Laserfiche WebLink
OCT -25 -11 10:18 FROM- DIVISION OF WATER RESOURCES <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLES) <br />Please type of print legibly in bleak or blue ink <br />Colorado Division of Water Resources 1313 Sherman St -Room 821 Denver CO 80203 <br />Phone 303- 866 -3581 Fax 303- 8664589 <br />AUTHORIZED INDIVIDUAL OR DRILLER <br />ows-61 <br />07/2008 <br />Contact Scott Leonhart <br />Company Northfield Partners, LLC <br />Address P. O. Box 630678 <br />City, State, Zip Littleton Colorado 80163 <br />Phone 303 -267 -0668 Fax No. 303- 267 -0880 <br />Driller Lie. No. (if applicable) 631 <br />Well Owner (Client) Information <br />Name Northfield Partners, LLC <br />Address P. O. Box 630678 <br />Littleton. Coloraj(io 80163 <br />Wel Owners Phone 303 -267 -0668 <br />Landowners Name : Chandler Creek Companies <br />3038662223 T - 000 P.04/06 F - 962 <br />Location: SW Y., SE %, Section 22 <br />Township 16 NI S Range 7Q E V sm._ <br />County Fremont <br />Subdivision NIA <br />Lot NIA Elk. NIA • Fig. NIA <br />Site/Property Address NIA <br />Hole(s) to be constructed: Number 6 <br />Estimated depth 100 Ft. Aqua unknown <br />Purpose of Monitoring Hole(a) groundwater <br />monitoring <br />Approximate Date of Conslrucli <br />se art <br />2 <br />_ /..AATi <br />i /% <br />.rizedS <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />5 0 2- S-47 FOR OFFICE USE ONLY <br />Mil FOR <br />BY <br />Div. 2 - WD 1 Z" SAS MD DATEACKNOWI.E0rr3ED I ° - Z S ° 6( <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILlINO SITE. <br />Notice was provided to the Slate Engineer at least 3 days prior to construction of monitoring & observation hotels). Construction <br />of the hole(*) must be completed within Wan 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 le obtained from the Stale Engineer. Water diverted during teasing ga,pgt be <br />used for beneficial purposes. The owner of the hole(s) is responsible for obtaining permits) and complyhig with all rules and regulations <br />pertaining to the discharge of fluids produced during testing. <br />All work muat comply with the Water Well Construction Rules, 2 CCR 402-2. Minimum construction standard must be met or a <br />variance obtained. Standard permit application and wait report forma are found on the PWR website at Jrttod/www.wateratatg.cp.u>t. <br />Well Construction and Test Reports (OWS -31) must be completed for each hale 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(.) niuet be plu9ged and sealed within are (1) yesr afar construction, <br />An Abandonment Report (form GWS-9) must be submitted for roach hots plugged within 60 days of plugging & sealing. The <br />mandating 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 remediation freemen() or as e permanent <br />dewatering system, if constructed In accordance with the Water Well Construction Rules and policies of the State Engineer. <br />THIS ACKNOWLEDGMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMIT(S) CAN BE APPROVED. <br />IF HOLES WILL NOT BE cONITTRUCTE0 UNDER THIS NOTICE WHIN 90 DAYS, PLEASE WRRE. 'NO HOLES CONSTRUCTED" ON A <br />COPY OF THE ACKyoYVL.EpOW KIM Willi TIE FILE NU thin AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES. <br />Additional Conditions <br />October 31, 2011 <br />