A22_-_140L1723Q0012-_Fortification_Well_Permit.pdf

C O L O R A D O

WELL PERMIT NUMBER 329960-

Division of Water Resources

DNR RECEIPT NUMBER 10026803

Department of Natural Resources

ORIGINAL PERMIT APPLICANT( S) APPROVED WELL LOCATION

BUREAU OF LAND MANAGEMENT( ROY E. SMITH) Water Division: 6 Water District: 54

Designated Basin: N/ A

Management District: N/ A

County: MOFFAT

Parcel Name: N/ A

Physical Address: N/ A

NE 1/ 4 NW 1/ 4 Section 4 Township 9. 0 N Range 91. 0 W Sixth P. M.

Well to be constructed on specified tract of land

PERMIT TO CONSTRUCT A NEW 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 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)( II)( A) as the only well on a tract of land of 35. 96 acres described as the NE 1/ 4 of the NW 1/ 4, Sec. 4, Twp. 9 N, Rng. 91 W, S P. M., Moffat County.

4) The use of groundwater from this well is limited to the watering of livestock on a farm or ranch.

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

6) Pursuant to Rule 6. 2. 3 of the Water Well Construction Rules, the well construction contractor shall submit the as- built well location on work reports required by Rule 17. 1 within 60 days of completion of the well. The measured location must be accurate to 200 feet of the actual location. The location information must include a GPS location ( UTM coordinates) pursuant to the Division of Water Resources' guidelines.

7) ADVANCE NOTICE REQUIRED - Pursuant to Construction Rule 6. 2. 2. 1 ( 2 CCR 402- 2), licensed or private drillers and pump installers must provide advance notification ( by 11: 59 pm the day before) to the State Engineer prior to each of the following for this well: the start of well construction, the initial installation of the first permanent pump, and the initial installation of a cistern connected to the water well supply system. Any change in the date of construction/ installation must be re-noticed prior to the activity ( by 11: 59 pm the day before). Information regarding the notification process and a link to the electronic notification form can be found on the Division of Water Resources website at dwr.colorado. gov

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 y Date Issued: 3/ 10/ 2023 it

Expiration Date: 3/ 10/ 2025 Issued By GEOFFREY DAVIS

Printed 03- 10- 2023 For questions about this permit call 303. 866. 3581 or go to https:// dwr.colorado. gov Page 1 of 1