HomeMy WebLinkAbout20120101 WATER SUPPLY INFORMATION SUMMARY
• Section 3O.28.133,(d), 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 be available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
1 f 1.1 (e ti K.� / _S .4-LC:-5'
2. LAND USE ACTION e I L ? �i•�S G4)K
3. NAME OF EXISTING PARCEL AS RECORDED Li.?T,4, 12 7.6 L)/65:,/,7,//e76 _ ge;
SUBDIVISION FILING BLOCK LOT
4. TOTAL ACREAGE 7,; 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? O YES R'NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? 0 YES, ] NO
If yes, describe the previous action
7. LOCATION OF PARCEL - Include a map delineating the project area and tie to a section comer.
LEI 1/4 OF 1/4 SECTION .2%11 TOWNSHIP C N ❑ S RANGE 6 ❑ E
PRINCIPAL MERIDIAN: ER 6TH 0 FtM. ❑ UTE ❑ COSTILLA
8. PLAT- Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat 0 Yes '51 No If not, scaled hand drawn sketch IS4 Yes 0 No
9. ESTIMATED WATER REQUIREMENTS - Gallant per Day or Acts Fut par Yam 10. WATER SUPPLY SOURCE
17,1 EXISTING ❑ DEVELOPED 0 NEW WELLS
WELLS SPRING PSOPOSED AOUfE16 PIM OKI
HOUSEHOLD USE # of units GPO AF WELL PERMIT NUMBERS Auuwu C urrta ARA.PANOf
C WEN DAWSOE CLOWN ARAPANDf
COMMERCIAL USE # of S.F. GPD AF _f.) 14 'J AC LONER DAWSON CUOMO(FOX HaLS
C antra C DAKOTA
C ors
IRRIGATION N of acres GPD AF
STOCK WATERING N of head GPD AF (7 MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER GPO AF ❑ COMPANY
❑ DISTRICT
TOTAL GPD AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT ❑ YES y NO IF YES, PLEASE FORWARD WITH THIS FORM. rims may ha milked halma our r.ra-e is complaud.J
12. TYPE OF SEWAGE DISPOSAL SYSTEM
* SEPTIC TANK/LEACH FIELD L �I,i'1~U/Ztc ) ❑ CENTRAL SYSTEM • DISTRICT NAME
• 0 LAGOON O VAULT • LOCATION SEWAGE HAULED TO
❑ ENGINEERED SYSTEM (Attach.cloy of enginurag daienl 0 OTHER
2012-0101
,
i I Form STATE OF COLORADO For Office Use Only
•No. OFFICE OF THE STATE ENGINEER RECEIVED
OWS•1l 818 Centennial Bldg., 1313 Sherman St.,Denver,CO 80203
06100 (303)866-3581 Fax(303)866-3589
N0V 1 fi 2005
CHANGE IN OWNERSHIP/ADDRESS
CORRECTION OF THE WELL LOCATION WATER RESOURCES
STATE ENGINEER
COLO.
Insert the Well Permit Number c3(d(o5t3 •
Name,address and ohone of the aersson claiming owne ship of the well:
NAME(S) �(lc mC HOC 63.11.1‘.0-1 - A. r dv, cc 7
1If your well has an absolute water right,decreed
Mailing Address !/57 Co C ion wool Ave• by the court and the well is not registered with the
// / / ' State Engineer,enter the Water Court Case
City,St.Zip rDri /1tl�t�J% / t-G/• 9062/
Number/Civil Action Number and well number
// as decreed.
Phone (.303 1 _54q- 91A0
This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above.
This filing is made pursuant to C.R.S.37-90-143.
WELL LOCATION: County Owner's Well Designation
(Address) (City) (State) (Zip)
SW 1/4 of the 1/4,Sec.'`?,Twp. LJ N.or 0 S.,
Range L0C ElE.or®W.io P.M.
• Distance from Section Lines LtCI° Ft. From ❑ N.or ZS., a7O Ft. From❑E.or ®W.Line.
' Subdivision Name Lot Block Filing/Unit
The above listed owner(s)say(s)that he,she (they)own the well described herein. The existing record is being
amended for the following reasons: ®Change in name of owner tsilChange in mailing address
❑Correction of location for exempt wells permitted prior to May 8, 1972 and non-exempt wells permitted after
May 17, 1965. Please see the reverse side for further information regarding correction of the well location.
I (we)claim and say that I (we)(are)the owner(s)of the well described above and that the commencement of.
extraction of ground water from this well,lawfully made under the well permit,occurred on the date indicated, and
that the statements made herein are true to my(our)knowledge.
Please print the Signer's Name&Title Signature(s)of the new owner. Date
Ro-- •iSCc tARROfl v V
P�-n 4. A A . POAP f2on ,, �f' ,.vim. ,Q avre+r� 1I—, >- 05
It is the responsibility ofThe new owner of this well to complete and sign the form. Signatures of agents are acceptable if an
j original letter of agency signed by the owner Is attached to the form upon its receipt.
For Office Use only
ACCEPTED AS A CHANGE IN OWNERSHIP
AND/OR MAILING ADDRESS.
0 /
Stale Engineer By V Dale
•
iForm 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 LIC
• WELL PERMIT NUMBER 266513 - 1If
APPLICANT DIV. 1 WD2 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
SW 1/4 SW 1/4 Section 24
GURTLER RUSSELL L FAMILY TRUST Township 3 N Range 65 W Sixth P.M.
&DOROTHY K GURTLER TRUST DISTANCES FROM SECTION LINES
7538 WCR 49 400 Ft.from South Section Line
HUDSON,CO 80642- 270 Ft.from West Section Line
(303)5364850 UTM COORDINATES(Meters,Zone:13.NAD831
PERMIT TO CONSTRUCT A WELL Easting: Northing:
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 40 acre(s)described as the SW
114 of the SW 114,Sec.24,Twp.3 North,Rng.65 West,6th P.M.,Weld County.
•4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than
three(3)single family dwellings,the watering of poultry,domestic animals and livestock on a farm or ranch and the
irrigation of not more than one(1)acre of home gardens and lawns.
5) The total depth of the well shall not exceed 600 feet,which corresponds to the base of the Laramie Fox Hills aquifer. At
a minimum,plain casing shall be installed and grouted through all unconsolidated materials and shall extend a
minimum of ten feet into the bedrock formation to prevent production from other zones.
6) The pumping rate of this well shall not exceed 15 GPM.
7) 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.
8) This well shall be constructed not more than 200 feet from the location specified on this permit.
9) The depth to the top of the Laramie-Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from
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.
NOTE:To ensure a maximum productive Ilfe of this well,perforated casing should be set through the 'e producing
interval of the approved zone or aquifer indicated above. 9.OC
APPROVED
•JLV .
State E gineer By
,Receipt No.0543671 DATE ISSUED 11-09-2005 IRAIIION DA E 11-09-2007
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