2008-10-20_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 10/20/2008
• Doc Name: Monitoring Well Transfer/Plug and Abandon
• From: WWC Engineering
• To: John E. Terry O Redd
• 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] http://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

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. . . . . . . . . . . . . . . . . . . . 6. Use Of Well

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Name of well owner
Use of this well is limited to monitoring water levels
John E. and Terry O. Redd
and/or water quality sampling
g- add re-r-e ......ss .........................................................................._.---.-_........................__.._.................................................................
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Mailing ad
7. Well Data (proposed)
7410 Sandy Lane
Total de th --q u------....-_..._...........-- ---._-..--?-
P A i fer
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City _ ................State...._.................... Zip code feet
87.7 ;Unknown
Mechanicsville VA 23111 8. Consultant Information (if applicable)
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P ..................... ..... ................... .............................................................. ......_.......,............................... .......................................
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Tele one # E-Mail (Optional)
Name of contact person
[phone] N/A
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2. TYPe Of Application ..check applicable boxes
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................ _.._.............. .. Company name
® Use existing well ? Replacement for existing monitoring well: ................. .-............... _.... ..._........ _....... _.__........... .................... ........ _........
................. ..................... .-......... ....... :........................ .............................................................. .......
? Construct new well
Permit no.:Not Permitted Mailing address
? Other:
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C
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3. Refer To (if applicable)
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p
o
City State
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Monitorin hole acknowledgment Well name or #
.......................... ........ .......... .... ......._..__....... ............... _.__........... .......... ..... ..._............................. _.._..........................
W_..............
MH- N/A REDD-1 Telephone #
osed Well
Of P
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rop
on
ocat
4.
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/A
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County ona :N
9. Proposed Well Driller License #(o t
Routt SE 1/4 of the SW 114 10. Signature Of Well Owner, Consultant Or Authorized
................."'f..........,_.....,....__......................_......._..._...._....._
Section Township N or S I Range E or W i Principal Meridian A ent
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The making of false statements herein constitutes perjury in the second
36 j 5 SE-1 86 El ® i 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)
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thereof and state that they are true to my knowledge....... ...... .. ... .. ......, . .. .... ......... . .
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946 Ft. from El N ® S 21 17 Ft. from [:1 E ®W

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Date
. be
signature
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orJginal
Sign here (Must.

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For replacement wells only - distance and direction from old well to new well

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N/A feet N/A direction
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Print name & title
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Well location address (Include City, State, Zip) ? Check if well address is same asitem 1.
N/A
....................... _.._......._...... .... ........................ _......................... _....... _.................. Office Use Only
............ .................... .................... ....... ---............................ _........................... .-.
Optional: GPS well location information in UTM format
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......... ............................................._....................._...._...._........................_._................,-.?._._.._.__..__........_ _._......... .... .................
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USGS map name DWR map no. I Surface elev.
You must check GPS unit for required settings as follows: i
Format must be UTM
Receipt area only
? Zone 12 or I@ Zone 13
Easting 331283.80
Units must be Meters
i
Datum must be NAD83 Northing 4467625.49
Unit must be set to true north
Was GPS unit checked for above? ® YES Remember to set Datum to NAD83
5. Property Owner Information
. ..._._................. ................................................ ............_................ ............... .............................. _...
............ ..................... ......................... ....... ..............................
Name of property owner
John E. and Terry O. Redd

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Mailing address i
7410 Sandy Lane
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City State Zip Code
Mechanicsville VA 23111
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Telephone #
DIV WD BA MD
[phone]