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OCT -25 -11 10:19 FROM - DIVISION OF WATER RESOURCES <br />3W8 -t <br />o7r2ooa <br />3038662223 T -000 P.05/06 F -962 <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 303-866-3581 Fax 303- 886 -35119 <br />AUTHORIZED INDMDUAL OR DRILLER <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 <br />Driller tic, No. (if applicable) 631 <br />Well Owner (Client) Information <br />Narne Northfield Partners, LLC <br />Address P. O. Box 630678 <br />Littleton. Co1910do 8Q1§./ <br />Well Owner's Phone 303 - 267 - 0668 <br />Fax No. 303 - 267 -0680 <br />Landowners Name : Chandler Creek Companies <br />Location; NW Y+, NW % Section 23 <br />Township 18 NO Range Range Z0 E ®WPM Atja__, <br />County Fremont <br />s, ,,;aeon N/A <br />Lot NIA Siic, N/A Fig, NIA <br />Site/Property Addresa NIA <br />Hole(s) to be constructed; Number 6 <br />Estimated depth 900 Ft. Aquifer unknown <br />Purpose of Monitoring liote(s) groundwater <br />monitoring <br />Approximate Date of construction October 31 2011 <br />tear s , prior <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />(D 2 FOR OFFICE USE ONLY <br />- MH PROCESSED BY <br />Div. 2 WD 12 BAs MO DATE ACKNOWLEDGED D _ Z ' . <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 construction amanita/big at observation hole(s). Construction <br />of the hole(s) must be completed within I 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 WADS be <br />used for beneficial purposes. The owner of the hole(e) is responsible for obtaining permit(s) and complying wIh all rules and regulations <br />pertaining to the discharge of fluids produced during testing. <br />All 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 farms are found on the DVVti website at <br />Well Conshuctlon and Test Reports (GWS - 31) must be completed for each hole drilled. The licensed cantraclor or authorized individual <br />must submit the completed forms to this office within 00 days of draping. <br />Unless a well permit le obtained, the hole(s) must be plugged and *salmi within one (1) year after conetn ction. <br />An Abandonment Report (form 0W6-e) must be eubmfttad for each hole plugged within 60 days of plugging & seakng. The <br />monitoring hole acknowledgement number, owners structure name, and hole owners name and address must be provided on all wan <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 De converted to a production water well, except for purposes of remedlat o n (recovery) or as a permanent <br />dewatering system, If constructed In accordance with the Water Well Construction Rules and policies of the State Engineer. <br />THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL. PERMIT(S) CAN BE APPROVED. <br />W HOLES WILL NOT SE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS, PLEASE WWI, "140 HOLES CONSTRUCTED" ON A <br />COPY OF THE AND FAX WE COPY TO THE DIVISION OF WATER RESOURCES. <br />Additional Conditions <br />