PERMFILE137719

• Permit No: M2005065
• IBM Index Class Name: Permit File
• Doc Date: 12/20/2005
• Doc Name: Adequacy Resposne for the Upper Animas Sand & Gravel
• From: Charles R. Ponchak
• To: DMG
• Media Type: D
• Archive: No

r Vnii
•No. GWS-2 NON-EXEMPT
6!2004 STATE OF COLORADO
DIVISION OF WATER RESOURCES
OFFICE OF THE STATE ENG{NEER
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 condNions of approval on your weal permit. The conditions and the information an
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 number 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 well
construction and pump installation must be received on appropriate forms PRIOR TO THE EXPIRATION
DATE OF THE PERMIT. The required forms are the Weil Construction and Test Report (Form No. GWS-31),
and the Pump Installation and Test Report (Form No. GWS-32). There are penalties if evidence of well
construction and pump 'installatiori is not received prior to the expiration date. The licensed contractor or well
owner (under the private driller or pump installer statutes and rules} performing the work is responsible for
completing the appropriate form(s) and submitting it to the Division of Water Resources.
The expiration date of the permit may be extended one time only for a period not to exceed one year for
good cause shown, at the discretion of the State Engineer. If an extension of time is necessary to construct the
must state why the well has not been constructed andlor pumping equipment installed, and must include an
estimate of time required to construct the well and/or install pumping equipment.
Water well construction and pump Installation contractors are licensed in Colorado to perform these
spec(allzed tasks. it is Illegal for Individuals who do not hold these licenses to construct wells and
install pumping equipment in or on wells. The welt must be constructed and pumping equipment
installed by contractors with current license(s) issued by the State of Colorado unless exempted as
described on the reverse side. 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 w(th at least one copy of the well permit. Keep a copy for your records. At least
one copy has been sent to the well driller if you indicated a driller license number on the application. You may
make additional copies for the well driller 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.
Use Form No. GWS-11. There is no filing fee.
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., Ste. 200 310 E. Abriendo Ave Ste B 301 Murphy Drive 1871 East Main St.
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
Direct mall to Box 396 Division 6
Direct mail to Box 773a5o Division 7 Denver Office

Glenwooo Spgs CO 81802
505 Anglers Dr. Suite 101 701 Camino Del Rio 1313 Sherman St, Rm. 818

50633 U.S. Hwy 6 & 2d
Steamboat Spgs, CO 80477 Ste. 205 Denver, CO 802D3
Glernrood Spgs., CO 81601 [phone] Durango, CO 81301 [phone]
(970) 9a5-56x5 Fax [phone] [phone] Fax (303} 888-3589
Fax [phone] Call First F0X [phone]
- _~es.~s.,..~- - a,:.~~~..-., .