 303-886-3581 Fax 303-888,358!1 <br />AUTHORIZED INDIVIDUAL OR DRILLER <br />Contact Jack Allen <br />Corr~any Allen Drillin8,, Inc <br />Address Pos Offi Sox gOR <br />Ciy, State, Zip Fairolay, Colorado 80440 <br />Phone (719) 836-2672 Fax No. 719) 836-0715 <br />Driller Uc. No. (d applicadej 7h3 <br />Wall Owner (Client) Informatlon <br />Name Jack A11en <br />Adores ~ Post Office Box 398 <br />Fairplav- Colorado 80440 <br />Wall Owners Phone (719) R36-2K72 <br />Landowner's Name: Jack Allen <br />M H- <br />DIV. WD BAS__ MD___ DATE ACKNOWLEDGED <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF 7HE WWTTEN NOTICE ORACKNO'NLEDGEMENTSHALL BEAVAILABLE AT THE DRILLING 31TE. <br />Notlce was provided W the State Engineer at les~st 3 days prior to canstructlon of monltodng 8 observation hde(s). Construction <br />of the hole(s) must be completed within 90_da~ of the date no5ce was given m the State Engineer, Testing enNar pumping shaA not <br />exceed a total of 200 Hours unle~ prior written approval is obtained from the State F1lginoer. Water dverted dudng testing shall not be <br />used for benefidal purposes. Tha owner o1 the hole(s) is responsible for obtaining permit(s) and compyinp with all rules end regulations <br />pertaining to the discharge of fluids produced durinE~ testing. <br />All work must comply vdlh the Water Well Consttuctlon Ruks, 2 CCR 402-2. Minimum wnsauction standards must be met or a <br />varia-rce oMained. Starderd permitapplication and work report forms are found on the DWR wabsita at httoYMvm.waeer.stete.oo.us. <br />Well Constructlon and Test Reports (GWS-31) must be oompletad for each hole dNled. The licensed contractor or audrorized individual <br />must subm¢ the completed forms to this office within 60 days of dolling. <br />Unless a wall permit Is obtained, the hde(s) mua:t be plugged and sealed within one (D)eer after cans Vuctlon. <br />An Abandonment Repoli (form GWS-9) must be submitted for each hde plugged wl0tin 80 days of plupging 8 sealing. The <br />monitoring hole acknowledgement number, owners struc4rre name, and hde owners name and address must be provftled on all well <br />perrttit applicaCeMs), well consctution and abandonment reports. <br />The ovmer of the hole(s) should maintain records of water quality testing and submitthla tle~ to the State Engineer upon request. <br />A. nronitodng hole cannot be converted to a F oductiun water well, exceptfor purposes or remediaoon (recovery) or as a permanent <br />dewaterng system, if constvcted in aaordance with !ha Water Wall Corslrucfian Rules and po6ctas of the State Engineer. <br />THIS ACKNOWLEDGEMENT OF NOTICE DOES fl10T INDICATE THAT WELL PERMIT(S) CAN BE APPROVED. <br />IF HOLES WILL NOT BE CONSTRUCTED UNDER TIil3 NOTICE WITHIN 90 DAYS, PLEASE WRITE, "NO HOLES CONSTRUCTED" ON A <br />COPY OF 7HE ACKNOWLEDGED NOTICE WRH 7NE FILE NUMBFJi AND FAX THE COPY 70 THE D1V1510N OF WATER RESOURCES. <br />Locatlon: _1y~Y.,~_'/., Sactian 14 <br />Tovnship_QAIS, Raige-ZZHIW, PM 6th <br />Cotnty Park <br />Subdivision <br />Lol Bik. Frg. <br />SRe/ProperyAddress Section 11 S 14. Towns p <br />10 South, Range 77 West <br />Hole(s)to be constructed: Number 2-Sac 14 ~& 1-Sec 11 <br />Estimated depth-2jj_Ft Aquifer rl nct al Alluv 1 <br />Purpose of Monitoring Hole(s) Division of Miner s <br />and Geoloev <br />Approximate Date ofCanstruction Aoril 12.i.20D6 <br />ACKNOWLEDGEMENT FROM STATE E18GINEER'S OFFICE <br />FOR OFFICE USE ONLY <br />PROCESSED BY <br />Additional Cord~tbns <br />