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OCT -25 -11 10:17 FROM- DIVISION OF WATER RESOURCES <br />i ," <br />NOV ..,A 8 „2011 <br />Colorado Division of Water Resources 1313 Sherman St -Room 821 Denver CO 80203 Division u d e16 n' <br />Phone 303 -886 -3581 Fax 303 -a66 -3889 Mining <br />r3W8 -6t <br />O71zoos <br />AUTHORIZED INDIVIDUAL. OR DRILLER <br />Weil Owner (Client) Information <br />Name Northfield Partners. LLC <br />Address P. O. Box 630676 <br />Littleton. Colorado 80163 <br />3038662223 <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(M) <br />Please type or print legibly in black or blue ink <br />Contact Scott Leonhart <br />company Northfield Partners, LLC <br />Address P. O. Box 630678 <br />City, Ste, Zip Littleton, Colorado 80163 <br />Phone 303 - 267 -0668 Fax N0. 303 - 267 - 0680 <br />Driller lac. No. (if applicable) 631 <br />502.5 -MH <br />Wet Ownere Phone 303 - 267 - 0668 <br />Landowners Name : Chandler Creek Companies <br />Dtv. Z WD 1 Z— BAs MD <br />Location: SW 'J., NE + /., Section 22 <br />Township 18 N SORenge 7Q_ . E V®PM Btu_ <br />County Fremont <br />Subdivision N/A <br />Lot N/A . Eilk. N/A , Fig. N/A <br />SitelProperty Address N/A <br />Hole(s) to be constructed: Number 6 <br />Estimated depth 100 Ft. Aquifer unknown <br />Purpose of Monitoring Hole(s) groundwater <br />monitoring <br />Approximate Date of construct October 31, 2011 <br />po t ...: 3 <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />FOR OFFICE USE ONLY <br />PROCESSED BY <br />DATE ACKNOWLEDGED t ° ZT - It <br />■ ZZIo -00 <br />T -000 P. 01/06 F -962 M 2 <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL 86 AVAILABLE AT THE DRILLING SITE. <br />Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation hotels). Construction <br />of the hole(s) must be completed within (I0 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 Mara be <br />used for beneficial purposes. The owner of the hole(s) is responsible for obtaining perm t(s) and complying with all rules and reputations <br />pertaining to the discharge of fluids produced during testing. <br />AU 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 littp://www,wateratat”o.us. <br />Well Construction and Test Reports (GWS -31) must be completed for each hole drilled. Tie licensed contractor or surnamed individual <br />must submit the completed forms to this office within 80 days of drilling_ <br />Unless a well permit to obtained, the hotels) 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 within SO 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 applicallon(s), weB consbuc lion and abandonment reports. <br />The owner of the hole(s) should maintain records of water quality testing and submit this data to Me state Engineer upon request. <br />A monitoring hole cannot be converted to a production water well, except for purposes of remedlation (recovery) or as a permanent <br />dewateting system, if constructed In accordance with the Water Weil Construction Rules and policies of the State Engineer. <br />THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERttIrT(6) CAN BE APPROVED. <br />IF HOLES WILL NOT BE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS, PLEASE WRITE, "NO HOLES CONSTRUCTED” ON A <br />COPY OF THEACKNOWLED9EQ NQUCE Wail THE FILE = R AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES. <br />Additioneb Conditions <br />