Laserfiche WebLink
DEC-09-2008 TUE 04:48 PH <br />FAX NO. 3037727039 FAE&AD <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) <br />Please type or print legibly in black or blue ink <br />Colorado Division of Water Resources 1313 Sherman St-Room 821 Denver CO 80203 <br />Ok 10 2 <br />w1?TENBESOYPCFi <br />RT?ff EN6INF.ER? <br />COl© <br />Contact Jeremy Deuto <br />Company Tetra Tpc <br />Address 1900 South. Sunset §treet. <br />Suite IF <br />City, State, Zip Longmont. CO 80601 <br />Phone 303-772-6282 Fax No. §9 <br />Driller Lic. No. (ii applicable) <br />Name Lafarge North America <br />Address 10170 Church Ranch Way. Suite 200 <br />Westminster. CO 80021 <br />Well Owner's Phones 303.6674000 <br />Landowner's Name: City Of Greeley <br />Location: a'/., ME-A, Section 334 <br />Township 6t / S, Range 611 E / W. PM <br />County Weld <br />Subdivision <br />Lot . Blk. Fig. <br />Site/Property Address NIA <br />Hale(s) to be constructed: Number 1 <br />Estimated depth 35 Ft. Aquifer <br />Purpose of Monitoring Hole(s) Groundwater <br />monitoring <br />Approximate Date of Construction 12-17-2008 <br />(Must be at least 3 days prior to oonstnidion) <br />Jeremy Deuto - <br />Authorized Signature <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />0482 66 FOR OFFICE USE ONLY <br />MH- PROCESSED BY ? <br />DIV. I WD 3 BAs - MD <br />DATE ACKNOWLEDGED 1.2 -/O -OF <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SMALL. BE AVAILABLE AT THE DRIL.UNO SITE. <br />Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation hole(s). Construction <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 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 website at hU :fANww water state.co.us <br />Well Construction and Test Reports (t3WS-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 well permit Is obtained, the hole(s) must be plugged and sealed within one (1) year after construction. <br />An Abandonment Report (form OW34) must be submitted for each hole plugged with 60 days of plugging 3 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 well, except for purposes of remediatfon (recovery) or as a permanent <br />Dewatedng 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 WITHIN 90 DAYS, PLEASE WRITE, -NO HOLES CONSTRUCTED" <br />ON A COPY OF THE e,CKNOWLEDQgD NOTICE WITH THE FILE _NUMBER AND FAX THE COPY TO THE DIVISION OF WATER <br />RESOURCES.