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Home My WebLink About20123195.tiff 11111111 lilt SELINE Engineering Design Report For an Individual Sewage Disposal System (ISDS) To be Located at 30985 County Road 64 • Weld County, CO April 27, 2012 Table of Contents 1.1. Location 2 1.2. Background 2 1.3. Purpose 3 1.4. Estimated Sanitary Sewer Demand 3 1.5. System Sizing 3 Appendix A: S1 — ISDS Layout Plan (TO BE PROVIDED ONCE COMPLETED) S2 - ISDS Details (TO BE PROVIDED ONCE COMPLETED) Calculations (TO BE PROVIDED ONCE COMPLETED) Weld County Department of Public Health & Environment Letter References: Geotechnical Exploration Report (2 copies) (TO BE PROVIDED ONCE COMPLETED) Percolation Test Letter (2 copies) (TO BE PROVIDED ONCE COMPLETED) Wells Ranch Page 1 . SELINE INTRODUCTION 1.1. Location The site requiring this ISDS is located at 30985 Weld County Road (WCR) 64. From the intersection of WCR 61 and WCR 64, the site is 1.3 miles east along WCR 64 and is adjacent to the north side of WCR 64 (See vicinity map below) . r - A CR 66 cR 66 >J+. 2 pr. . , ici .. 1„..- IzA : ----__ i - - zs Y; . Aetift, , k t• i I t P J alai) P �' :" w ,` t j � • / J ,,+t 4 I •1 P" 1/2, -"al- 0,,,,,,, "44 • 0' 7 ‘ . '7 ' - N.Nli I , -_ nerviiir ,. • I ! ; 1 SITE '. �� `� - 1 _ V _ R ik.1 r /J/� \1 " r I wlt t Ass 1.4 --%14 ilk ‘Atfr . , Vicinity Map 1.2. Background One structure currently exists on the site. The structure is approximately 7,500 square feet and serves as an office and equipment building. It contains a restroom, break room, office areas, and vehicle/equipment storage area . The property will be used by the following three entities: a ) All Around Roustabout LLC, an entity owned and controlled by Josh Wells and Ashton Janssen b) All Around Trucking LLC, an entity owned and controlled by Josh Wells and Ashton Janssen Wells Ranch Page 2 .o, 6' 6. a6* SELINE c) Reliable Field Services, Inc., an entity owned and controlled by Josh Wells and Ashton Janssen All three entities will use the property for their operation of general roustabout services for oil and gas production. These roustabout services include, without limitation, tank battery construction, hot shoting, welding, fencing, washing rigs and tanks, pipeline construction, access construction, concrete barrier erection, maintenance of drilling rigs/tank batteries/cranes, hauling of water, and any trucking related to these services. Entities (a), (b), and (c) will operate 10 hours a day and are expected to employ a total of 6 mechanics and office staff. These entities are also expected to employ a total of 99 truck drivers and roustabouts. Although there are times when these entities will operate 24 hours a day, the number of employees listed above is expected to remain the same. The anticipated sewer demand for each operation is explained in Section 1.4. 1.3. Purpose The purpose of this Individual Sewage Disposal System ( ISDS) Report is to provide an explanation of the ISDS design for the existing building on site. All design considerations were according to Chapter 30, ISDS Regulations of the Weld County Department Public Health and Environment, Environmental Health Division, later referred to as Weld County Regulations. 1.4. Estimated Sanitary Sewer Demand The sanitary sewer demand is based on a total of 6 mechanics and office staff, as well as truck drivers and roustabouts that may use facilities located in the existing building during their time on site. Based on an estimate of 99 total truck drivers and roustabouts, and assuming 1/3 usage by these visitors, an additional 33 person usage has been estimated . The total number of expected users of the facility is therefore estimated to be 39 persons daily. Flow determination is based on Appendix 30-A Quantities and Biochemical Oxygen Demand ( BOD) Strength of Sewage for Various Types found in the Weld County Regulations. The commercial office building establishment type best represents the quantities per person per day expected at this site. The average wastewater flows, average loading, and design wastewater flows expected at the office building are as follows: Average Flow = 15 gal/person/8 hour shift x 39 persons x 1.25 8 hour shifts = 732 gallons/day Design Flow = 150% Average Flow = 1.5 x 731.25 gallons/day = 1098 gallons/day 1.5. System Sizing A. ISDS Tank According to the Weld County Regulations, the septic tank shall provide detention of incoming sewage for a minimum period of 30 hours. The Weld County Regulations also state that for industrial, commercial, or institutional facilities the minimum capacity shall permit detention of incoming sewage Wells Ranch Page 3 SELINE for 30 hours at 150% of the estimated daily average flow. Since the estimated daily average flow could be achieved over a 10 hour period based on the proposed operations at the site, the tank would need to retain 3 times 150% of the daily average flow over a 30 hour period . The tank would therefore be required to retain 3 x 1.5 x 732 gallons, resulting in 3294 gallons of minimum tank capacity. B. ISDS Absorption Field Once a Geotechnical Exploration Report and a Percolation Test has been completed, their results will be made a part of this report and both will be provided in the References. At that time, Baseline will provide a design for the absorption field . Baseline expects the soil types and average percolation rate at the site will meet the criteria in the Weld County Regulations for a soil absorption type system (between 5 and 60 minutes per inch) . Wells Ranch Page 4 SELINE RECELVEC •w rd-S-R:v: 76 COLORADO DIVISION OF WATER RESOURCES C AUG 13198 - ' 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 RECEIVEQ„ ECEIVED ATER RESOURCE PERMIT APPLICATION AFIM JUL 1 1 1984 STATE•ENGINEER Application must pp��''rr (��7 CO% be complete where (X) A PERMIT TO USE GROUND'[\-`R 2 1984 applicable. Type or (X ) A PERMIT TO CONSTRUCT �J(� L PvLAT.E�R� RESOURCES print in BLACK FOR: (X ) A PERMIT TO INSTALL A Pl1A1P_ RESOURCES �i•ENGINEER INK.No overstrikes E-ENGINEER or erasures unless ( ) REPLACEMENT FOR NO, WILL initialed. ( ) OTHER WATER COURT CASE NO. (1) APPLICANT - mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN NAME Jack Wells Receipt NO" '1 N W O / STREET 31025 Weld Co. Rd. 66 Basin — _ Din. CITY Gill, Colo. 80624 - CONDITIONS OF APPROVAL (State) (Zip) TELEPHONE NO. 352-2952 This well shall be used in such a way as to cause . no material injury to existing water rights. The ' (2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water County Weld right from seeking relief in a civil court action. NW 'A of the NW 1h, Section 29 1) APPROVED PURSUANT TO CRS 37-92-602 (3) (b) (II) AS THE ONLY EXEMPT WELL ON Twp 6 N Rng 63 W 6 P.M. A TRACT OF LAND OF 40 ACRES DESCRIBED AS w,SJ E,,Ail NA, NW31, SEC. 29, TWP. 6 N. , RNG. 63 W. , (3) WATER USE AND WELL DATA 6 P.M. 2) THE USE OF GROUNDWATER FROM THIS WELL IS LIMITED Proposed maximum pumping rate (gpm) 15 TO FIRE PROTECTION, ORDINARY HOUSEHOLD PURPOSES INSIDE A SINGLE FAMILY DWELLING, THE IRRIGATION Average annual amount of ground water OF NOT MORE THAN ONE ACRE OF HOME GARDENS to be appropriated (acre-feet): 2 AND LAWNS, AND THE WATERING OF DOMESTIC ANIMALS. Number of acres to be irrigated: Less than one 3) THE RETURN FLOW FROM THE USE OF THE WELC MUST BE THRL AN INDIVIDUAL IMAOTE WATER ntnnn Proposed total depth (feet): 75' n T rrnlLf E EAL SYSTEM OF THE NON - EVAPORATIVE TYPE WHERE THE Aquifer ground water is to be obtained from: WATER IS RETURNED TO ATHE SAME SEEM SISIEMM IllWHICH INE WILL 5 1.00gTED, -I s - $y /s1 r Alluvium Y�Q Owner's well designation Domestic GROUND WATER TO BE USED FOR: ( ) HOUSEHOLD USE ONLY - no irrigation (0) (XI DOMESTIC (1) ( ) INDUSTRIAL (3n ( ) LIVESTOCK (2) ( ) IRRIGATION 16( ( ) COMMERCIAL (4) ( ) MUNICIPAL (8) ( I OTHER (9) a$P?,ICAUIt_?N /"kVr MOVED u1/4/7 6- v DETAIL THE USE ON BACKIN (11) 136565 PERMIT NUMBER (4) DRILLER DATE ISSUED AUG 16 1984 LESH DRILLING, INC. AUG 10 1986 Name EXPIRATION DATE Street Box 56 �� / c/ City Ault, Colo, bii6 iZip \\ �'�'�`('�TATE E GI ER) (State) I:0 ste B34-2868 I BY Telephone No. Lic. No. LD. / - d / COUNTY 6 11 (5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED$ELQW which the water will be used must be indicated on the diagram below. by distances from section lines, Use the CENTER SECTION (1 section, 640 acres) for the well location. • -t 125 ft. from North sec. line — t — _i- — * — -}- — 4; — H._. — 4 — + (north or south) 1 1L-----1 MILE,5290 FEET—_I I 125 ft. from West sec. line or west) ± + + ± ± - f + t LOT BLOCK FILING • I I I _ _ NORTH SECTION LINE _ + _ SUBDIVISION I I (7) TRACT ON WHICH WELL WILL BE I NORTH LOCATED Owner: SAMP w —_ _ —— z — D + ± No. of acres 40 Will this be n co I z I i -i o m the only well on this tract? yes + + w o + - + (8) PROPOSED CASING PROGRAM I . I z y r I Plain Casing -- 3- - -+- - - - 4- - -m -I- f _5_in.from 0 ft. to 55 ft. I I I I in.from ft.to ft. }- - -}- - 1 I I _ -4_ - 4, Perforated casing SOUTH SECTION LINE 5 in.from 55 ft. to 75 ft. T + + -I- -i- + + -- + in.from ft. to 't. I I (9) FOR REPLACEMENT WELLSgivedistance and direction from old well and plans for plugging — 4. — + — - - + - H_ - + - + - _k it: The scale of the diagram is 2 inches = 1 mile NA Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) . . .449 gallons per minute (gpm) A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot . . .43,560 cubic feet . . .325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (10) LAND ON WHICH GROUND WATER WILL BE USED: Owner(s): Jack Wells No. of acres: 640 Legal description: NW'-, of the NWI of Section 29. Twp 6N. Rng 63W. 6 PM (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. tiON An approved return type sewage disp osal posal system ,xill_be used. • (Septic tank-Leech field) Less than one acre of lawn and garden irrigation & Domestic usage. (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for(purpose) Description of land on which used None (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KN WLEDGE. N TURF OF APPLICANT(S) Use additional sheets of paper if more space is required. 6, ' . . SUTTMEMENTAL INFORMATION 'n_tial Permit..c.::o t 'c ioai Permit � rate verbs. �Y ro:�.l �_•ren: REQUEST FOR VERBAL APPROVAL e G1841 y Cwn er Driller Location � p ,- C �e,s Count': W"Y-cK Address: Lie. ;To. Phone See ___..TIT.__w_.agi... New 0 Reel. 1 Petit o. Li-y ?hone Alt. Pt. 01v JJ T.n._L] Dis`�.ances *rcra(Sec. Lines 4Prorave Yes `_Ta j�� , ?dosed ,1!=t of Construction =$s'�• . U Per!; _ C Subd;v',lion Contact and Late Initial, der REMARKS g//9.7/ /6.1‘/S- je.ii �e.JJ ,...„,.....„,‘. ...-, ,,:y ,z/..7(--- . 6. p.,___If$. .3 /R7 �/ - /U , 0GyLg',7-:--) ,:z„,,,,J.‘.._ ,_4.„Z,...7 „....4„...5 4 ` Z oa.c-cl� e j >4 L r c h..-� Tra,,...,-, -,v .1, 4,- c / t it /dj i I [ 1 II Applicant: Date Sub.: Sec:_ 'rap: Rzg: PM: • a*Yt+'k5' ''.VAS.. '1'l• 7BTe• + +a+-• o ti top, ~'y '. t ev. o •c wOp: 'Prot. Sac _— .* c•Ceas •a.,. grew r_, vo• _ Source ±cr ?la A—na EH r'Ti✓I \y$ti LC. 11 [.)RII�ING, t"J l; ,11.1u13 /. ni Euo Slate � v .. - „113 at, fly r C/ ti ox 5611 Ault, Colo <3061 FICE OF THE STATE ENGINEER UIVU IUN OI WA I ER RI:SOL)RCE_J \ i\I\-& 1313 :Thurman Stroel•Roum Inn Danger, Colorado 80203 (303) 866-3581 TO: WELL PERMIT APPLICANT RECEIPT t40.g73 O Your application fur a well permit is being returned for the reasons indii Led below. The information and corrections which we are requesting is required for evaluation of your application. Prompt completion or correction of all items and the innnediate return of the application to this office will expedite its processing . Additional delay can be avoided by correctly completing the application in full and supplying the information that is requested . The application must be typed or printed in black ink . Al ) chances , corrections , or additions t0 the_applicatiorl must be initialed and dated . Do not alter or change any questions on the application, c ni��4 AvQ ��_- : p ^5 AA ea > . � 9- I a1\.4 en, OO 1VJam. • QWQ onc _ FROM: Sandy Johnson DNTL: < Cni,uunuu In VI tuN OF WATERI;i::;nuu(:I::; FRUM : Sandy Johnson 8LR' Centennial Building, 1113 :Sh •rwan Street DACE: 1-j3-D7_ DS-over, Co.lornde 80203 YNONE: (303 B66-35X7 REC. ' 4 '(3 - O - • APPLICANT Vl) WELL DRILLER ( ) AGENT ( ) ATTORNEY ( ) RE: Well Permit Application Your application for a well permit is being returned for the reason(s) indicated below. The additional data and corrections which we are requesting will aid us in evaluating your application. Prompt completion or correction of ALL items checked and the immediate return of the application to this office will expedite its processing. Please make corrections on the application, NOT on this flyer. Thank you for your attention. PLEASE INITIAL ALL CHANCES--PLEASE TYPE OR PRINT IN BLACK INK] Item Nos. ( ) Statute requires a $ fee for this application. Please return the application with required fee . 2 ( ) The well location must be designated by the county and the 1/4 of 1/4, Section, Township, Range and P.N. 2,6, 10 ( ) The 1/4 of 1/4 section (Item 2) does not agree with distances from section lines (Item 6). ' Distances place well in 1/4 of 1/4. 3 ,11 ( ) For a HOUSEHOLD USE ONLY WELL, no irrigation of lawns or gardens or stock watering can be Permitted. In this area, a household use only well is all that may be permitted. 3,11 ( ) For a DOMESTIC WELL, no more than one (1) acre of lawn or gardens can be irrigated (Item 3) . 3 ( ) Please indicate the proposed total depth. 3 ( ) If this well is to be used for HOUSEHOLD PURPOSES ONLY, with no lawn or garden watering, please indicate on the application under "Ground Water to he Used For." Do not indicate HOUSEHOLD USE ONLY and DOMESTIC as they are different. 6 ( ) Distances from section lines must be shown. 8 ( ) The proposed casing program must be completed. 9 ( ) The existing well must be plugged and abandoned according to rules and regulations. Please include the distance and direction from the old well. 10 ( ) If this well is to he the only well on 35 acres or more, please describe the acreage on the back of the application in Item 10. PLEASE ATTACH FULL METES AND BOUNDS PROPERTY DESCRIPTION OR SURVEY. 11 ( Please indicate the specific use intended for the water, awdesk•e Fermi 12 ( ) Please describe other water rights on this land and their use. 13 ( ) Signature of applicant is required on application unless it is accompanied by a power of attorney. ( ) Please provide a copy of a tax receipt , a surveyor' s plat or a warranty deed to show ownership of the property described in Items 6 and 10. This must give the date when the land was subdivided. ( ) Please complete Item(s) where checked. ( ) Please complete the enclosed ownership affidavit in full and return it with your application. ( ) Other: 9 [l5,11 � � a rams - "Forte-C Rev. STATE OF COLORADO iz�� t"' If `` 9-62/10M APPLICATION FOR: A PERMIT TO USE GROUND WATER FEB 14 1966 X A PERMIT TO CONSTRUCT A WELL 6R0Uii1 WATER SECT. Applicant Jackson B. Wells LOCATION OF WELL COLORADO County Weld Wilk EN6WEN P.O. AddressRt. 11 Box 35 . Gill, Colo.Quantity applied for 25 gpm or NEB, of NW i of Sect. 29 , Twp. 6 , AF Storage w Rge. 63 W , 6 P. M. OR Used for Domestic Purposes on/et NEB . NWk. 29, 6 . 63 440 m Street Address or Lot & Block No. (legal description of land site) "3 �c o Town or Subdivision Total acreage irrigated and other rts. .2 En ESTIMATED DATA OF WELL ° N Hole size: 10 in. to 10 ft. -e m in.to ft. ae e + X 6 5/g" t,O _ _ _ _ _ Casing Plain in. from U to 35 ft. Locate 6 5/8” in. from to ft. aa? I well in Open oz Pert in. from 35 to 50 ft. A ' 40 acre _in. from to ft. .0 I E (small) PUMP Outlet ;w i I square DATA: Type Unknown . HP Size as near $c - as possible. Use initiation date February 19 66. to ; Large square (Use Supplemental pages for additional data) F'x,�. ' is one section. Gi S $25. 00 fee required for uses other THIS APPLICATION APPROVED than Domestic or Livestock. PERMIT NO. 26343 Applicant Jackson B. Wells ISSUED: FEB 1466 Agent or DATE 19 Driller Cummins Well Works No. 73 Address 121- 13th St. Greeley. Colo NOTE -- SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION APR 2 5 1968 Lig 9172 etswgREF FORM E L9EV.1 ) • d M STATE OF COLORADO = ts!� '. rr- DIVISION OF WATER RESOURCES APR 8 1966 IndexNo...2&&B OFFICE OF THE STATE ENGINEER WI, IDWD / GROUND WATER SECTION MOW We / IM. Registered....H..:.&.-.G.4x_:.. LOG AND HISTORY OF WELL ,r. (For State Engineer's Use) PERMIT NO 26343 WELL LOCATION Driller Cummins Well darks Lie. No._-_73 Ge Owner Jack.son.....:. Wells _,._ Well _..._ . .County Street R t- I, A nx 4-5 Ciry__..Qi l 1 t Cal n NF, 1/4 of_IlVVL_.—ys of Sect. 29 _— Tenant ..._ Twp. 6N , Rge. 63 W L PM Use of Weter_._.___Tlnrnr'St i r. _..... ____ No.. On or By_-NE4. NW a 29, 6N t 63W_ ...—Acres _ North (description of rlt. or land) i �` Date Started February 21 _.. , 19 _ 1/h�r'/' Date Completed February 21 _.. .,.._ , 19 66 _ __ _Nvt w. - -_-- _ _NP„__ - - Yield 2.5 GPM Or.... __.__CFS i weer I Beet WELL DESCRIPTION: Depth to Water 25 ft. Total Depth 60 .._..ft. r (m.esured from ground surface) - ^ ^;yp�- _ _ • -- --!!' .-- -` in. 10 from 0 . ft, to 60 ft. Hole n, from ft. to ft. Diameter in. from ft. to ft. south TEST DATA: How Tested Pump or I Bailed ABOVE DIAGRAM REPRESENTS ONE FULL SEC- TION. LOCATE WELL ACCURATELY IN SMALL Date Tested 222 196h Length— 2 hrs. SQUARE REPRESENTING 40 ACRES. Rate 25 _...__GPM Drawn Down_.._4 _ ft. or PUMP DATA: If the above is not applicable fill in: Did not install Pump Type Outlet Size in. No. Street Driven by HP .._-,r. City or Town CASING RECORD: Plain Casing or tt Size6 5/A , Kind.. tr.eelfrom 0 ft. to. 43 ft. Lot , Block_ Size , Kind—____from ft. to . ft. Subdivision (include filing or number) Size , Kind from_. _ft. to ft. Perforated Casing TO BE MADE OUT IN QUADRUPLICATE: 6 r2/at Original Blue (both sides) and Duplicate Green Size .t Kind1, from —ft. to 60 ft. Copy must be filed with the State Engineer .. within 30 days after well is completed. White Size ,..,___, Kind _ ,from ft. to —ft. copy is for the Owner and Yellow copy for the Size , Kind_....—from ___._ft. to..-. ft. Driller, SIGN BLUE COPY ..w Fv"e:•, M1Y rv. x.,�' .� 7'..., d �", 1i R "w ..1 t., f A"M �>,r. '�...yyq. rA ,'� • WELL LOG Ground Elevation (if known) How Drilled Rotary CC REMARKS 3 1 FROM FEET TYPE OF MATERIAL (such es Cementing, 2 8gEt Pecking, Shut off, etc.) ¢3 e A Y 6 c5s n !I. Tops(); 1 . Washed Graded. 4 30 Sand gravel pack 30 55 Sandxtone 43 55 60 shale to 60 BF men space Is ngvired use sddl anal sheet) . WELL DRILLER'S STATEMENT This well was drilled under my supervision and the above information is true and correct to the best of my knowledge and belief. Signed (2nnipn i n 4 lea l 1 Wnrkc By (mss . N� ( YL4LYLGfA t. Omsk April7 t9 ' l r � � �., pw ' m +fy,?��'5.� 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 889 WELL PERMIT NUMBER 248266 - A APPLICANT DIV. 1 WD 1 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY NE 1/4 NW 1/4 Section 29 WELLS RANCH Township 6 N Range 63 W Sixth P.M. 32010 WCR 63 DISTANCES FROM SECTION LINES GILL, CO 80624- 50 Ft. from North Section Line 2300 Ft. from West Section Line �)= UTM COORDINATES PERMIT TO CONSTRUCT A WELL Northing: Easting: 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. 248266. The old well must be plugged in accordance with Rule 16 of the Water Well Construction Rules within ninety(90)days of completion of the new well. The enclosed 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 the watering of livestock(feedlot comprised of 500 head or less, as described in Policy Memorandum 93-2)on a farm or ranch. 5) The average annual amount of ground water to be appropriated shall be less than 3 acre-feet. 6) The maximum pumping rate of this well shall not exceed 15 GPM. 7) This well shall be constructed not more than 200 feet from the location specified on this permit. 8) For the future administration of this well,the Division Engineer of Water Division 1 may require the well owner to install and maintain a totalizing flow meter on this well. ✓3IQ 316 /p3 APPROVED dd "y40(reSKB �_c\ State Engineer By Receipt No.0506379B DATE ISSUED 03-06-2003 EXPIRATION DATE 03-06-2005 Form No. OFFICE OF THE STATE ENGINEER GWS-25 :COL'ORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203 (303)866-3581 889 WELL PERMIT NUMBER 248282 - A APPLICANT DIV. 1 WD 1 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY NE 1/4 NW 1/4 Section 29 WELLS RANCH Township 6 N Range 63 W Sixth P.M. 32010 WCR 63 DISTANCES FROM SECTION LINES GILL, CO 80624- 50 Ft. from North Section Line 2400 Ft. from West Section Line UTM COORDINATES PERMIT TO CONSTRUCT A WELL Northing: Easting: 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. 248282. The old well must be plugged in accordance with Rule 16 of the Water Well Construction Rules within ninety(90)days of completion of the new well, The enclosed 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 the watering of livestock(feedlot comprised of 500 head or less, as described in Policy Memorandum 93-2)on a farm or ranch. 5) The average annual amount of ground water to be appropriated shall be less than 3 acre-feet. 6) The maximum pumping rate of this well shall not exceed 15 GPM. 7) This well shall be constructed not more than 200 feet from the location specified on this permit. 8) For the future administration of this well,the Division Engineer of Water Division 1 may require the well owner to install and maintain a totalizing flow meter on this well. ,(f 3 hips 9 APPROVED 7/d a SKB Gsa- f- K \ State Engineer By � Receipt No.0506379D DATE ISSUED 03-07-2003 EXPIRATION DATE 03-07-2005 WJR-26.'] - COLORADO DIVISION OF WATER RESOURCES RECEIVED THIS FORM MUST BE SUBMITTED 1313 Sherman Street - Room 818 WITHIN 60 DAYS OF COMPLETION Denver, Colorado 80203 M0V 1 3 19g4 OF THE WORK DESCRIBED HERE. E ON.TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATIQN REPORT - ,R RESOURCES INK. PERMIT NUMBER 136565 ✓ "rE ENGINEER rota WELL OWNER Jack ;jells __.. NW .__ Y. of the N.f Y. of Sec. 29 ADDRESS 31025 Weld Co. Rd, 66-Gill, Colo. T 6_ N A. 63 IT 6 P.M. DATE COMPLETED 9-16-84 _... 19 _.__ HOLE DIAMETER WELL LOG 7�/8 . in. from_ 0 _ to 210 ft. Water From To Type and Color of Material Loc. -- ----- in. from._.. to __ ft. 0 7 Surface and Sandy Clay in. from _ to ft. 7 11 Coarse Sand DRILLING METHOD Standard Rotary 11 15 Clay CASING RECORD: Plain Casing 15 37 Med. Gravel 37 45 Boulders and. Irg, Gravel Size 5 _ & kind Plastic from 0 to 110 ft. 45 101 Shale 101 123 Shale w/Sandstone Streaks Size _____ & kind ___ from - to ft. 123 124 Hard Black Rock 124 160 Shale .w/Sandstone Streaks Size _ & kind _ —_ from to ft. 160 161 Hard Black Rock 161 210 Hard Shale Perforated Casing Size _.5 & kind Plastic from - 110_to to 210 ft. Size ___ __ & kind —__—. from _ to _.. ft. Size —_ & kind -- -___ from _.__to ft. GROUTING RECORD Material _ Cement Intervals _ 0 - 63' Placement Method _ Poured GRAVEL PACK: Size 3/8" Interval 63 - 210' TEST DATA Date Tested 9-16-84 19 Static Water Level Prior to Test 25' ft. Type of Test Pump Baler Length of Test 2 Hours TOTAL DEPTH 210' Sustained Yield (Metered) 5 GPM Use additional pages necessary to complete log. Final Pumping Water Level Bottom I PUMP INSTALLATION REPORT •°a7' s,.,. ••.; . ,i1, `" Pump Make Unknown Type Powered by HP ,,:: Pump Serial No. r, h j3 J W j WATER Motor Serial No. _� k:. �w TABLE W FW Date Installeo �J cc tn ' W • Pump Intake Depth t l% a Remarks Owner to install pump t, ;;, r, E. ?, 3 , DI ` a- i W ♦+ Z r S + t :: WELL TEST DATA WITH PERMANENT PUMP a I•„ ,:- ` Date Tested Unknown _i = CONE of la- a ..:. .,` DEPRESSION Static Water Level Prior to Test F g Le^nth of Test Hours Sustained yield (Metered) _ GPM Pumping Water Level • Remarks Owner to install pump `' N ,f w sr. CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation described hereon; that s read the statement made hereon; knows the content thereof, and that the same of h' own owl tfe. Signature —o /I License No. 21 State of Colorado, County of l"h.LeoL SS Subscribed and sworn to betore me this day of a / , 19AI. My Commission expires: My Commission Explreeg. my 30, 1988 Notary Public 021- , ,./ . • FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller. Hello