HomeMy WebLinkAbout20123582.tiff D
Form.No. OFFICE OF THE STATE ENGINEER
GW ,-25 COLO8 RAl DOg., 3DI13 VIISION erman St., OFrWATEReRESOURCES LIc
(303)866-3581 WELL PERMIT NUMBER s.:u —
DIV. 1 WD 1
DES. BASIN MD
APPLICANT
APPROVED WELL LOCATION
WELD COUNTY
NW 114 SW 1/4 Section 15
Township 2 N Range 64 W Sixth P.M.
9 43 WC 16 BEARSON DISTANCES FROM SECTION LINES R FOR LUpTON, CO 80621-
1650 Ft. from South Section Line
FORT UP
320 Ft. from West Section Line
UTM COORDINATES
(303)857-9323 N
Northing: Fasting:
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL ce of this p rmit
1) This well shall be used in h a way as to cause
does not assure the applicant that no injury will occur to l another vested water right or injury to existing water Ip preclude another ghts. The iowner of a vested
water right from seeking relief in a civil court action. th the r Well Construction ules 2 CCR 402-2,unless 2) The consrucion of this wel shall be in comliance of a variatncethas been gralne d by the Sta ep l
Board ofExami Examiners Water Well ConstructionR approval and Pump Installation
Contractors in accordance with Rule 18.
3) Approved pursuant to CRS 37-92-602(3)(b)(1)and policy of the State Engineer under the following conditions.
4) The use of ground water from this well is limited to ordinary household purposes inside two(2)single family dwellings,
the watering of the users own non-commercial domestic animals,and the irrigation of not more than 1 acre of home
gardens and lawns. which corresponds to the interval between 580 feet
5) Production from this well is restricted to the Laramie Fox Hills aquifer,
and 935 feet below the ground surface. Plain casing shall be installed
Taensure d roted to prevent
n of produpoor ction
from
other
fromzones.o 6) The depth to the top of the
aquifer,
Hills aquifer is approximate.
zones immediately above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous
shale that overlies the Laramie sand portion of the aquifer.
7) The maximum pumping rate of this well shall not exceed 15 GPM.
8) The annual withdrawal of ground water from this well shall not exceed 3 acre-feet.9) The return flow from the use of this well must be through an individual waste water disposal system of the type so that not
less than 2%of the total amount of water withdrawn is returned to the same stream system in which the well is located.
10) This well shall be constructed not more than 200 feet from the location specified on this permit.
tNOTE:The ailty of this he 100 yea sbulpon which the amount of water in the aquifer is allocated,due too withdraw its authorized amount of water from lanticipated waters non-renewable level quifer may be less than
level declines.
NOTE:To insure a maximum productive life of this well,perforated casing should be set through the entire producing 2� UI
interval of the approved zone or aquifer indicated above. �— (JV_I �'ll
e
APPROVED �� o BS
�lr i 3 2t 3
JLV EC D.3 2001 " 'TI.N . 'T%
State Engineer
Recei•tNo.0483331
DATE ISSUED I
04.„ WELLWl CONSTRILI1ON AND TEST REPORT • Far
- IWItt STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1a13 Shannon.Sf Ff7r1 gl L Den CO enn.o
NAME
1. WELL PERK I NUMBER x3805-5 DEC : 0 2003
2 DOWW 1TEi RE`T';ACES
(S) he-Krell. f eat-rson STAYS :N+:. "R
Mall1gAddress •
COLO.
City,SL rip $0(p,.) 1
P (3O.3 ) 75 7- . CO3 , O 333 / ,
3. WEU.LOCATION AS DRILLED: N/A..) 4k) 1/4,Sec. /5 Teel N . Range L/p r/ IV
DISTANCES FROM W.,LINES:
R from • Sec. lie. and 3aU R. tram" `1/....‘Sec. line. OR
mmitrrerstrater
SUBDIVISION: LOT BLOCK FILING(UNIT)
St tittm ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION 2 Durum METHOD Rotary 44 coal-
DATE COMPLETED /1-,,0 r03 . Tow yam 8Ioo ft DEPTH COMPLETED 5°&3 r
S GEOLOGIC LOG: 6.HOLE . (In.) From (It) To p(k)
Depth Dwaiptim al Pedal gyp.,sim Odor,water Lacdot) 10 11Q- 0 __n ph
I
fs0:
-
- ao � 4�L
—
n '- n S/ia7Z 7. PLAIN CASING •
Sal) -3loo Sari d ryn) Wail Size From(ft) To(n) I
34=O - 575- Sj,A I P NIb— 521 « ./iS f a-- 590-1
SIC- - 57? "%KM_ I
?9 - .5RS �i rl
8s - 587 krte
SA? — 80 San ,ShAle14 ,orC �� CASING: Screen Slot Size:a _. _. I
asp - snap . 11 el A.E y gist. ,ate/ ,as 5=9r. . repo:
$ FILTER PACK 9. PACKER PLACEMENT
}Astoria' TypeTiabek _ I
-
Size _ [�71n r
—
Interval Depth J� _
10. GROUTING RECORD: 1
REMMQi. Material Amount Density Interval PIa�emenr
l'c.ritnl� I sack al ,S.
f>`opr44i
C,mNeti 3 Y a( n 1 Ste? eerie 6}42-
11. DISINFECTION: Type /t,yl)Ik Ant. Used Q p-1
12 WEIR 'ES' DATA Ciwk triad Test Data is submitted an Form No. GWS 39 Supplemental Weil Test.
TES►*1G METHO2nD qA,Y I
Statictave! Y ft. Date/Time ma�ied /1-.w r )3 . ProductionFie /s gpa
PtanPing level 5?) it Date/Tree'measured //-a-D-03 , Test length (hrs.) a _----
13 I her.tad ilha srrrrrae mach halt and raw haves dewed.add tar they ere this to my tr,oerledR. (Pwaaru,a Saaon 24-4-104 n'11 1111
ant.to reekkq al Was Wfansr herein centhilithis pa}ay 1,h aaoand degas and is punishable es a class I rnmdern.ano.I
CONTRACTDR�[ (4/1/l''3 100k-N , { l�Y;/t,Y4 Photo (322.J t e9?4- 6x0 uc. No./dr7)--9 I Mailing Address 0
n pr t Sig natureDate I
DG</Ol� Llll1Lf11/L(1/ y l N sy Q 1 �y LQ 1?- 9 -as " ;
11
am. PUMP' RETALLA'nON AND'JESST REPORT Ferias.Ur only
5=03 STATE OF COLORADO.OFFICE OF THE STATE ENGINEER O t% 3 SJ r
1. WELL yew M 3?05:6—
a OMERNAIE(S) Darrc)l tear-Sr . DEC - 0 2003
using Address 97%3 tN +`
ctI.ST.ah rnr!- pup-bn . CO SQ6d/ c,•. v„cEs
Ptiane 003) SS7— 93x3 nrwl : c—,s:::art
a Val WtiDT14t4 AS Qi /�/ t/4 5w/ f/4.Sec. /S 7bµ c2 Al .Renpe / 4 wDISTANCES
/(o eomFROIA,�Ser..ftre.and,300 It kom iAla sec.Me.
SI.DPASION: LOT +moo BLOCK F1UN8(tAd1)
STREET ADDRESS AT WELL LOCATION
/:_ /
4. PUMP DATA:Type tai c bA UPSlgEY Installation Completed //-o'f A -OS
Pump Madeetaer S/a. Purnp Model No. /onc c A'
Design GPM /0 at RPM .3'VS1) .It ca .iftt n233O .Fui Load Ar ps a
Pump tra y Depth SO'/ Feet WopiCokeR,Pipe Ste / Week fed PVC
AODRIONAl,IPFOPMATfON FOR PUMPS Qfl1Bt TINT 50 emit
TURBINE DRNER TYPE 0 Electric DEng.* ❑Other
•
Design Heed feet Number c%Stages Shasta) itches
S. OTrElEQUIPleflT
Anne maw Dyes
[ Na Office Depth Q Mta.T Installed 0 Yee❑Na, Depth It
Ran MS Mfg. Meter Serial No.
MOW Read at❑mom.❑Tanad deaf=,❑ice leek 0 Beginilg Readrg
6 Merit DATA: 0 Check box i Test data is on Supplemental Fenn
Dem /(-.24/-03
Total_
amnion 309 Rafe(OPI4
One Measwed //-f24-03 Pumping Let 396 11 A
7. DISfsFECTlOt Type { V 10(;11-0.- Ant Used__Lard
a Water Welty er Ij amiable.❑Yee No �J
& Remake
to l has tead the statements made herein and Imam the canters thereof, and that they are true to my knowledge,
(Punmrt to sateen 244-,04 r9j(a) CAS..the nmiig d tape stammerers herein (orstitlss pe y In the second
degree and is winnable m a d as 1 miedemeener.) '/ '�1
CONTRACTORCV 1/3 � cod iril/i aq prone(3o�i/aaa-0076 uc. No./29.
MaingAddress X35'/ .SWi-asizurt3, 110 J 1/0,365'
NamWTlle(Please type or pat) Signature Date
/-hoardG'-anrla/l Ow/zer Q4C0141,A4Q9c C, I, /a- 9-0.3
12
WATER SUPPLY INFORMATION SUMMARY
Section 30.28.133,Id). C.R.S. requires that the applicant submit to the County,'Adequate evidence that a water supply that
is sufficient in terms of quantity, quality and dependability will he available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
2. LAND USE ACTION
3. NAME OF EXISTING PARCEL AS RECORDED
SUBDIVISION FILING BLOCK LOT
4. TOTAL ACREAGE A (I, S`t 5. NUMBER OF LOTS PROPOSED PLAT MAP ENCLOSED, YES
6. PARCEL HISTORY - Please attach copies of deeds, plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1. 1972? 0 YES 71 NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? 0 YES I5-140
If yes, describe the previous action
7. ATION OF PARCEL - Include a map deliniating the project area and tie to a section corner.
Ni I/2 1/4 OF S Lc 1/4 SECTION 7 S TOWNSHIP Pct.' OS RANGE C.? '" ❑ E rg.W
PRINCIPAL MERIDIAN: 0 6TH 0 N.M. ❑ UTE 0 COSTILLA
B. PLAT - Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat ❑ Yes jd No If not, scaled hand drawn sketch ❑ Yes Iff No
f/
9. ESTIMATED WATER REQUIREMENTS - Gallons per Day or Acre tier per Year 10. WATER SUPPLY SOURCE �mac, `Ycl 1l r+, —C b'
'EXISTING ❑ DEVELOPED ❑ NEW WELLS
WELLS SPRING PROMOSm AOUFERS (CHECK ONE)
HOUSEHOLD USE p of units GPO AF WELL PERMIT NUMBERS 0 AeUVIAE 0 UPPER ARAPAHOE
1J S C,J 6 0 UPPER CIAWSON 0 LOWER ARAPAHOE
COMMERCIAL USE p of S.F. GPO AF o LOWER oAwsox ❑LARAMIE FOX teas
❑DENVER ❑DAKOTA
`A-arHFa"lII
IRRIGATION p 0 of acres GPO AF 1501 /tel Lc E'—
STOCK WATERING p (7 of head GPO AF El MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER - GPD AF 0 COMPANY
❑ DISTRICT
TOTAL GPO AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES ❑ NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES gNO IF YES, PLEASE FORWARD WITH THIS FORM. (Thu may be required before our review is completed.
12. TYPE OF SEWAGE DISPOSAL SYSTEM
) JSEPTlC TANKILEACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME
/❑ LAGOON ❑ VAULT - LOCATION SEWAGE HAULED TO
1 1
El ENGINEERED SYSTEM IAlbch.copy of engineering dmipnlDTHER '' C? '1 C - C c"
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