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DEC-09-2008 TUE 04;49 PM <br />FAX NO, 3037727039 RECE1VA <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) <br />Please We or print legibly in black or blue ink <br />Colorado Divlslon of Water Resources 1313 Sherman St-Room 821 Denver CO 80203 <br />0EC 10 U8 <br />'NA7EAYESUUHCEr <br />8747E E161SUR <br />Cm0 <br />Contact Jeremy Deuto. P.G. <br />Company Tetra Tech <br />Address 1900-South. Sunset Street <br />Suite If <br />City, State, Zip Lonamont CO 80501 <br />Phone 303-772-5282 Fax No. 303-T/2-7038 <br />Driller Lic. No. (If applicable) <br />Name - Lafarge North-America <br />Address 10170 Church Ranch Way Suite 200 <br />Westminster. CO 80021 <br />Well Owner's Phones 303-657-4000 <br />Landowners Name: _ CRY Of Greeley <br />Location: NE %, Wl-s, Section it <br />Township 6bJ N / S, Range 66W E / W. PM <br />County ftd <br />Subdivision <br />Lot . Blk. Fig. <br />Site/Property Address WA <br />Hole(s) to be constructed: Number. <br />F-stimated depth M Ft. Aquifer <br />Purpose of Monitoring Hole(s) Groundwater <br />Approximate Date of Construction IZ-J6-2008 <br />(Must be at least 3 days prior to construction) <br />Jeremy Qeutq <br />Authorized Signature <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />Ct 4 8 2 6 7 FOR OFFICE USE ONLY <br />MH- PROCEssrm By <br />`- <br />Div. WD z _ BAs MD DATE ACKNOWLEtxEb <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING SITE. <br />Notice was provided to the State Engineer at least 3 days prior to construction of monitoring 3 obae'vatlon hole(s), Construction <br />of the hole(s) must be completed with go 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 testing shall not 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 met or a <br />variance obtained. Standard permit application and work report forms are found on the DWR websit6 at http://rwv?i?.water.stats.ro. us. <br />Well 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 60 days of drilling. <br />Unless a wall permit Is obtained, the hole(s) must be plugged and sealed within one (1) year after construction. <br />An Abandonment Report (form GWS-8) must be submitted for each hole plugged with 60 days of plugging & seating. The <br />monitoring hole acknowledgement number, owners structure name, and hole owner's 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 well, except for purposes of remediation (recovery) or as a permanent <br />Dewatering system, If constructed in awm dance with the Water Well Construction Rules and policies of the State Englneor. <br />TH13 ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMIT(S) CAN BE APPROVED. <br />IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WITHIN so DAYS, PLEASE WRITE, "NO HOLES CONSTRUCTED' <br />ON A COPY OF THE ACKNlO/WJLEDdED NOTICE WITH THE FILE NUMBER AND FAX THE COPY TO THE DIVISION OF WATER <br />RESOURCES. 2 '*/7 A -1 - 1__ . - All