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OCT -25 -11 10:20 FROM- DIVISION OF WATER RESOURCES <br />GWS.st <br />e7r20oa 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 303.888 -3581 Fax 303-886-3589 <br />AUTHORIZED INDIVIDUAL OR DRILLER <br />contact Scott Leonhart <br />Company Northfield Partners LLC <br />Address P. O. Box 630678 <br />City, State, 4p Littleton, Colorado 80163 <br />Phone 303 -267 -0668 Fax No. 303 -267 -068 <br />Driller Lic. No. (if applicable) 631 <br />Well Owner (Client) Information <br />Name Northfield Partners. LLC <br />Address P O Box 630678 <br />1 Colorplio 8Q1 <br />Well Owners Phone 303 -267 -0668 <br />Additional Conditions <br />3038662223 T -000 P.06/06 F -962 <br />NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) <br />Landowners Name : Chandler Creek Companies <br />Location: NW 1/4, NW ''4, Section 23 _ <br />Township 18 N Qt ' > nge Z E 0PM 6th <br />County Fremont <br />Subdivision NIA <br />Lot NIA Bik. NIA , Fig. N/A <br />Site/Property Address NIA <br />Hole(a) to be constructed; Number 6 <br />Estimated depth1 Ft. Aquifer unknown <br />Purpose of Monitoring Hole(s) groundwater <br />monitorinsl <br />Approximate Dahl of Co <br />( te at 3 <br />Arad <br />October 31, 2011 <br />ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE <br />0 Z I FOR OFFICE USE ONLY <br />MI{ PROCESSED BY <br />DN. . Z WD 12- BAs MD DATE ACKNOWLEDGED ( - Z S` J <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 of monitoring & obaarvatlon hotels). Construction <br />of the holes) must be compteted within 9Q 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 sflaII t be <br />used for beneficial purposes. The owner of the hole(s) is responsible for obtaining permlt(s) and complying With all rules and regulations <br />pertaining to the discharge of fluids produced during tasting. <br />All work must comply vi lth the Water Well Construction Rules, 2 CCR 402.2. Minimum canal uctian standards must be met or a <br />variance obtained. Standard permit application and work report forms are found on the DVNR webelte at tan:Nyrwyv war r.statae.Fg.et. <br />Well Construction and Test Reports (GWS -31) must be completed for each hole drilled. The licensed contractor or authorized individual <br />must submit the completed tons to this office within 60 days of drilling. <br />Unless a well permit is Obtained the hales) must be plugged and sealed within one (1) year after construction. <br />An Abandonment Report (form GW6-8) must be submitted for each hole plugged within 60 days of plugging & sealing. The <br />monitoring hole acknowledgement number, owners structure name, end 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 tee converted to a production water west, except for purposes of rernedlatlon (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(8) CAN BE APPROVED. <br />IF HOLES WILL. NOT OE CONSTRUCTED LINIDER THIS NOTICE WITHIN 80 DAY$, PLEASE MUTE, "NO HOLES CONSTRUCTED" ON A <br />COPY OF THE Aomoyitt mon Yf17H mg FILE Neer AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES. <br />