2008-09-19_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: General Documents
• Doc Date: 9/19/2008
• Doc Name: Registration of Existing Wells
• From: WWC Engineering
• To: DRMS
• Permit Index Doc Type: Exploration
• Email Name: JDM
• Media Type: D
• Archive: No

COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-46 (12/2007)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., RM 818, DENVER CO 80203
phone - info: [phone] main: [phone]
Fax: [phone] hftp://www.water.state.co.us
MONITORING/OBSERVATION
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be completed in black or blue ink or typed.
1. Well Owner Information

....-........__......-_..__........_._-._._..... 6. Use Of Well
- - - - .... _
......................
Name of well owner
Fredrick G. Hoeptner et All Partners c/o Scott Hayden
Use of this well is limited to monitoring water levels
and/or water quality sampling
Mailing address 7. Well Data (proposed)
....... _....... _
.
.
360 S. Monroe, 5th Floor _
...
_.-..__...... ....... .-.._._....--- ............._ .............. ..... ---....... -............. _.-._................... _.
Aquifer
Total depth (
__........_--------- _.... - - _ .............-._ ....._...__....... .....p ........._....... __.... .................. _.._..............._.....
City state Zi 'code feet
Unknown Unknown
Denver CID 80209 8. Consultant Information (if applicable)
-.-.........__.-.._....._. - ...... _. _ ....__._.._........---......._....-_...__....._..._........._-_._-._...---_....._...._........_....--'
TeleP hone # E-Mail (optional)
Name of contact person
[phone] Troy Summers
...... __.... _........... _-...... ----................. ..... _....... _......................... _ ...................... _.....................
2. Type Of Application ?check applicable boxes)
-........__.......__ ............. _...._...... _..._........... --_--.--................------ Company name
__
® Use existing well ? Replacement for existing monitoring well: WWC Engineering
_....... _ ---......_._....- ............... _.... _............. -...... _-.............
? Construct new well
Permit no.:Not Permitted Mailing address
? Other: 611 Skyline Road
-.............. -.__ -....................__...__-.._-......_-._.._.._..__._.._.._...._...........__..._.._.....__ ................. _...... __...................... _.__....... _.....
3. Refer To (if applicable)
State Zip Code
city
_ ...... _. _ _ _ _ ..... _ _ ........_
_ ............._.__...._._..___.__...__..____.._-_.-....__.__-..__..
Monitoring hole acknowledgment well name or #
Laramie WY 82070
........ _....... ..-_.._._.------ ........................ _.. -......... _............ _...... _...... --_............. __......... ..... _.... _._.__............. _....... _................
_..._.._
MH- N/A OKa Telephone #

osed Well
Of Pro
ti
L
4 [phone]
p
on
oca
.
... __ .............. ._....... ...... _.......... .-............ _...... _........ .._............. _..... _._
County --_..._..._._..... _.__._ ........... T_._.-_... 9. Proposed Well Driller License #(optional):N/A
Routt NW 1/4 of the NW 1/4 10. Signature Of Well Owner, Consultant Or Authorized
........... 1....... -.--.--......... _.._... _.---..........__.......
Section '" " Township ' N'or S i Range E or W Principal Meridian
Agent
The making of false statements herein constitutes perjury in the second
4 ®? ? ®
20 85 6
degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S.
.................. ............... _-....... .._..-.-....... __.._.---.-.--.•-_-----_........_-...._.._..._.-_......_....-.. - .___............. ..._.................. ....... 24-4-104
(13)(a). I have read the statements herein, know the contents
Distance of well from section lines (section lines are typically not property lines) thereof and state that theY_ are true tom Y knowledge.

_
._................ ._._................................... ......-_ _....... _........._...__.._.........._.... ...... _..... _........ ..... _........
573 Fl. from ® N ? S 23 Ft. from ? E ® W __.....__-...----..
Date
Sign here (Must be .f si
...__....-.......... _------_.__.......... --._.............. _.__....._....._._..._.....---............_._..._................._....--- 9 l?l oe
For replacement wells only- distance and direction from old well to new well
. _........ __...... . -- ..._.__...._..._ ................. _...__.._..........:... _ ___....._.................._.
N/A feet N/A direction P??t e a me
__.._._..._.._..__._._._-_._.._.-....._-__.._....__._._.._......_........_..._....-__...__ _ _.___.._ -_-•-•-
Well location address (Include City, State, Zip) ? Check if well address is same asltem 1. apt C?GIS'r
&mAA0&" r AS?aIA?
N/A Office Use Only
Optional: GPS well location information in UTM format -- ce el--
USGS map name - - ? DWR map no. Surface elev.
You must check GPS unit for required settings as follows:
...
__...._.__..... _.... __......._....... _..---.._...._..._....._ ................
Format must be UTM
.__.... _-_.......... _......... ..-.-___.......... ..._.-
.......... ._._........ __......__.._._..i._..._.._..... _....... -._..._-------------------
Receipt area only
p Zone 12 or ®Zone 13
Fasting 333464.98 I
Units must be Meters
Datum must be NAD83 Northing 4464233.87 {
Unit must be set to true north
Was GPS unit checked for above? 0 YES Remember to set Datum to NAD83
5. Property Owner Information
Name of property owner
Fredrick G. Hoeptner et All Partners c/o Scott Hayden
Mailing address
360 S. Monroe, 5th Floor
._-.. ............. _.__..__...... .._..... __._........... ' __-__.__.__......._.__._._.-.__............. .... _..___.... ............. ._...... _...... _..... _.._._.__...........
__...... ..... ....__...-._.._.__.___.-............ _._
City State Zip Code
Denver CO 80209
Telephone #
DIV WD BA MD
[phone]