2011-11-08_REVISION - X200522600

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OCT -25 -11 10:17 FROM- DIVISION OF WATER RESOURCES GINS-51 NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) Please type or print legibly In black or blue Ink 07rzoos Colorado Division of Water Resources 1313 Sharman St -Room 821 Denver CO 80203 Phone 303- 886 -3581 Fax 303- 866 -3889 AUTHORIZED INDIVIDUAL OR DRILLER contact Scott Leonhart Company Northfield Partners, LLC Address P. O. Box 630678 City, State, Zip Littleton, Colorado 80163 Phone 303 - 267 -0668 Fax No. 303 - 267 -0680 Driller i.ic. No. (if applicable) 631 Well Owner (Client) Information Name Northfield Partners, LLC Address P. O. Box 630678 Littleton. Colgrado 110163 We Camera Phone 303- 267 -0668 Landowners Name : Chandler CreeK Companies Additional Conditions 3038662223 T -000 P.03/06 F -962 Location: NW 1 4, SE %, Section 22 Township 11._ N SQRange 7Q E . WPM County Fremont Subdivision NIA Lot N/A elk N/A , Fig. N/A Stte#Praperty Address NIA Holes) to be constructed: Number 6 Estimated depth 200 Ft. Aquifer unKnown Purpose of Monitoring Holes) groundwater monitoring Approximate Date of Con ce ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE Yo 2-5 7 -mH FOR OFFICE USE ONLY PROCESSED BY October 31, 2011 Div. 2- WD ! BAs MD DATE ACKNOWLEDGED 10.25 • it CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING BITE. Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation hotels). Construction of the hole(a) must be completed within 90 days of the date notice was given to the State Engineer. Testing andlor pumping shall not exceed a total of 200 hours unless prior written approval is obtained from the State Engineer. Water diverted during testing agallitgl be used for beneficial purposes. The owner of the hole(s) is responsible for obtaining permit(s) and emptying with all rtes and regulations pertaining to the discharge of fluids produced during testing. All work must comply with the Water Weil Construction Rules, 2 CCR 402 -2. Minimum construction standards must be met or a variance obtained. Standard permit application and work report forms are found on me DWR webelia at lhprww.lyrrtsr si .ce . Well Construction and Test Reports (OWS -31) must be completed for each hole Oiled. The licensed contractor or authorized individual must submit the completed forms to this since within 60 daya of trifling. Unless a well permit is obtained, the boie(e) must be plugged and sealed within one (1) year after construction. An Abandonment Report (form GWS -9) must be submitted for each hole plugged within 60 days of piuigging & sealing. The monitoring hole acicnowiedgernent number, owner's structure name, and hole primer's name anti address must be provided on all well permit application(s), well construction and abandonment reports. The owner of the hole(s) should maintain records of water quality testing and submit this data to the State Engineer upon request. A monitoring hole cannot be converted 10 a produclttan water well, except for purposes of remediatlon (recovery) or as a permanent dewaterfng system, if constructed In accordance with the Water Well Construction Rules and polices of the State Engineer. THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERM T(S) CAN BE APPROVED. IP HOLES WILL NOT BE CONSTRUCTER UNDER THIS NOTICE WITHIN 00 DAYS, PLEASE WRITE, "NO HOLES CONSTRUCTED" ON A COPY OF THE xosuigJ.g0QJp NQTICR yV)JH THE FHA NUMBER AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES.