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DEC-09-2008 TUE 04:50 PM FAX NO. 3037727039 P. 08 <br />RECEIVED <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) <br />Please type or print legibly In black or blue Ink DEC 1U <br />"nums <br />""AN NE# <br />TE <br />Colorado Division of Water Resources 1313 Sherman St Room 821 Denver CO 80203 STAATE EM6INEER <br />COLD <br />Phnnw RA URRA..VA1 Fskv 9MMU IRAQ <br />AUTHORIZED DMDUAL DRILLER <br />Location, l1('/++, SE'h, Section &4, <br />Contact Jeremy Deuto. Q.G. Township §_N N / S, Range HIV E / W, PM <br />Company_ Tetra Tech County Weld _ <br />Address 1900 South. Sunset Street. <br />Suite IF Subdivision <br />City, State, Zip 1 onamont. CO 80501 Lot . Blk. , Fig. <br />Phone 303-772-6282 Fax No. 303-772-7039 . <br /> Site/Property Address 5011 F Stfeet <br />Driller Lic. No. (If applicable) Gresigy, CO 80631 <br />Well Owner (Client) Information Hole(s) to be constructed: Number $_- <br />Name LgLaa ae North Am@[IN Estimated depth Z Ft. Aquifer <br />Address 10170 Church Rench Way. Suite 200 Purpose of Monitoring Hole(s) Groundwater <br />11t gstmtnster. CO W021 monitoring <br />- <br /> Approximate Date of Construction 12.15.2008 <br /> (tduel be at least 3 days prior to oonatrucoon) <br />Well Owner's Phones 303-857-4000 <br />Landowner's Name: Tim Iverson Jeremy Deuto <br /> Authorized Signature <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />048268 FOR OFFICE USE ONLY <br />MH- PROCESSED BY' ?-- <br />Div. i WD ? BAs MD <br />DATE ACKNOWLEDGED 1?2 - /o - o g <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DiOLLING SITE. <br />Notice was provided to the Stets Engineer at least 3 days prior to construction of monitoring & observation hole(s). CorWjuc ion <br />of the hole(s) must be completed with 90 days of the date notice was given to the State Engineer. Testing and/or pumping shall not <br />exceed a total of 200 hours unless prior written approval Is obtained from the State Engineer. Water diverted during tasting phalli be <br />used for beneficial purposes. The owner of the hole(s) is responsible for obtaining permit(s) and complying with all rules and regulations <br />pertaining to the discharge of fluids produced during testing. <br />All work must comply with the Water Well Construction Rules, 2 CCR 402.2. Minimum construction standards must be motor a <br />variance obtained. Standard permit application and work report forms are found on the DWR website at htto IMrww.wstaristaft Mus- <br />Wetl Construction and Test Reports (GWS-31) must be completed for each hole drilled. The licensed contractor or authorized Individual <br />must submit the completed forms to this office within 80 days of drilling. <br />Unless a well permit is obtained, the hole(s) must be plugged and sealed within one (1) year after construction. <br />An Abandonment Report (form GWS-9) must be submitted for each hole plugged with 80 days of plugging & sealing. The <br />monitoring hole acknowledgement number, owner's structure name, and hole owners name and address must be provided on all well <br />permit application(s). well construction and abandonment reports. <br />The owner of the hole(s) should maintain records of water quality testing and submit this data to the State Engineer upon request. . <br />A monitoring hole cannot be converted to a production water web, except for purposes of mmedlation (recovery) or as a permanent <br />Dewatering system, if constructed in accordance with the Water Well Construction Rules and policies of the State Engineer. <br />THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMIT(S) CAN BE APPROVED. <br />IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS, PLEASE WRITE, 'NO HOLES CONSTRUCTED' <br />ON A COPY OF THE AND FAX THE COPY TO THE DIVISION OF WATER <br />RESOURCES.