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01-17-11 11:42 FROM-Colo Div of Water Resources +3038663589 T-572 P.002/002 F-830 <br />GW"1 NCMCE OF INTENT TO CONSTRUCT MONITORING HOLES)Oeolooe <br />Pam We or ph iegittiy in mcit or blue ink _ 4/ <br />COLORADO DMSION OF WATER RROURCES-1313 SMOWAly ST-RM 8Z4D 9???/ -?? <br />P"11, 303-SM-M1-FAX; 3DUW%gM <br />fold( O is fno a Plfone (rl. (?!/ ? n ?y? ?O <br />Landowner's Name <br />Pieria check erne and OOmPlete as Indleated kouding contact infer <br />0 Water Wstl DrlQsr LlowaW In Colorado, Llc. NM <br />13 Profaeslonel Enpinaer Re am ad In CO wWo ^ Rag. No. <br />Pr slOnel Cseoiogtet Per CRO 34.1.201(5) <br />ew V*"l 4sclgr MPbyod bb or ft.1 the <br />enplnNW aer err err a efeei,,.eu.,.d ? <br />Contact / Com <br />Address <br />Carr. sate a Zip <br />Phone _ 7/ 9, <br />Print Name: <br />Signature: -_ <br />6 <br />Location: Y /YG Y., section <br />TOMAIP -CON 3d Range ? ?E <br />&Ibdivlsion, Lot. Elk, Rg (as ap io") <br />S blrrPropergr Add?gm ov <br />OPS Laco*m In U7 AR farmat (optlond): <br />bet t3PS unit to true north, datum NADBS, and use masters for <br />the dletenee units. ClUr i 12 or DZone I& <br />Fjftng Northing <br />----- <br />0,0 monlto" Hota(s) to be conetructad: <br />99dmdad Depth -AzQN Aquifer <br />Purpoes of monitodng Hoht(a), <br />a <br />AMIOIpded DaEs of constt„dfon: O/-/ -- <br />Date Novo. Submitted: <br />(Must be at lase! a d" prW to WmMi don) <br />15- ACWOWI.EDC> WENT FROM STATE ENGINEI~R'8 OFFICE <br />4 7o FOR OFF= LISE ONLY <br />Div. 2 - MH PROMSS&D BY ahe?) <br />wo t 2- eAS MID `?-- <br />DATEACKNOWLEDGED <br />CONDITIONS OF MoNnvq NO ww ACKNOWLEMMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLIMEMENT SHALL BE AVM MLE AT THE DRILI.INti SITE <br />1) <br />2) <br />3) <br />4) <br />13) <br />7) <br />NoBW was pmvidedto N» lift Englnesrat least 3 days petorto consUuctton of <br />ntonaoring 3 ottsorvatlon hole(s). <br />CorletrttdNn of on hope(s) mast be can~ w(gyn 90 dM <br />Pttntp110 shag not exceed a total of 200 Fraser unless prior w of the ride notlcs vKfs glv?trt to the aft Englnsa f; Teatlng and/or <br />s Is to otkatrted trrom the Spot r ndlneer. Wabr diverted durlru? g <br />SW LNI be used for bend" M&poess, The owner of the <br />hoW <br />re9uiagons pertaWng b the ? POrtslbla for otttslnkV penttk(s) and ??PIYbV with aq rules and <br />diet hmp of fads produced during few. <br />All work must comply with On Wdw Wap Con W;djm Rides, 2 COR 40a Mlnlm<m oO*ucgon stw tit must be met or a variance <br />obtained. standtud permit applk aeon bird work MW ft= are found on the DWR wetwe at IIIaWben &&W m n . Wou <br />Cat26"'Non and Test Reports (OW") must be COMPleted for each hole drftd, The ioensed <br />submit the wmp*W foals 1o flue office w#hln 6D days of mon <br />>9 hofa QO corftrar?r Or authormed kedividusi must <br />Unless a wall permit Is 000W. the ttabt must bs mPlstbn. <br />?) RbMW and seated wwWdn ans (1) yOw 81ftr ucyon. An Abandonment <br />Report (farm GM M must be submitted wkWn W days of plaggtng & es <br />sbucttsa name, and owrrers non* and address must be '?B. The shwa Nei aclrnosdedpemerrt numbeu ownrr+s <br />8Vu tV08 of lira Provided an d well perm t a"s),111O won and abandonmwt reports. <br />hohr(s) W M maintain records ara? q"Nytestlrto and submit Oft d4ts to the State Engross upon rawest. <br />A A MONITOMmi; HOU CANNOT BE CONVERTED TO A PRODUCTION WATER WELL„ "too for pub of remedfatton (reoft" <br />or an n Demnnent dewatering gym, If cotwtructed In atxoedattee with fete Water Wail Constmcoo" Rules and poiides of the state <br />agineer. <br />IF HOLAS WILL NOT Bp CONSTRUCTED UNDIR THIS NOTICE 1M MIN ea DAYS, PLB486 WRrM ,NO HOLES CONSTRUCTED" ON A <br />COPY OF THE ACKNOVyLKGRp NOMCE WITH THE FILL NUMBER AND FAX TM COPY TO THE DIVISION OF WATER RESOURCES. <br />THIS ACMOWLED004MT OF NOME DOER NOT WDtCATI; THAT WELL PeRmMs) CAN BE APPROVED. <br />SPA ror labels or aMonal Oonditkats as