2016-09-06_INSPECTION - P2009025

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Form No. OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg, 1313 Sherman St, Denver, Colorado 80203 (303)866-3581 1039 ED WELL PERMIT NUMBER 295839 - - APPLICA EL' 'ly DIV. 2 WD 12 DES. BASIN MD V i� tr' 20�6 Lot 102 Block Filing; 6 Subdiv SOUTH T BAR Sg O 1 j APPROVED WELL LOCATION S10NcIv � FREMONT COUNTY M1N1 '1 NW 1/4 NE 1/4 Section 27 BLACK RANNGPdGE MATERIALS Township 17 S Range 73 W Sixth P.M. 110 N RUBEY DR ,f DISTANCES FROM SECTION LINES STE 201 995 Ft from North Section Line GOLDEN, CO 80403- 2609 Ft. from East Section Line (303) 279-4946 UTM COORDINATES (Meters Zone:13 NAD83) PERMIT TO USE AN EXISTING WELL Easting, 452762 Northing- 4266332 ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL 1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil court action. 2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18 3) Approved pursuant to CRS 37-92-602(3)(b)(1) for uses as described in CRS 37-92-602(1)(0. Use of this well is limited to monitoring water levels and/or water quality sampling. 4) Approved for the use of an existing well acknowledged for construction under monitoring hole notice MH-51858, and known as MW-DG-1 (MW-27-290). 5) This well must be equipped withlocking cap or seal to prevent well contamination or possible hazards as an open well. The well must be kept capped and locked at all times except during sampling or measuring. 6) Records of water level measurements and water quality analyses shall be maintained by the well owner and submitted to the Division of Water Resources upon request. 7) Upon conclusion of the monitoring program the well owner shall plug this well in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment Report must be completed and submitted to the Division of Water Resources within 60 days of plugging. 8) The owner shall mark the well in a conspicuous place with the well permit number and name of aquifer as appropriate, and shall take necessary means and precautions to preserve these markings. 9) This well must have been constructed by or under the supervision of a licensed well driller or other authorized individual according to the Water Well Construction Rules. 10) This well must be located not more than 200 feet from the location specified on this permit. NOTE: Issuance of this permit does not guarantee that this well can be converted to a production well under a future permit. Additionally, pursuant to Rule 14.2 of the Water Well Construction Rules (2 CCR 402-2), monitoring holes constructed pursuant to a monitoring hole notice shall not be converted to a production well. (Upon obtaining a permit from the State Engineer, a monitoring hole may be converted to a monitoring well, recovery well for remediation of the aquifer, or a dewatering system for dewatering the aquifer.) NOTICE: This permit has been approved subject to the following changes:The distances from section lines were calculated from UTM coordinate values provided with the permit application. You are hereby notified that you have the right to appeal the issuance of this permit, by filing a written request with this office within sixty(60) days of the date of issuance, pursuant to the State Administrative Procedures Act. (See Section 24-4-104 through 106, C.R.S.) APPROVED SMJ State Engineer B Recei t No. 3666395A DATE ISSUED 09-30-2014 EXPIRAT ON A