Attachment 7: DWR GWS 44 Copy of Original Well Permit Application

ORIGINAL PERMIT APPLICANT(S)

WELL PERMIT NUMBER

22197--A

RECEIPT NUMBER

10028833

APPROVED WELL LOCATION

USA RIO GRANDE NATIONAL FOREST

AUTHORIZED AGENT

ANDREW KEHLER

UTM COORDINATES (Meters, Zone:13, NAD83)

Easting:

353519.0

Northing:

4166906.0

PERMIT TO REPLACE EXISTING WELL

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 assure the applicant 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)(c) for the relocation of an existing well, permit no. 22197-A, on a residential site described as a Tract of Land in the NE1/4 of the SE 1/4 of Section 9, Township 39 North, Range 3 East, N.M.P.M., Rio Grande County. The old well must be plugged in accordance with Rule 16 of the Water Well Construction Rules within ninety-one (91) days of completion of the new well. A Well Abandonment Report form must be completed and submitted to affirm that the old well was plugged.

4)

The use of ground water from this well is limited to ordinary household purposes inside two single family dwellings and the watering of domestic animals.

5)

The maximum pumping rate of this well shall not exceed 15 GPM.

6)

The return flow from the use of this well must be through an individual waste water disposal system of the non-evaporative type where the water is returned to the same stream system in which the well is located.

7)

This well shall be constructed not more than 200 feet from the location specified on this permit. NOTE: This permit will expire on the expiration date unless the well is constructed by that date. A Well Construction and Yield Estimate Report (GWS-31) must be submitted to the Division of Water Resources to verify the well has been constructed. An 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: dwr.colorado.gov
NOTICE: You are hereby notified that you have the right to appeal the issuance of this permit, by filing a written request with