2008-11-20_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 11/20/2008
• Doc Name: Registration of Existing Well
• From: WWC Engineering
• To: DRMS
• Permit Index Doc Type: General Correspondence
• Email Name: JDM
• Media Type: D
• Archive: No

DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., RM 818, DENVER CO 80203
phone - info: [phone] main: [phone]
Fax: [phone] htt://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
.................... ._.............. _........................................ _.......... _........................................................._........_......
Name of well owner
John E. and Terry O. Redd
7410 Sandy Lane
1 Mechanicsville VA 23111
[phone]
2. Type Of Application (check applicable boxes)
..................... ................................. ...................... _......... ..... ............................................. _.._............................... _._..__..............
................ __.................... ............ _._.._.............
® Use existing well ? Replacement for existing monitoring well:
? Construct new well Permit no.:Not Permitted
? Other:
3. Refer To (if applicable)
..: .......:....9...... .... .............. ................. _.. _.....-.__.._....__.._......................__..................................._.._.................._........_....._.__...........
......._....._........................
Monitorin hole acknowledgment i Well name or #
i
Office Use Only
Form GWS-46 (12/2007)
6. Use Of Well
................... .._.............. .... ....................................................... __...................... ............_.......................... _.........................
_.............. _.................... _._.... __.......... .
Use of this well is limited to monitoring water levels
and/or water quality sampling
7. Well Data (proposed)
.......... ................. _...................___............ ........-.__._..__._.....-----------
Total depth Aquifer
145 feet ; Unknown
8. Consultant Information (if applicable)
..... ..................... ..._.... __ -......................_.__...........................---......._...................._...................._...................._......_.. .._.
Name of contact person
N/A
.
.... ....... ............ _.......... ..... _.._........................ _..................... __.._........................... ..... ...................................... .........................
. .............. ....... ............. _._....
Company name
Mailing address
City
State Zip Code
MH- N/A GMO-lp Telephone #
4. Location Of Proposed Well ( )
co??ty .................................................................................................._......................._._................................................_..................
_................................................_._.._..__._. 9. Proposed Well Driller License # o tional):N/A
Routt SW 1/4 of the SE 114 10. Signature Of Well Owner, Consultant Or Authorized
....................... .................. r--.._..._..... _.............. __._...................... i -................................................................r.._....._._........._........
......._..................._.._._._._
Section I Township N or S i Range E or W I Principal Meridian __...... Agent
.
............................. _...................... ..._...................... ---..._..... _....................................................._........................................
.._......... ............. ........ .... .........
36 5 ®? 86 ? ® 6 The making of false statements herein constitutes perjury in the second
degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S.
i........_.._ .............................
..............................._!..............._.............................. _.................... .................. ..... _..... ....._....................... _. 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 tomy knowled......9.......e. . _... ....... .. .. .... .....
__._...._..._ _..__ . _........... -- ...... ........................................_...............................................................................,.........................
-. .
141 Ft. from r-1 N ® S 1929 Ft. from ® E ? W Sign here (Must be original signature) Date
...............................................- - .........._...... _.._...................... _........................... ---............. _....... _..... _....... ..... ._..............
................._............ _..................
Far replacement wells only - distance and direction from old well to new well
N/A feet N/A direction
....... ................... ......................................................................................... _.............. ....._........ ............. ...................
.................._.................................................... ......... _.......
Well location address (Include City, State, Zip) ? Check if well address is same asltem 1.
N/A
.................................................................... ....................... ..........................................................................................................
............. _...... _............
.
Optlonal: GPS well location information in UTM format
You must check GPS unit for required settings as follows:
.,_....
.................... _.............. __....................
Format must be UTM
i
? Zone 12 or ® Zone 13 Easting 331653.65
Units must be Meters
Datum must be NAD83 Northing 4467380.26
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
Mailing address
7410 Sandy Lane
City State Zip Code
Mechanicsville VA 23111
............................................................................................................................................__._._.............._............_......._..........._.....
.._......_.........._....__._...__..__._._.._._..
Telephone #
[phone]
DIV WD BA MD

Prt/amame & title
J@) r
F. -ZDO ,J.2 0,01J04-
Office Use Only
,._..._ ........... ......... .._._..................__......_.................- -- ...--
USGS map name** DWR map no.
Receipt area only