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r, <br />DEC-09-2008 TUE 04:48 PM <br />FAX NO. 3037727039 P. 03 <br />RECEIVED <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 />Phone 3034888.3681 Fax 303.8664689 <br />DEC 1- Q 2006 <br />--*YATEA aESourz" <br />ATATEEIRMA <br />00 <br />AUTHORIZED IND IDW OR DRILLER <br />Location: NE_ X, Wle, Section a <br />Contact Jeremy Deuto. P.G. Township §I" / S, Range 66W E I W, PM <br />Company Tetra Tech County Wild <br />Address 1900 South. Sunset StreetSuite IF <br /> Subdivision <br />City, State, Zip Longmont. CO 80501 Lot . Blk. Fl g. <br />Phone 303-772-6282 Fact No. 303-772-7039 <br />Driller Lie. No. (if applicable) Site/Property Address WA <br />Well Owner (Client) information Hole(s) to be constructed: Number 1 <br />Name Lafamg North America Estimated depth M Ft. Aquifer <br />Address 10170 Church Ranch Way. SUite 200 Purpose of Monitoring Hole(s) CP2roundwa_ter <br />Westminster. CO 80021 monitoring <br /> <br /> Approximate Date of Construction 12-17-2008 <br /> at least 3 days prior to c«,stnraaon) <br />(Must <br /> <br />Well Owner's Phones §92:g <br />-67000 <br />-4 <br />Landowner's. Name. LafQme. North America <br /> Jeremy DeutQ <br /> Authorized Signature <br />_ ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />048265 FOR OFFICE USE ONLY <br />MH"' PROCESSED BY <br />- o <br />Div. WD : BAs MD DATE AcKNow=00 ?1 -/0 <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 cormtructlon of monitoring & observation hole(s). Construction <br />of the hole(s) must be completed with e0 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 tesdng lball 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 fiuids produced during testing. <br />All work must comply with the Water Well Construction Rules, 2 GCR 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 webe to at WQgWWW,&;ater state.co.us. <br />Well Construction and Test Reports (GWS•31) must be completed for each hole drilled. The licensed contractor or authorized individual <br />mast submit the completed forms to this office within 60 days of drilling. <br />Unless awell permit is obtained, the hole(s) must be plugged and sealed within one (1) year after construction. <br />An Abandonment Report (form GWS4) must be submitted for each hole plugged with 60 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(a), well eonstnaction 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 />Dewaboring system, If construuced in accordance with the Water Well Construction Rules and polities 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 ACKNOWLEDGED NOTICE WITH THE FILE NUMBER AND FAX THE COPY TO THE DIVISION OF WATER <br />RESOURCES.