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Form STATE OF COLORADO For Office Use Only <br />No. OFFICE OF THE STATE ENGINEER <br />GWS-1 g18 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 <br />6/2006 (303) 866-3581 Fax (303) 866-3589 <br /> htt ://water.state.co.us/default.htm <br />REGISTRATION OF EXISTING WELL <br />NAME. ADDRESS AND PHONE OF T_HE WELL OWNER:, <br />NAME(S) <br />John E. and Terry O. Redd <br />MAILING ADDRESS <br />7410 Sandy Lane <br />CITY: STATE: ZIP CODE: <br />Mechanicsville VA 23111 <br />TELEPHONE NUMBER E-MAIL (OPTIONAL) <br />(804)746-7112 <br /> <br />WELL LOCATION County Routt Owner's Well Designation (optional) OS-03-0005 <br />N/A N/A CO N/A <br />(Address) (City) (State) (Zip) <br />SW 1/4 of the SE 1/4, Sec. 36 , Twp. 5 ®N. or ^ S., Range86 ^ E. or ®W., 6th Principal P.M. <br />Distance from Section Lines 1166 Ft. ^ N. or ®S. Line, 1664 Ft. ®E. or ^ W. Line. <br />PLEASE ATTACH A COPY OF A CURRENT DEED FOR THE SUBJECT PARCEL <br />Subdivision Name N/A ,Lot ,Block ,Filing/Unit <br />Optional: GPS well location information in UTM format. The following GPS settings are required: Fasting 331742.64 <br />Format must be UTM. Units must be in meters. Datum must be NAD83. Unit must be set to true <br />north. ^ Zone 12 or ®Zone 13 <br />Was GPS unit checked for above items? ®YES ^ NO Northing 4467685.54 <br /> <br />The well has historically been used for the following purpose(s): Monitoring Well <br /> <br />Water from the well was first used beneficially by the original owner for the above described purposes on Unknown <br />The total depth of this well is 163 feet. <br />The pumping rate of this well is N/A gallons per minute. <br />The average annual amount of water diverted is N/A acre-feet. <br />The lawn and garden irrigated (watered) by water from this well is N/A ^ Acre or ^ Square feet. <br />Number <br />The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to <br />C.R.S. 23-3-104(13)(a). I have read the statements herein, know the contents thereof, and state that they are true to my knowledge. <br />Signature(s) of the Well Owner Print Name and Title of Well Owner Date <br /> <br /> <br />For Office Use Only <br />WE <br />WR <br />CWCB <br />TOPO <br />MYLAR Div WD Basin MD <br />