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Dlvt*lon of Wat€r Resourcer
FepErtr$ent of Hatural Reiourees
WELL PERA'TIT NUI'TBER
RECEIPT N[JiIBER
320233-
rooo8319
oRrGrHAL PERfiTT APPLICAHT(5I
CASEY sHEETs
PERt'ilT TO CONSTRUCT A HEW WELL
APPROVED WELL LOCATION
Wat€r Dlvision: 5 Water Distrlct: 45
D€signated Basin: N/A
Managemert Districi NiA
County: GARFIELD
Farce| NAME: SIERRA VISTA
Lou 2 Block:
PhysicalAddress: N/A
Fiting:
NE 1i4 NE 1/4 Section 27 Tornship 6.0 S Bange gl.0 W Sixth P.M
Well tc bs constructed on specified tract of land
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ISSUANCE OFTHIS PERtttlT DOES NOT CONFER A WATER RIGHT
COHDITIOI.IS CIF AFPROVAL
Thb r,rrett shatt be used in such a way I to cause no rnaterial injilry to existing water rights. The issuance of this p€rmit does not
ensure that no inJury witt occur to another vested water right or preclude another owner of a 'Jestd water right from seeking
retief in a civil court action.
The construction of thh well shatt b€ in compliance with the \trfaterWell Construction Rutes 2 Cf,R 402"2, untes approral of a
variance ha* been granted by the State Board of Ex*minerc of Water Wett Construction ard Pump lretattathil Contnctors in
xcordance with Rute 1E.
Approned pursuant to CRS 37-92-6m{3}{b}{ll}{A} as the onty'aretton a tnrct of tand of 16.16 acres described as Lot ?, Sierra Vista
division of tand, Garfietd f,ounty.
The us€ of groundwfrter from this urett is timited to fire prot€ction, ordinary hous€hotd purpos€s insile not
singte famity dwettings, the watering of poultry, domestic animats and livestock on a farm or ranch and the
fTlore than one {1} xre of home gardens and l5wns.
The pumping rate of thB r,rett shatl not exceed 15 GPrvt.
The return flow from the use of this rarelt must b€ throLqh an individuat waste$iater dhposat $lttem of the non+vapomti\€ typ€
wherc the water b returned to the earne ctream systern in whth the wett is tocated.
Puruuant to Rut€ 6.2.3 of the Water \4Etl Construction ftules, the lvett conttruction contractor shatt submit the ag-built \,tietl
tocation on work reports required by Rute 17.'l within 60 dayrof canrptetion of the wett. The rneasurud location must be
#cur6te to 200 feet of th€ actLtat location. The location information must inctude a GPs tocation {uTM coodinater} pursuant to
tl1e Dkisimr of Water Resources' guitletines.
ADVANCE NOTICE REQUIRED - Pursuant to Constructhn Rute 6.2.2.1 {2 CCR 48?-2}, licensed or private dritter: and pump
institters must provide advance norifkathn (by 1 1: 59 pm the day beforel to the State Engineer prior t0 each of the fottowing
for thir vwth the start of rrletl construction, the initiat instatlithn of the first perfrBnent pump, and the initiat instattation of a
cistern connected to the water v*ell suppty systern. Any change in $e date of constructhn/initatlation musl b€ re-mticed prior
to the frctivity {by 11 :59 pm the day before}. lnformation regarding the notification proces and a link lo the €lectronic
notificathn form can be found sn the 0ivishn of Water Resources webcite at dwr.cotorado.Sov
NOTE: This permit witl expire on th€ expirathn date untess the rr/ett is constructed ry that date. A Wett Construction and Yietd
Estirnale Report {GVr5"31} must b€ submitted to $e Divi$ion of Vff,ter Resourceg to verify the wetl has b€en canstructed. An
extension of the expirathn date nmy be available. Contfft the DWR for additionat information or refer to the extension request
form {GW544} svsitabte at dwr.cotorado.gor
NOTICE: Thi* permit hm been approred subJect to the fottoaring changes: The $tarter/quarter and qmrter section tnrcre
determined from nrapping software used by thB office. You are hereby notified thfit you have the right.to appeal the irsuance of
this permit, by fiting a wiitten request with this offke within sixty {60} days of the date of issuarce, puEuant to the state
Mminbtrati$e Procedures Act. {See Section 74.4"1M through 106, C.R.5. }
HOTE:ThisparcetistocatedintheSEl/4of theSEltAof s€ction22, tlreNEl/4of theNEl/.4,the5E1/4of theNEl/4and
the N\- /4 of the NE 1/4 of Sectiofi 27, To,.rnship 6 tuuth, Range 92 Wst of the Sixth Frincipal
^4eridian.
The vuett may b€
comtructed ofi the rcet.
rrnga
Prinred 01-?9-10?1 For questions abo,ut this permit call 101,866,1581 or !o to www,water.state.co.L6 Page 1 of I
IryELL FERJIIIT HUIIIBER 320233-RECEIPT XUIIIEER 1OOO83T9
NOTE: Parel ldmtlficatirn Number {PlN}: Zl?9-ftl-0t-m2
0ate lrriled: l l19l?:gll
Explratlon D*tel 1 l79l7tl,l*-#J}-"
bsued By GmFFftFY nAVF
Prtlted 0l-19"202t Fr q*rtiorr *rut th* permit calt 103,866.3581 tr go b wwttr.watff.ltat€.o,l.c Page z of I