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Form <br />No. GWS -7 EXEMPT PERMIT INFORMATION SHEET <br />1012011 STATE OF COLORADO <br />OFFICE OF THE STATE ENGINEER <br />1313 Sherman St., Ste 821, Denver, Colorado 80203 <br />(303) 866 -3581 Fax (303) 866 -3589 <br />INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37 -92 -602 <br />(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES) <br />Carefully read the conditions of approval on your well permit. The conditions and the information on this <br />information sheet must be complied with in order for the permit to remain valid. <br />THE PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. The well must be constructed and <br />evidence of it's construction must be received by this office in the form of a Well Construction and Test report from <br />the well construction contractor confirming that the well was constructed prior to expiration of the well permit. The <br />— <br />sir permit nu r Is tad in t' apperright I I co fitfs ztin-tls� <br />lower right hand comer. The expiration date of the permit may be extended one year at a time at the discretion of <br />the State Engineer for good cause shown. If an extension of time is necessary to construct the well, a written <br />request for the extension of time must be received by this office prior to the expiration date of the well <br />pennit� In-the request; #%u mast provide- the well permit number,,-your- name.and malting address.aed the <br />reasons why the well has not been constructed and approximately when it will be constructed. <br />Water well construction and pump installation contractors are specifically licensed in Colorado to perform these <br />specialized tasks. It is illegal for contractors who do not hold these licenses to construct wells and /or install pumping <br />equipment in or on wells The well must be constructed and the pump installed by contractors with current <br />license(s) issued by the State of Colorado unless exempted as described on the reverse side. Please ask to see <br />their license(s). Backhoe Operators and Licensed Plumbers may or may not hold the respective Well Construction <br />and/or Pump Installation licenses. Please be aware of this when you contract to construct the well .and install <br />pumping equipment. The well construction report including a test of the well yield must be submitted to the office of <br />the State Engineer within sixty (60) days of completion of the work or within seven days after expiration of the <br />permit, whichever is earlier. The pump installation report including a pumping system test must be submitted within <br />sixty (60) days of completion of the work. The contractors) must provide you with a copy of the work report(s) filed <br />with the State Engineer. The Well Construction and Test Report, Form Number GWS -31 and the Pump Installation <br />and Test Report, Form Number GWS-32 are available from the Division of Water Resources offices. Additional <br />information regarding well construction, pump installation, required testing and well plugging and sealing regulations <br />are found on the reverse side of this sheet. <br />You have been provided with at least two copies of the well permit. Keep a copy for your records. There is <br />also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller <br />license number on the application, or two additional copies have been enclosed. You may make additional <br />copies for the well construction contractor if you select one different from the one indicated in your application. <br />The original permit is on file in the Denver office Records Section. Copies may be obtained for a fee of 50 cents per <br />page. Statutes require that any change of mailing address or ownership be reported to the State Engineer. Form <br />gnu ntmr- GWS -11 is -- both-by new owners o report�wnershl��tang�s ai�ct�un`ent�wr'ier� t�i�eporradctr <br />changes. <br />If you have questions, contact the Denver Office, or the Division Office in the area where your well is located. <br />Division 1 <br />Division 2 <br />Division 3 <br />Division 4 <br />810 9"' St. 2nd Floor <br />310 E. Abriendo Ave Ste B <br />301 Murphy Drive <br />1871 East Main St. <br />Greeley, CO 80631 <br />Pueblo, CO 81004 <br />Alamosa, CO 81101 <br />Montrose, CO 81401 <br />(970) 352 -8712 <br />(719) 542 -3368 <br />(719) 589 -6683 <br />(970) 249 -6622 <br />Fax 970 392 -1816 <br />Fax 719 544 -0800 <br />Fax 719 589 -6685 <br />Fax 970 249 -8728 <br />Division 5 <br />Division 6 <br />Division 7 <br />Denver Office <br />Direct mail to Box 396 <br />Direct mail to Box 773450 <br />160 Rock Point Dr., Ste. E <br />1313 Sherman St. , Ste 62- 1 <br />Glenwood Spgs CO 81602 <br />505 Anglers Dr. Suite 101 <br />Durango, CO 81301 <br />Denver, CO 80203 <br />50633 U.S. Hwy 6 & 24 <br />Steamboat Spgs, CO <br />(970) 247 -1845 <br />(303) 866 -3581 <br />Glenwood Spgs., CO 81601 <br />80477 <br />Fax (970) 259 -0944 <br />Fax (303) 866 -3589 <br />(970) 945 -5665 <br />(970) 879 -0272 <br />Fax (970) 945 -8741 Call first <br />Fax (970) 879 -1070 <br />