2011-01-20_HYDROLOGY - M1980244 - Laserfiche WebLink

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12-03-10 15:52 FROM-Colo Div of Water Resources +3038663589 T-488 P.001/002 F-518 ccW3,61 NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) o"Coe Pieria type or Pont lealbly in block or blue ink COLORADO DM8JON OF WATER RESOURCES-1319 3NERMAN ST•RM 821-0EN ? VER-CO.802Q3 PHONE; 303.889-3581--FAX; 303-866-.3589 Well Owner's Name, Address & Phone %660 / AO 69 J&P Landowner's Name (2604 1 Wa4a eyao&m g_67 Please check one and Complete as Indicated Incfuding contact info; Water Wall D911or Lloensed In Colorado - Lic. No. ? Professional Engineer Registered In Colorado - Reg. No. C] Professional Geologist per CRS 34-1-201(3) ;TOthar -anyone d"cuy employed by or under the supervision of a lioem,ed driller, reglatered professional angi ser or rrofaalonal geologist 10,02 Contaot / Company / '41 4 /1tV Address t°. •D, City, State & Zip Phone Fax 719- ?r>¢ _ ?,?j'y Print Name: Signature: Location: y .1:W V., Section 1 Township l]NAS, Range _A2 CIE [ W.jg? M County 1^d6E.tg Subdfvlelon, Lot, Bik, Fig (as applicable) Site/Proparty Address?? GPS Location in UTM format (optional); Set GPS unit la true north, datum NAD83, and uce metes for the distance units, [3Zona 12 or []Zone 13, Ea3ting Northing # of Monitoring Hole(s) to be constructed: -- - f Estimated Depth ..C-?-at., Aquifer Purpose of Monitoring Hole(s) 1 -ir ?.O v72o AFMClpated Data of Construction: ?aZ l Data Notice Submitted: (Must be al least 3 daye prior to oonsiruouon) ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE U `•.. 2-C' FOR OFFICE USE ONLY ( ?l 7 ,..._._ ' MH PROCESSED BY -64- Div. r WD `I BAS MD DATE AawOWLEDWD ( Z ' 3 '10 CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING SiM 1) Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation hole(s), 2) Construction of the hole(s) must be completed withln 90 days of the data notice was given to the State Engineer. Testing and/or pumping shell not exceed a total of 200 hours unless prior written approval is obtained from the State Engineer. Water diverted during testing pbqI1 Do be used for beneficial purposes, The owner of the hole(s) Is reepc %lble for obtaining permll(s) and complying with all rules and regulations penalri ft to the discharge of fluids produced during testing, 3) All work must compiy with the Water Well Construction Rules, 2 CCR 402.2. Minimum construction standards must be met or a variance obtained. Standard permit applloatlon and work report forms arc found on the DWR websits at Imp.- w??r ctatr ca, . Wall Construction and Test Reports (GWS-31) must be oomplatsel for each hale drilled, The Noensed coMraotor or authorized Individual must submit the completed farms to this office within 60 days of monil0ft hole completion, 4) Unless a well permit Is obtained, the hotels) must be plugged and sealed within one (1) year after construction. An Abandonment Report (term GINS-9) must be submitted within 80 days of plugging & sealing. The above MH admowfedgemant number, owners structure name, and owners name and address must be provided an all wall permit applloation(s), well construction and abandonment reports. 6) The owner of the hole(s) shall maintain records of water qu&IIW testing and submit "clots to the State Engineer upon request. 6) A MONITORING HOLE CANNOT BE CONVERTED TO A PRODUCTION WATER W13LL, except for purposes of remedlation (recovery) or as a permanent dewatering system, If constructed In accordance with the Water Well Construction Rums and policies of the State Engineer. 7) IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS, PLKA86 WRITE, "NO HOLES CONSTRUCTED" ON A COPY OF THE ACKNOWLEDGED NOTICE WITH THE FILE NUMBER AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES. THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMIT(S) CAN BE APPROVED, spaoa for labels or additional conditions as