2011-01-20_HYDROLOGY - M1980244 ‎(2)‎

• Permit No: M1980244
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/20/2011
• Doc Name: Notice of Intent to Construct Monitoring Wells.
• From: CC&V
• To: DWR
• Permit Index Doc Type: Hydrology Report
• Email Name: BMK
• Media Type: D
• Archive: No

12 -03 -10 15:52 FROM -Colo Div of Water Resources [phone] T -488 P 002/002 F -518
Gws-51
0W2008
NOTICE OF INTENT TO CONSTRUCT MONITORING HOLE(S)
COLORADO DIVISION OF WATER RESOURCES -1313 SHERMAN ST -RM 821- DENVER -CO -80203
PHONE: [phone] —FAX: 303.8t36 -3589 ,, /' /
Location: / � �/, / v l 'A. section
Township ! N XS, Range � 1 DE pB N, eafbm
County 7124 -
Subdlvlsion, Lot, Elk, PIg (as applicable) /✓14
Well Owner's Name, Address & Phone I iV G.D d ✓ a
,W,B /94 144,fixt , c 'ono
Landowner's Name CC-9 (/ 4 /2 yr 6;7
Please check one and complete as indicated Including content Info;
❑ Water Well Driller Licensed In Colorado - Lio, No.
❑ Professional Engineer Registered In Colorado - Reg. No.
❑ Professional Geologist per CRS 341. 201(3)
Other - anyone directly employed by or under the supervision of a licensed driller,
registered pridesabnal engineer or al gsologlat
Contact/ Company /A, W O , / /c ov� J levi,‘
Address / Afar /9/
City, State & Zip ! a .ms C D "wet o
9-�O' 9
Phone 7 - 5p r}f Fax J /9" 6i2i-3. y
/Z1+R Print Name: p' "401✓/
Signature'
Please type or print legibly In black or blue Ink
ACKNOWLEDGEMENT FROM STATE ENGINEER'S OFFICE
FOR OFFICE USE ONLY
MH PROCESSED BY
Site /Property Address (Dv rr p
GPS Looatlon in UTM format (optional):
Set GPS unit to true north, datum NAP83, and use meters for
the distance units, ❑tone 12 or ❑Zone 13.
Resting Northing
# of Monitoring Hole(e) to be constructed: /
Estimated Depth 'sat., Aquifer
Purpose of Monitoring Helots) 72) . e- �,17 vT3o
.24rvt',Ove, /yepw)7,' A g-rL
Anticipated Data of Construction: , / - /
71
Date Notice Submitted: � e � - - Q % 0
(Must be at least 3 days prior to constnuctlon)
( 4 9524
DIV. WD BAS MD DATEACKNOWLEDGF-D 1 L 3 - [D
CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT
A COPY OFTKE WRITTEN NOTICE OR ACKNOWLEDGEMENT SHAD, BE AVAILABLE AT THE DRILLING SITE.
1) Notice was provided to the State Engineer at least 3 days prior to construction of monitoring & observation holes).
2) Construction of the hoists) must be completed within 80 days of the date notice was given to the State Engineer. Testing and/or
pumping shall not exceed a total of 200 hours unless prior written approval Is obtained from the State Engineer. Water diverted during testing
shall not be used for beneficial purposes. The owner of the hole(s) Is responsible for obtaining perrnit(s) and complying with all rules and
reguiuUons pertaining to the discharge of fluids produced during testing.
All work must comply with the Water Well Construction Rules, 2 CCR 402.2. Minimum construction standards must be met or a variance
obtained. Standard permit application and work repan fors are found on the DWR wobstte at hnn: / /wn,?v.wetar.rtate.ce.us, Weil
Construction and Test Reports (OWS - 31) must be completed for each hole drilled. The licensed contractor or authorized individual must
submit the completed forma to this office within 60 days of monitoring hole completer.
4) Unless a well permit Is obtained, the hole(s) must be plugged and sealed within ono (1) year after construction. An Abandonment
Report (Form GWS -9) must be submitted within 80 days of plugging & sealing. The above MH aoknowledgement number, owner's
structure name. and owner's name and address must be provided on all well permit apptcation(s), well construction and abandonment reports.
5) The owner of the holes) shall maintain r000rds of water quality testing and submit this data to the State Engineer upon request
6) A MONITORING HOLE CANNOT BE CONVERTED TO A PRODUCTION WATER WELL except for purposes of remediation (recovery)
or as a permanent dewatering system, If constructed In accordance with the Water Wall Construction Rules and policies of the State
Engineer.
7) IF HOLES WILL NOT DE CONSTRUCTED UNDER THIS NOTICE WITHIN 90 DAYS, PLEASE WRITE, 140 HOLES 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.
(Use above space for !abets or additional conditions as needed