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DEC-09-2008 TUE 04;49 PM <br />FAX NO. 3037727039 REC114 <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) <br />Please type or print leglby in black or blue ink <br />Colorado Division of Water Resources 1313 Sherman St-Room 821 Denver CO 80203 <br />DEC, .10 2= <br />'MA1tR YESp1AQE <br />c747E E?aWEra <br />cm 0 <br />Contact Jeremy Deuto. P.G. <br />Company Tetra Tech <br />Address 1900 South. Sunset Street. <br />Suite 1 F <br />City, State, Zip Longmont. CO 9M- 1 <br />Phone 303-772-8282 Fax No. 303-772_ <br />Driller Lie. No. (if applicable) <br />Name Lafame North America <br />Address 10170 Qhurch Ranch Way. Suite 200 <br />Westminster, CO 80021 <br />Well Owner's Phones .303-667-4000 <br />Landowner's Name: _ City Of Greeley <br />Location: NE 7/., Section It <br />Township §N N / S, Range 66E / W. PM <br />County 1Wgid <br />Subdivision <br />Lot Blk.. Fig. <br />Site/Property Address WA <br />Hole(s) to be constructed: Number'.. .? <br />Estimated depth Al FL Aquifer <br />Purpose of Monitoring Hole(s) _Groundwater <br />montorine <br />Approximate Date of Construction I&16-2008 <br />(Must be at least 3 days prior to construction) <br />Jeremy eute <br />Authorized Signature <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />0 4 8 2 67 FOR OFFICE USE ONLY <br />MH- <br />PROCEsSr:D BY Div. I WI) Z3 -BAS MD DATE ACKNOWLEDGED /a -/6- S <br /> <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRrfTEN NOTICE OR ACKNOWLEDGEMENT SMALL 8E AVAILABLE AT THE DRILLING SITE <br />Notice was provided to the State Engineer at [east 3 days prior to construction of monitoring 5 observation hoie(s). Construction <br />of the hole(s) must be completed with 90 dW 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 [tie State Engineer. Water diverted during testing has of 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. fNinimum construction standards must be met or a <br />variance obtained. Standard permit.applicatkm and work report forms are found on the DWR weWte at Lt{)p ater•. ts.co.us. <br />Well Construction and Test Reports (GWS-31) must be completed for each hole drilled. The licensed contractor or authorized individual <br />must subunit the completed forms to this oftke within 60 days of drilling. <br />Unless a weN 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 hots plugged with 60 days of plugging 6 sealing. The <br />monitoring hole acknowledgement number, owners 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 wen, except for purposes of remediatlon (recovery) or as a permanent <br />Damtering 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 sE APPROVED. <br />IF HOLES WILL NOT Be CONSTRUCTED UNDER THIS NOTICE WrrHiN 90 DAYS, PLEASE WRITE,'NO HOLES CONSTRUCTED' <br />ON A COPY OF THE ACKNOWLEDG D NOTICE WITH THE FILE-NUMBER AND FAX THE COPY TO THE DIVISION OF WATER <br />RESOURCES.