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OCT -25 -11 10:17 FROM - DIVISION OF WATER RESOURCES <br />aws.st <br />Q7/2008 <br />Colorado Division of Water Resources 1313 Sherman St -Room 821 Denver CO 80203 <br />Phone 303 - 866 -3581 Fax 303 866 - 3589 <br />AUTHORIZED INDIVIDUAL OR DRILLER <br />Contact Scott Leonhart <br />company Northfield Partners, LLC <br />Address P. 0. Box 630675 <br />City, State, 7_ip Littleton, Colorado 80163 <br />Phone 303- 267 -0668 Fax No. 303-267-0680 <br />Driller Lie. No. (if applicable) 531 <br />Well Owner (Client) Information <br />Name Northfield eart LLC <br />Address P. 0. Bolt 630678 <br />Littlp�on. Coloriii o 8016 <br />Well owners Phase 303 - 267 - 0668 <br />3038662223 T -000 P.02/06 F -962 <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLES) <br />Please type or print legibly in buck or blue Ink <br />Landowners Name : Chandler Creek Companies <br />Location: NE 1 /,, NE %, Section 22 <br />Township 19 N Q - ; nge !O E IPM �,_,,,_ <br />county Fremont <br />Subdivision N!A <br />Lot N/A Bik. N!A Flg, N/A <br />Site/Properly Address NIA <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />o 2_54. FOR OFFICE USE ONLY <br />- MH PROCESSED BY <br />Div. 'Z WD I Z _ Ras MD DATE ACKNOWLEDGED to - 25 - (,I <br />Hole(s) to be constructed: Number 6 <br />Estimated depth 160 Ft. Aquifer unknown <br />Purpose of Monitoring Hole(s) groundwater <br />monitoring <br />Approximate Date of Construction October 31 2011 <br />muses Most 3 .... piforto . • i <br />7.11 /� � i <br />Trued Si. <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING &TE. <br />Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation hote(s). Construction <br />of the hole(s) must be completed within 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 unities prior written approval is obtakied from the State Engineer. Water diverted during testing slaw be <br />used for beneficial purposes. The owner of the hole(s) is responsible for obtaining pemtit(s) and complying with all rules and regulations <br />pertaining to the discharge of fiulds produced during testing. <br />All work must comply with the Water Well Construction Rules, 2 CCR 02 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 ht :ewww.ryater <br />Well Construction and Teat Reports (GWS -31) must be completed for each foie drilled. The licensee contractor or authorized individual <br />must submit the completed forms to this office within 60 days of drilling. <br />Unless a well permit le opined, the hola(e) must be plugged and smiled within one (1) year attar construction. <br />An Abandonment Report (form GW8 -9) muat be submitted for each hole plugged within 130 days of plugging & sealing. The <br />monitoring hole acknowleclgsment number, owners structure name, and hoe owners name and address must be provided on all well <br />permit application(s), well construction and abandonment reports. <br />The owner of fife hole(s) should maintain records of water quality testing and submit tits data to the State Engineer upon request. <br />A monitoring hole cannot be converted to a production water wed, except for purposes of remedlation (recovery) or as a permanent <br />dewatering system, If constructed in accordance with the Water Well Construction Rules end policies of the State Engineer. <br />THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERIIAIT(S) CAN BE APPROVED. <br />IF HOLES WILL NOT SE CONSTRUCTED LINDER THIS NOTICE WmtIN S0 DAYS, PLEASE WRITE, "NO HOLES CONSTRUCTED" ON A <br />COPY OF THE AC1imag.F,l2DED NOTIGIATff THE Fij,E NUMBER AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES. <br />Additional Conditions <br />