2012-08-27_PERMIT FILE - C2009087A

• Permit No: C2009087A
• IBM Index Class Name: Permit File
• Doc Date: 8/27/2012
• Doc Name: Hydrologic Information
• Section_Exhibit Name: Exhibit 2.04.7-E1 Hydrology Information
• Media Type: D
• Archive: Yes

Form
No. GWS -7 EXEMPT PERMIT INFORMATION SHEET
8/2009 STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 868 -3581 Fax [phone]
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37- 92-602
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully read the condlllons of approval on your well permit. The conditlons and the information on this
information sheet must be compiled with in order for the permit to remain valid.
THE PERINIT EXpiRAj%M DATE IS TWO YEAR11 FROM IJED. The well must be constructed and
evidence of it's construction must be received by this office In the form or a Well Construction and Test report from
the well construction contractor confirming that the well was constructed odor to wmirstion of the won perm8. The
well permit number is locate M the upper right hand corner of the permit, and the expiration date is located in the
lower right hand comer. The expiration date of the permit may be extended one year at a time at the discretion of
the State Engineer for good cause shown. H an extension of time Is necessary to construd the we% a writtan
request for the extension of time must be received by this ofilce prior to the expiration data of the well
pernlL In the request, you must provide the well permit number, your name and mailing address and the
reasons why the well has not been constructed and approximately when It will be constructed.
Water well construction and pump Installation contractors are specifically licensed In Colorado to perform these
specialized tasks. it is illegal for contractors who do not hold these licenses to construct webs and/or install pumping
equipment in or on wells. The web must be constructed and the pump Installed by contractors with current
license(s) issued by the State of Colorado unless exempted as described on the reverse side. Please ask to see
their Iicense(s). Baddwe Operators and Licensed Plumbers may or may not hold the respective Well Construction
and/or Pump Installation licenses. Please be aware of this when you contract to construct the well and install
pumping equipment. The well construction report Including a test of the well yield must be submitted to the office of
the State Engineer within sbdy (60) days of completion of the work or within seven days after expiration of the
permit, whichever Is earlier. The pump installation report including a pumping system test must be submitted within
sixty (60) days of completion of the work The contractor(s) must provide you with a copy of the work report(s) filed
with the Stabs Engineer. The Wen Construction and Test Report, Form Number GWS-31 and the Pump Installation
and Test Report, Form Number GWS-32 are available from the' Division of Water Resources offices. Additional
information regarding well construction, pump installation, required besting and well plugging and sealing regulations
are found on the reverse side of this sheet.
You have been provided with at least two copies of the well permit. Keep a copy for your records. There Is
also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller
license number on the application, or two additional copies have been enclosed. You may make additional
copies for the well construction contractor If you select one different from the one indicated in your application.
The original permit Is on file in the Denver office Records Section. Copies may be obtained for a The of 50 cents per
page. Statutes require that any change of mailing address or ownership be reported to the State Engineer Form
number OWS-11 is used both by new owners to report ownership changes and current owners to report address
changes.
H you have questions, contact the Denver Office, or the Division Office in the area where your well N located.
Division 1
810 SP Sir a Floor
Division 2
310 E. Abriendo Ave Sts B
Division 3
301 Murphy Drive
Division 4
1871 East Main St
Greeley, CO 80631
Pueblo, CO 81004
Aiamose, CO 81101
Montrose, CO 81401
(970) 352- 8712
(719) 542 -3388
(719) 5896883
[phone]
Fax [phone]
Fax [phone]
Fax [phone]
Fax [phone]
Division 5
Division 6
Division 7
Denver Olfte
Direct mail to Box 398
Direct mail to Box 773450
180 Rode Point Dr., Ste. E
1313 Sherman St. Rm. 818
Glenwood Spgs CO 81802
505 Anglers Dr. Suite 101
Durango, CO 81301
Denver, CO 80203
50633 U.S. Hwy 8 8 24
Steamboat Spgs, CO
(970) 247 -1845
[phone]
Glenwood Spgs., CO 81601
80477
Fax [phone]
Fax [phone]
(970) 945 -5865
[phone]
Fax [phone] Call first
Fax [phone]