HomeMy WebLinkAbout20120465.tiff • STATEMENT OF WELL USAGE
The undersigned applicants have read Colorado well permit #140143 and are familiar
with the contents thereof and the restrictions and limitations placed on the use of the water from said
well according to the terms of the said permit. Applicants hereby represent to the Commissioners
of Weld County Colorado and to all others concerned that they will use the water from the above
well only in accordance with the terms of the said permit and will not allow the use of said waters
in any manor or for any purpose contrary to the terms of Colorado well permit #140143.
Lawrence Scott Therese Scott
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•
2012-0465
State of Colorado Water Resources - View Well Details: Receipt 0255321 Page 1 of I
Colorado Department of Natural Resources
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Colorado's Well Permit Search
Well Constructed Help 1 Last Refresh:1/13/201112:02:31AM
Receipt: 0255321 DiWsion: 1
Permit*: 140143-- Water District: 2
Well Name/#: County: WELD
Designated Basin: Management District:
Case Number:
WDID:
I [-] Applicant/Owners History
Date Range Applicant/Owner Name Address City/State/LP
Unknown-Pment PEHR ALICE E 11222 CO HWY 52 FT.LUPI ON,CO 60621
[-] Location Information
Approved Well Location:
Q40 Q160 Section Township Range PM Footage from Section Lines
NE SW 1 1.0N 67.0W Sixth 2500 S 2500 W
Northing(UIM y): 4436591.0 Luting(UTM x): 513654.9
Location Accuracy: Spotted from section lines
Physical Address Subdivision Name
City/State/Zip Filing Block Lot
Parcel ID: Acres In Tract: 35
[-] Permit Details
Date Issued; 06/28/1985 Date Expires: 06/28/1987
Use(s): COMMERCIAL Aquifer
• Special Use:ISSUED UNDER PRESUMPTION 3b-IIA (s):
QUATERNARY ALLUVIUM
Area which may be irrigated;
Maximum annual volume of appropriation: 0.33
Statute:
Permit Requirements: Totalizing Flow Meter Geophysical Log Abandonment Report
No No No
Cross Reference Permit Number
Receipt Description Pennit(s):
Comments:
(-7 Construction/Usage Details
Well Construction Date:11/07/1985 Pump Installation Date;
Well Plugged: 1st Beneficial Use:
Elevation Depth Perforated Casing(Top) Perforated Casing(Bottom) Static Water Level Pump Rate
39 19 39 6 15
Lic# Name Address Phone Number
Driller 513 RANK,SAMUEL C 1106 50TH AVE GREELEY,CO 80634 303-352-8130
(-3 Application/Permit History
Well Construction Report Received 12/06/1985
Well Constructed 11/07/1985
Permit Issued 06/28/1985
Application Received 05/13/1985
C-] Imaged Documents
Document Name Date Imaged Annotated
Original File 12/05/2007 No
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http://www.dwr.state.co.us/WellPermitSearch/View.aspx?receipt=0255321 7/11/103 1
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Company Name: I S e 151/C Phone number. 657- rho/n
Customer Name: 1--A(( (I
Address of Pumping: �( �jt J �d — /7:1 . Ij�� �
Pumping Date: 2_� 7'O
1, Tank Size:/(2(7o Gallons Pumped: /eOnn
2. Lift Station: Yes NoX If yes, functioning: Yes^No_
3. Excessive water running back into tank from field?Yea NolC
If yes, estimate in gallons:
4. Liquid level in tank over inlet line?Yes No)C
5. Tank Construction(check one)
Concrete ix. , Metal Brick Plastic or Fiberglass
Cesspool or Seepage Pit Other•
• 6. Tank Construction Observed:
One Compartment Two Compartment..
7. Inlet/outlet tees and/or baffles in good condition?Yes X No
8. Filter on outlet cleaned and inspected(if applicable)?Yes`Nox
9. Access to clean-out lids within 8 inches of grade?
Inlet: Ya NoX Outlet:Yes No k
10.20 mi.plastic replaced and sealed over tank lid (flood plain only)?Yes_Nox
11.Tank/lid structurally sound and water tight?Yes,,>C No
12.Obvious cracks/leaks observed?Yes No)
If yes, explain area:
13. Other conditions noted which may affect proper functioning of system?
N le
14.Reason thr Service:
Maintenance Real Estate Sale Emergency/Backup_Other J(
15. Notes:
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