Free GWS-02, WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37-90-137(2) - Colorado

Form No. GWS-2 6/2009

NON-EXEMPT STATE OF COLORADO DIVISION OF WATER RESOURCES OFFICE OF THE STATE ENGINEER 821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 Fax (303) 866-3589

WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37-90-137(2) Carefully read the conditions of approval on your well permit. The conditions and the information on this information sheet must be complied with in order for the permit to remain valid. THE ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT The well permit number is located in the upper right corner of the permit, and the expiration date is located in the lower right corner. THE WELL PERMIT EXPIRATION DATE IS ONE YEAR FROM THE DATE ISSUED. Evidence of well construction and pump installation must be received on appropriate forms PRIOR TO THE EXPIRATION DATE OF THE PERMIT. The required forms are the Well Construction and Test Report (Form No. GWS-31), and the Pump Installation and Test Report (Form No. GWS-32). There are penalties if evidence of well construction and pump installation is not received prior to the expiration date. The licensed contractor or well owner (under the private driller or pump installer statutes and rules) performing the work is responsible for completing the appropriate form(s) and submitting it to the Division of Water Resources. The expiration date of the permit may be extended one time only for a period not to exceed one year for good cause shown, at the discretion of the State Engineer. If an extension of time is necessary to construct the well and/or install pumping equipment, the owner must file a written request for the extension, along with a $60 filing fee. The request and fee must be received by the State Engineer prior to the expiration date. The request must state why the well has not been constructed and/or pumping equipment installed, and must include an estimate of time required to construct the well and/or install pumping equipment. Water well construction and pump installation contractors are licensed in Colorado to perform these specialized tasks. It is illegal for individuals who do not hold these licenses to construct wells and install pumping equipment in or on wells. The well must be constructed and pumping equipment installed by contractors with current license(s) issued by the State of Colorado unless exempted as described on the reverse side. Additional information regarding well construction, pump installation, required testing and well plugging and sealing regulations are found on the reverse side of this sheet. You have been provided with at least one copy of the well permit. Keep a copy for your records. At least one copy has been sent to the well driller if you indicated a driller license number on the application. You may make additional copies for the well driller if you select one different from the one indicated in your application. The original permit is on file in our Denver office Records Section. Copies may be obtained for a fee of 50 cents per page. Statutes require that any change of mailing address or ownership be reported to the State Engineer. Use Form No. GWS-11. There is no filing fee. If you have questions, contact the Denver Office, or the Division Office in the area where your well is located.

Division 1 th 810 9 St., Ste. 200 Greeley, CO 80631 (970) 352-8712 Fax (970) 392-1816
Division 5 Direct mail to Box 396 Glenwood Spgs CO 81602 50633 U.S. Hwy 6 & 24 Glenwood Spgs., CO 81601 (970) 945-5665 Fax (970) 945-8741 Call First

Division 2 310 E. Abriendo Ave Ste B Pueblo, CO 81004 (719) 542-3368 Fax (719) 544-0800
Division 6 Direct mail to Box 773450 505 Anglers Dr. Suite 101 Steamboat Spgs, CO 80477 (970) 879-0272 Fax (970) 879-1070

Division 3 301 Murphy Drive Alamosa, CO 81101 (719) 589-6683 Fax (719) 589-6685 Division 7 160 Rock Point Dr. Ste. E Durango, CO 81301 (970) 247-1845 Fax (970) 259-0944

Division 4 1871 East Main St. Montrose, CO 81401 (970) 249-6622 Fax (970) 249-8728 Denver Office 1313 Sherman St. Rm. 818 Denver, CO 80203 (303) 866-3581 Fax (303) 866-3589

WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER You may construct the well and/or install pumping equipment yourself if the well is for your own use, is on property you own, and is constructed or pumping equipment is installed with equipment owned and operated by you. It is your responsibility to complete and submit the Well Construction and Test Report (Form No. GWS-31) and/or the Pump Installation and Test Report (Form No. GWS-32). These forms are available from our website at the following link: http://www.water.state.co.us/pubs/wellforms.asp, or from any Division of Water Resources office. The well must be constructed and the pumping equipment installed in accordance with the well construction standards of the Board. The WATER WELL CONSTRUCTION RULES and BOARD OF EXAMINERS RULES can be obtained from our website at the following link: http://www.water.state.co.us/pubs/rule_reg.asp, or purchased from any Division of Water Resources office for a small fee. These Rules cover the minimum requirements for well construction, pump installation, disinfection, plugging and sealing and contractor licensing regulations. If you are constructing your own well or installing pumping equipment, it is recommended that you obtain a copy of these Rules for reference. The well construction and pump installation reports including testing of well yields and pumping systems must be submitted to the office of the State Engineer by the respective contractors within sixty (60) days of completion of the work or prior to the expiration date of the permit, whichever is earlier. Your contractor(s) must provide you with a copy of the work report(s) filed with the State Engineer. RULE 12 WELL TESTING 12.1 General - The provisions of this rule establish minimum standards for the testing of water wells. Every well constructed for the purpose of producing ground water shall be tested to determine: a. a stabilized yield for the well; and b. the production rate of the equipment installed when the well is placed into service. 12.2 Well Yield Test - The yield of a well shall be determined as a stabilized production rate where the withdrawal rate and the drawdown do not change by more than 10 % during the last hour of the test. The test shall demonstrate that either: a. the well is capable of producing the permitted pumping rate for the well; or b. that the maximum yield of the well is less than the permitted production rate. 12.3 Responsibility for Well Yield Test - Well construction contractors are responsible for performing the well yield test and submitting the test data to the State Engineer. If the construction contractor also installs the production equipment, the well yield test may be combined with the production equipment test, provided that the test meets the requirements of Rule 12.2. The construction contractor may forgo the well yield test if he can show that a licensed pump installer will perform the well yield test with the permanent production equipment within thirty (30) days of completion of construction of the well. If the pump installation contractor performs the well yield test, he/she shall submit the test information on the Pump Installation and Test Report. 12.4 Production Equipment Test - The production equipment installed in wells shall be tested to ensure it is functioning as designed. The test shall demonstrate the production capacity of the equipment as actually installed in the well. It is the responsibility of the person installing the pumping system to ensure that the production from the well complies with the conditions of the permit. 12.5 Responsibility for Production Equipment Test - Pump installation contractors are responsible for testing the production equipment installed in a well upon completion of their work. If the well construction contractor determined the well yield and submitted a report, the pump installer need not perform another well yield test. If the pump installer does not perform a well yield test with the permanent production equipment, he shall perform a production equipment test and report the data (results) to the State Engineer on the Pump Installation and Test Report. Wells to be plugged and sealed must be plugged in accordance with of the Water Well Construction Rules. A Well Abandonment Report, Form No. GWS-9 must be submitted to confirm plugging and sealing of the well. This form is available from our website at the following link: http://www.water.state.co.us/pubs/wellforms.asp, or from any Division of Water Resources office. The specific rules for plugging and sealing wells are found on the reverse side of the Well Abandonment Report form, or under Rule 16 of the Water Well Construction Rules.