2011-01-20_HYDROLOGY - M1980244 (2)

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12 -03 -10 15:52 FRONT -Colo Div of Water Resources owls, 08/20be Print Name: Signature: NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S) Please type or print legibly in black or blue ink ‘V/ 0 0 2 — COLORADO DIVISION OF WATER RESOURCES -1313 SHERMAN ST•RM 8 21-DENVER-00-60203 PHONE: 303- 888- 3581 --FAX; 303 - 886-3589 ,/ 0 Landowner's Name _CGO� !/ /n/ ,p Please check one and complete as indicated Including contact info: ❑ Water Wall Driller Licensed In Colorado - tic. No. _ ❑ Professional Engineer Registered in Colorado - Reg. Na ❑ Professional Geologist per CRS 34-1. 201(3) ['Other -anyone directly employed by or under the supervision of a licensed driller, registered pro eneigaer or prof onai geologist Contaot / Company Address /-, iZ Au. 17 Cit State 8. ap „p c.TD�Q rQ r "OG, p Phone 7/ 9 ctrl/” PoYdr Fax 719 112 3.li y /74RA Yr✓Qiv/ +3038663589 T -488 P 001/002 F -518 Location: SA/ % .S % jam/'A, Section / 6 Township L.,❑Ny�s, Range 6f CIE [ , rvk,M County 7'a6LE7,P Subdivielon, Lot, BIk, Flg (as applicable) /1 Site/Proparty Address —Th4002 6py_ all ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE FOR OFFICE IJSE ONLY MH PROCESSED BY GPS Location in UTM format (optional): Set GPS urns to true north, datum NAD83, and use metenr for the distance units, DZane 12 or Ozone 13. Easting , Northing DN. WD 1 BAS MD DATE ACKNOWLEDGED 3 'JO # of Monitoring Holes) to be constructed: Estimated Depth _�G_ 2t., Aquifer Purpose of Monitoring Hotels) 72) 4 e - gi? " vmo 27e/lya"Dyaw /70ovare 14/51.1 Anticipated Date of Construction: /)- — 07-1 0 Date Notice Submitted: /0 `C„ ? —l0 (Must be el least 3 days prior lo construction) CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT A COPY OF THE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHALL BE AVAILABLE AT THE DRILLING SiTE, 1) Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation hole(s), 2) Construction of the hole(s) must be completed within 90 days of the data notice was given to the State Engineer. Testing and /or pumping shell not exceed a total of 200 hours unless prior written approval is obtained from the State Engineer. Water diverted during tasting sh91 not be used for beneficial purposes, The owner of the hole(s) Is responsible for obtaining permits) and complying with all rules and regulations pertaining to the discharge of fluids produced during testing, 3) All work must comply with the Water Well Construction holes, 2 CCR 402.2. Minimum conslructlon standards muss be met or a variance obtained. Standard permit applloation and work report forms are found on the DWR website at bne:Nmvw.wrttor,state.ce.te. Well Construction and Test Reports (GWS -31) must be oompleted for each hale drilled, The licensed contractor or authorized Individual must submit the completed forms to this office within 80 days of monitoring hole completion. 4) Union a wall permit la obtained, the hote(s) must be plugged and sealed within ono (1) year after construction, An Abandonment Report (term OWE must bo submitted within 60 days of plugging & sealing. The above MH aoknowtedgement number, owner's structure name, and owner's name and address must be provided on all wall permit applioation(s), well construction and abandonment reports. 5) Tho owner of the hotels) shall maintain records of water quality testing end submit this data to the State Engineer upon request. 8) A MONITORING HOLE CANNOT BE CONVERTED TO A PRODUCTION WATER WELL, except for 'imposes of remediation (recovery) or as a permanent dewatering system, if constructed In accordance with the Water Well Construction Rules and policies of the State Engineer. 7) IF HOLES WILL NOT SE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS, PLEASE WRITE, "NO BOLES CONSTRUCTED" ON A COPY OF THE ACKNOWLEDGED NOTICE WITH THE FiLE NUMBER AND FAX THE COPY TO THE DIVISION OF WATER RESOURCES. THIS ACKNOWLEDGEMENT OF NOTICE DOES NOT INDICATE THAT WELL PERMITS) CAN BE APPROVED. (Litre above space for labels or additional conditions as needed) 0