HomeMy WebLinkAbout1.03 Well permitsATTACHMENT to SPECIAL USE PERMIT APPLICATION Laramie Energy II, LLC CO Office of the State Engineer Well Permits
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 WELL PERMIT NUMBER __-'S!<'7'-'1'-'-1"
-S __-..F... _ APPLICANT LARAMIE ENERGY II LLC 1512 LARIMER ST STE 1000 DENVER, CO 80202-DIV. 5 WD45 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY NW 114 NW 1/4 Section 29 Township
6 S Range 93 W Sixth P.M. DISTANCES FROM SECTION LINES 190 Ft. from North Section Line 944 Ft. from West Section Line EXST (303) 339-4400 UTM COORDINATES (Meters,Zone:13,NAD83) PERMIT
TO USE AN EXISTING WELL Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 1 of 2 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 37-90-137(7)(b),
for the use of a dewatering well in a non-tributary ground water geologic formation, to be used in conjunction with oil and gas exploration. If oil and gas production ceases, then this
well permit is no longer valid and diversion of the non-tributary ground water from the well must cease immediately (production of water from the well and application to beneficial use
may resume if a new water well permit is obtained for the well). This well will be known as the Overacker Federal 29-05B well. 4) The use of ground water from this well is limited to
industrial, commercial, the irrigation of 40 acres as described on the attached Exhibit A, the watering of livestock, road spreading, dust suppression, recovery, recycling, drilling
and mitigation for oil and gas production and exploration, and in-stream flows. All necessary discharge permits and approvals from the Colorado Department of Public Health and Environment,
Water Quality Control Division, must be obtained prior to production from this well, and the State Engineer may request any water quality and data to determine if the requirements of
use to senior appropriators are met. 5) The maximum pumping rate of this well shall not exceed 2 GPM. The applicant is required to notify the State Engineer's Office of any increase
in oil and gas production that will ultimately increase the yield of this well. 6) The average amount of ground water to be appropriated shall not exceed 3 acre-feel. 7) Production from
this well is limited to the hydrostratigraphic zone within the Mesa Verde aquifer that correlates with the Williams Fork and lies Formations from which the applicant is producing ground
water associated with the production of oil and natural gas. :rhe production interval is located from 6,847 feet below ground surface and extends to a depth of 9,533 feel. 8) The owner
shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions
to preserve these markings. 9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by
the well owner (recorded at least annually) and submitted to the Division Engineer upon request. APPROVED JSG Receipt No. 3626793U Siale Enwneer .I DATE ISSUED 05-07-2008 By EXPIRATION
DATE 05-07-2009
Receipt No. 3626793U WELL PERMIT NUMBER 67116 -F ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 2 10) Upon completion of the dewatering program, the
applicant shall plug this well in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment report form must be completed and submitted to the Division of Water
Resources within 60 days of plugging. 11) This well must be located not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration
date unless a pump is installed by that date. A Pump Installation and Test Report (GWS-32) must be submitted to the Division of Water Resources to verify that the pump has been installed.
A one-time extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension request form (GWS-64) available at: http://www.water.state.co.us/pub
s/forms.as~ '/7;,<>g
Form No. GWS-25 APPLICANT OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 WELL PERMIT
NUMBER __ -'6..,7'-!1.!.17'--__ -·.!.F _ DIV.5 WD45 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY NW 1/4 NW 1/4 Section 29 LARAMIE ENERGY II LLC Township 6 S Range 93 W Sixth
P.M. 1512 LARIMER ST DISTANCES FROM SECTION LINES STE 1000 90 Ft. from North Section Line DENVER, CO 80202-944 Ft. from West Section Line EXST (303) 339-4400 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO USE AN EXISTING WELL Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT Page 1 of 2 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 37-90-137(7){b),
for the use of a dewatering well in a non-tributary ground water geologic formation, to be used in conjunction with oil and gas exploration. If oil and gas production ceases, then this
well permit is no longer valid and diversion of the non-tributary ground water from the well must cease immediately (production of water from the well and application to beneficial use
may resume if a new water well permit is obtained for the well). This well will be known as the Overacker Federal20-15B well. 4) The use of ground water from this well is limited to
industrial, commercial, the irrigation of 40 acres as described on the attached Exhibit A, the watering of livestock, road spreading, dust suppression, recovery, recycling, drilling
and mitigation for oil and gas production and exploration, and in-stream flows. All necessary discharge permits and approvals from the Cotorado Department of Public Health and Environment,
Water Quality Control DiviSion, must be obtained prior to production from this well, and the State Engineer may request any water quality and data to determine if the requirements of
use to senior appropriators are met. 5) The maximum pumping rate of this well shall not exceed 2 GPM. The applicant is required to notify the State Engineer's Office of any increase
in oil and gas production that will ultimately increase the yield of this well. 6) The average amount of ground water to be appropriated shall not exceed 3 acre-feet. 7) Production from
this well is limited to the hydrostratigraphic zone within the Mesa Verde aquifer that correlates with the Williams Fork and lies Formations from which the applicant is producing ground
water associated with the production of oil and natural gas. The production interval is located from 7,162 feet below ground surface and extends to a depth of 8,874 feet. 8) The owner
shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions
to preserve these markings. 9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by
the well owner (recorded at least annually) and submitted to the Division Engineer upon request. APPROVED JSG State EngJ€r Receint No. 3626793V I DATE ISSUED. 05-07 -2008 By EXPIRATION
DATE 05-07-2009
Receipt No. 3626793V WELL PERMIT NUMBER 67117 -F ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 2 10) Upon completion of the dewatering program, the
applicant shall plug this well in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment report form must be completed and submitted to the Division of Water
Resources within 60 days of plugging. 11) This well must be located not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration
date unless a pump is installed by that date. A Pump Installation and Test Report (GWS-32) must be submitted to the Division of Water Resources to verify that the pump has been installed.
A one-time extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension request form (GWS-64) available at: http://www.waler.slate.co.us/pub
s/forms.asJl::::7o S 77~:;
Form No. GWS-25 OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 APPLICANT LARAMIE ENERGY
II LLC 1512 LARIMER ST STE 1000 DENVER, CO 80202-WELL PERMIT NUMBER __ -'S""7...!1..c1S"--__ .-..:..f _ DIV.5 WD45 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY NW 114 NW 114
Section 29 Township 6 S Range 93 W Sixth P.M. DISTANCES FROM SECTION LINES 130 Ft. from North Section Line 944 Ft. from West Section Line EXST (303) 339-4400 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO USE AN EXISTING WELL Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 1 of 2 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 37-90-137(7)(b),
for the use of a dewatering well in a non-tributary ground water geologic formation, to be used in conjunction with oil and gas exploration. If oil and gas production ceases, then this
well permit is no longer valid and diversion of the non-tributary ground water from the well must cease immediately (production of water from the well and application to beneficial use
may resume if a new water well permit is obtained for the well). This well will be known as the Overacker Federal 20-140 well. 4) The use of ground water from this well is limited to
industrial, commercial, the irrigation of 40 acres as described on the attached Exhibit A, the watering of livestock, road spreading, dust suppression. recovery. recycling. drilling
and mitigation for oil and gas production and exploration, and in-stream flows. All necessary discharge permits and approvals from the Colorado Department of Public Health and Environment.
Water Quality Control Division. must be obtained prior to production from this well. and the State Engineer may request any waterqualily and data to determine if the requirements of
use to senior appropriators are met. 5) The maximum pumping rate of this well shall not exceed 2 GPM. The applicant is required to notify the State Engineer's Office of any increase
in oil and gas production that will ultimately increase the yield of this well. 6) The average amount of ground water to be appropriated shall not exceed 3 acre-feet. 7) Production from
this well is limited to the hydrostratigraphic zone within the Mesa Verde aquifer that correlates with the Williams Fork and lies Formations from which the applicant is producing ground
water associated with the production of oil and natural gas. The production interval is located from 6,792 feet below ground surface and extends to a depth of 8,416 feet. 8) The owner
shall mark the well in a conspicuous place with well permit number(s), name of the aquifer. and court case number(s) as appropriate. The owner shall take necessary means and precautions
to preserve these markings. 9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by
the well owner (recorded at least annually) and submitted to the Division Engineer upon request. APPROVED JSG RecetpJ No. 3626793W DATE ISSUED 05-07 -2008
Receipt No. 3626793W WELL PERMIT NUMBER 67118 ·F ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 2 10) Upon completion of the dewatering program, the
applicant shall plug this well in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment report form must be completed and submitted to the Division of Water
Resources within 60 days of plugging. 11) This well must be located not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration
date unless a pump is installed by that date. A Pump Installation and Test Report (GWS-32) must be submitted to the Division of Water Resources to verify that the pump has been installed.
A one-time extension of the expiration date may be available. Contact the DWR for additional information Of refer to the extension request form (GWS-64) available at: http://www.water.state.co.us/pub
s/forms.as~ "-/7 /o~
Form No. OFFICE OF THE STATE ENGINEER GWS-2S COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 WELL PERMIT NUMBER __
-"6"-71.!..!2=.2 __ -o.!:F _ _ APPLICANT LARAMIE ENERGY /I LLC 1512 LARIMER ST STE 1000 DENVER, CO 80202-DIV.5 WD45 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY NW 1/4 NW 1/4
Section 29 Township 6 S Range 93 W Sixth P.M. DISTANCES FROM SECTION LINES 150 Ft. from North Section Line 944 Ft. from West Section Line EXST (303) 339-4400 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO USE AN EXISTING WELL Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 1 of 2 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 37-90-137(7)(b),
for the use of a dewatering well in a non-tributary ground water geologie formation, to be used in conjunction with oil and gas exploration. If oil and gas production ceases, then this
well permit is no longer valid and diversion of the non-tributary ground water from the well must cease immediately (production of water from the well and application to beneficial use
may resume if a new water well permit is obtained for the well). This well will be known as the Overacker 29-04B well. 4) The use of ground water from this well is limited to industrial,
commercial, the irrigation of 40 acres as described on the attached Exhibit A, the watering of livestock, road spreading, dust suppression, recovery, recycling, drilling and mitigation
for oil and gas production and exploration, and in-stream flows. All necessary discharge permits and approvals from the Colorado Oepartment of Public Health and Environment, Water Quality
Control Oivision, must be obtained prior to production from this well, and the State Engineer may request any water quality and data to determine if the requirements of use to senior
appropriators are met. 5) The maximum pumping rate of this well shall not exceed 2 GPM. The applicant is required to notify the State Engineer's Office of any increase in oil and gas
production that will ultimately increase the yield of this well. 6) The average amount of ground water to be appropriated shall not exceed 3 acre-fee!. 7) Production from this well is
limited to the hydrostratigraphic zone within the Mesa Verde aquifer that correlates with the Williams Fork and lies Formations from which the applicant is producing ground water associated
with the production of oil and natural gas. The production interval is located from 6,706 feet below ground surface and extends to a depth of 8,261 fee!. 8) The owner shall mark the
well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions to preserve
these markings. 9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner
(recorded at least annually) and submitted to the Division Engineer upon request. APPROVED JSG Receipt No. 3626793X -StateEng-----.l-.inJJ~·~i~~j~~=--q N DATE ISSUED 05-07-2008 ~DATE
05-07-2009
Receipt No. 3626793X WELL PERMIT NUMBER 67122 -F ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 2 10) Upon complelion of the dewatering program, the
applicant shall plug this well in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment report form must be completed and submitted 10 Ihe Division of Waler
Resources within 60 days of plugging. 11) This well must be located not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration
date unless a pump is installed by that date. A Pump Installation and Test Report (GWS-32) must be submitted to the Division of Water Resources to verify that the pump has been inslalled.
A one-time extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension request form (GWS-64) available at: http://www.water.state.co.us/pub
s/forms.asp-.""._ //. /. ~.,~ /7/'e
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 WELL PERMIT NUMBER __
---"'67w1"'2><.3 __ --'...F _ APPLICANT LARAMIE ENERGY II LLC 1512 LARIMER ST STE 1000 DENVER, CO 80202-DIV.5 WD45 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY NW 1/4 NW 1/4
Section 29 Township 6 S Range 93 W Sixth P.M. DISTANCES FROM SECTION LINES 176 Ft. from North Section li n e 967 Ft. from West Section line EXST (303) 339-4400 UTM COORDINATES (Meters,
Zone: 13, NADa3) PERMIT TO USE AN EXISTING WELL Easting: Northing· ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 1 of 2 1) This well shall be used
in sucl, 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 37-90-137(7)(b), for the use of a dewatering well in a non-tributary ground water geologic formation, to be used in conjunction with oil and gas exploration. If oil and
gas production ceases, then this well permit is no longer valid and diversion of the non-tributary ground water from the well must cease immediately (production of water from the well
and application to beneficial use may resume if a new water well permit is obtained for the well). This well will be known as the Overacker 29-030 well. 4) The use of ground water from
this well is limited to industrial, commercial, the irrigation of 40 acres as described on the attached Exhibit A, the watering of livestock, road spreading, dust suppression, recovery,
recycling, drilling and mitigation for oil and gas production and exploration, and in-stream flows. All necessary discharge permits and approvals from the Colorado Department of Public
Health and Environment, Water Quality Control Division, must be obtained prior to production from this well, and the State Engineer may request any water quality and data to determine
if the reqUirements of use to senior appropriators are met. 5) The maximum pumping rate of this well shall not exceed 2 GPM. The applicant is required to notify the State Enginee(s Office
of any increase in oil and gas production that will ullimately increase the yield of this well. 6) The average amount of ground water to be appropriated shall not exceed 3 acre-feet.
7) Production from this well is limited to the hydrostratigraphic zone within the Mesa Verde aquifer that correlates with the Williams Fork and lies Formations from which the applicant
is producing ground water associated with the production of oil and natural gas. The production interval is located from 6,824 feet below ground surface and extends to a depth of 8,418
feet. 8) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary
means and precautions to preserve these markings. 9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions
must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request. APPROVED JSG Ll -----<=,:~L~,~,U-:', .I_U_".P~/'lo_ _~ ··~ 6L State
Engineer ~ Receipt No. 3626793Y DATE ISSUED 05-07-2008 EXPIRATION DATE 05-07-2009
Receipt No. 3626793Y WELL PERMIT NUMBER 67123 -F ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 2 10) Upon complelion of lhe dewatering program. the
applicant shall plug this well in accordance with Rute 16 of the Water Well Construction Rules. A Well Abandonment report form must be completed and submitted to the Division of Water
Resources within 60 days of plugging. 11) This well must be located not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration
date unless a pump is installed by that date. A Pump Installation and Test Report (GWS-32) must be submitted to the Division of Water Resources to verify that the pump has been installed.
A one-time extension of the expiration date may be available. Contact the DWR for additional information Of refer to the extension request form (GWS-64) available at: ht!p:llwww.water.state.co.us/pub
s/forms.a~ ..... h/..Y
Form No. GWS-25 OFFICE OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 APPLICANT LARAMIE ENERGY
II LLC 1512 LARIMER ST STE 1000 DENVER, CO 80202-WEll PERMIT NUMBER __ -"SC!...71!...!1."-9 __ -"'-F __ DIV.5 WD45 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY NW 1/4 NW 1/4
Section 29 Township 6 S Range 93 W Sixth P.M. DISTANCES FROM SECTION LINES 130 Ft. from North Section Line 944 Ft. from West Section Line EXST (303) 339-4400 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO USE AN EXISTING WEll Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 1 of 2 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 w'ith Rule 18, 3) Approved pursuant to CRS 37-90-137(7)(b),
for the use of a dewatering well in a non-tributary ground water geologic formation, to be used in conjunction with oil and gas exploration. If oil and gas production ceases, then this
well permit is no longer valid and diversion of the non-tributary ground water from the well must cease immediately (production of water from the well and application to beneficial use
may resume if a new water well permit is obtained for the well). This well will be known as the Overacker 20-13B well. 4) The use of ground water from this well is limited to industrial,
commercial, the irrigation of 40 acres as described on the attached Exhibit A, the watering of livestock, road spreading, dust suppression, recovery, recycling, drilling and mitigation
for oil and gas production and exploration, and in-stream flows. All necessary discharge permits and approvals from the Colorado Department of Public Health and Environment, Water Quality
Control Division, must be obtained prior to production from this well, and the State Engineer may request any water quality and data to determine if the requirements of use to senior
appropriators are met. 5) The maximum pumping rate of this well shall not exceed 2 GPM. The applicant is required to notify the State Engineer's Office of any increase in oil and gas
production that will ultimately increase the yield of this well. 6) The average amount of ground water to be appropriated shall not exceed 3 acre-feet. 7) Production from this well is
limited to the hydrostratigraphic zone within the Mesa Verde aquifer that correlates with the Williams Fork and lies Formations from which the applicant is producing ground water associated
with the production of oil and natural gas. The production interval is located from 6,694 feet below ground surface and extends to a depth of 8,486 feet. 8) The owner shall mark the
well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions to preserve
these markings. 9) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner
(recorded at least annually) and submitted to the Division Engineer upon request. /=::L&: By EXPIRATION DATE 05-07-2009 APPROVED ~.' L. ~ ~ JSG ~ I:;/~ State Engine .-~ '. Receipt No.
0047721A DATE ISSUED 05-07-2008
Receipt No. 0047721A WELL PERMIT NUMBER 67119 -F ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL Page 2 10) Upon completion of the dewatering program, the
applicant shall ptug this well in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment report form must be completed and submitted to the Division of Water
Resources within 50 days of plugging. 11) This well must be located not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration
date unless a pump is installed by that date. A Pump Installation and Test Report (GWS-32) must be submitted to the Division of Water Resources to verify that the pump has been installed.
A one-time extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension request form (GWS-54) available at: http://www.water.state.co.us/pub
s/forms.as~ 0(r;$