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WRJ-t.595
COLORADO DIVISION OF WATER RESOURCES wtteE9
TYPE OR 300 Columbine Bldg., 184$ Sherman St.
•PRINT IN BLACK INK.
COPY OF ACCEPTED Denver, Colorado 80203 *1°�4��s16.As�
STATEMENT MAILED R�'�
ON REQUEST- STATE OF COLORADO SS AFFIDAVIT
COUNTY OF_ I 11410 ognek
Slates
STATEMENT OF BENEFICIAL USE OF GROUND WATER
_ AMENDMENT OF EXISTING RECORD
LATE REGISTRATION ��
Q PERMIT NUMBER Q �39/ LOCATION OF WELL, %U
tdi
1 _/ W' p ftlna
o.
THE AFFIANT(S) Lyle E SA 1t 2 / e s/ county f/L�e rV
whose mailing / / / SE h j
address is R ryy Q /js g� 8073-4/
7 Mt iv _
of the A 'G. Section
City LJ V /! e / r CJ CDI Q. (/ O / Twp / /Y _ Rng. / __ P.M
Intel (nut IN on si le newt
being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well is
72 located as described above, at distances of 11 feet from the ,4 um, section line and 4 17 feet from the
ao.tu o. soar£)
G a s section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the
day of wtl2C 4 , 119 P
9A; the maximum sustained pumping rate of the well is /0 gallons per minute, the pumping
rate claimed hereby is ye8 gallons per minute; the total depth of the well is Fhb feet; the average annual amount
• of water to be diverted is acre-feet; for which claim is hereby made for L "rye SLOG K well
purpose(s); the legal description of the land on which the water from this well is used is
of which
/+T O acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in
compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he
(they) has (have) read the statements made hereon; knows the content thereof; and that the same ore true of his (their) knowledge.
j§O�r LETS R RSE OF THIS FORM)
Signature(s) ✓/ —v�y� f� t
Subscribed and sC7s FON OFFICE USE ONLY
to before me on this _sr day of , 19_4
Court Cose No. .
My Commission expires: Su 11 /9 79
ss..: P,iot Mo. Doy yr.eit-
r”,:rr(: A."da Div Cty. 6 a
ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO
PURSUANT TO THE FOLLOWING CONDITIONS: Sec - i. _ '• A.
Well Use
G.�_ _
Dist. eosin _ Man. Des.
•
DATF STATE ENGINEER BY
__.__ . __ 2011-1317
Slw a.YZ at I ' n(f drilled by e VI - y CO, bb
Welt . Lic. No.
Rsrmanent rK� n / i { h/
• Pump installed byKl/ l e r S Je S aj,SServi ic. No. bp 6
-,Meter Serial No. ,J ❑ Flow Meter Date Installed ®G t /Iy / 774
Owner of land on which/ / f 1 / e / i h a id / e/
water is being used � � u Y) 1 f J
THEE LOCATION OF THE/WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE
AREA'ON WHICH THE WATER IS USED MUST BE SHADED OR CROSSHATCHED ON THE DIAGRAM BELOW.
This diagram represents nine (9) sections. Use the CENTER SQUARE
(one section) to indicate the location of the well, if possible.
I I I I I I I
- + — + — .+ — + — + — + -
J
1 I I - I I -i--
- + — + — .+ — + — + — + -
4 , NORTH SECTION LIf-1E ` 1
NORTH — + — +
rli in
N J 0m
(1 O I ever
z
D W
r I it
/ w
I- + - + m_ 1 + - + - *.
W jI
SOUtH SECTION LII4E
- + - + - + - + -r- + - + -
THE SCALE OF THE DIAGRAM IS TWO INCHES E+'1UALS ONE-MIL E
- + - + - 4 - + - + - + -
'1i M i I eI I ;
WATER EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covers I acre of land 1 foot deep.
1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm).
1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons.
1,000 gpm pumped continuously for one day produces 4.42 acre-feet.
100 gpm pumped continuously for one year produces 160 acre-feet.
• (WHITE AND PINK COPY TO BE FILED WITH THE STATE ENGINEER
PINK COPY WILL BE RETURNED TO OWNER)
WR126-72 - '
COLORADO DIVISION OF WATER RESOURCES , RECEIVED
THIS FORM MUST BE SUBMITTED (JJA�'p 300 Columbine Bldg., 1045 Sherman St. (toA
WITHIN 80 DAYS OF COMPLETION V Denver, Colorado 80203
OF THE WORK DESCRIBED HERE.
• �1�A717
ON.TYPE OR PRINT IN BLACK- WELL COMPLETION AND PUMP INSTALLATION REPORT 27'76
INK. C.a.—../
PERMIT NUMBER 84391 WATER REa0URCa
SINE DORM
WELL OWNER I 1e $,- Shavley NE K of the SE 'b of SOW-25
ADDRESS Stonohata, 0e2erad0 80754 T_ 10 N . R, 57 W 6 P.M.
DATE COMPLETED August 12 , 19 7. HOLE DIAMETER
was t o 7* in.from 0 to 866 ff.
Water
_From To Type and Color of Material Loc, in.from to ft.
0 10 Top ,!Oil in.from to ft.
10 15 8an4, DRILLING METHOD Rotary
15 11.5 Hardpan CASING RECORD: Plain Casing
45 95 Sapetene
95 160 Yellow sale Size 5/8 & kind Meal from 0 to 7145 ft.
160 866 Blue shale XX
Size & kind from to ft.
Size_ & kind from to ft.
Perforated Casing
Size 6448i kindctssl from 71+5 to 866 ft.
Size &kind from to ft.
•
Size & kind from to ft.
GROUTING RECORD
Material Cement
Intervals From 0 to 65 ft_
Placement Method Mixed & poured
GRAVEL PACK; Size None
Interval
TEST DATA
Date Tested August 12 , 197.€,
Static Water Level Prior to Test 162 ft
Type of Test Pump Bailer
I Length of Test 4 hours
I
Sustained Yield(Metered) 15 GPM
TOTAL DEPTH 866 ft
• Use additional pages necessary to complete log. Final Pumping Water Level 500 ft
- /.
PUMP INSTALLATION REPORT ;
He hasn't installed a l: f`,PAP yet.
:s
Pump Make -R \\
® :, f�
pelnr-`,.. �.
' Poweredby HP C* ''�
Pump Serial No. a Z _ g
. .. _ - .. `�- '`^� •• _, 31 WATER
Motor Serial No. j m TABLE
41 iJ
Date Installed _ _ _ ¢ a
W
Pump Intake Depth _ .M -4; - - -- -
Remarks - .. -. _ E :Y
O •'-'.-J: . Sa .; . ..
:- •' .o cii
i
A
C'
WELL TEST DATA WITH PERMANENT PtIMP a.
O H /`
CONE OF
Date Tested ,- 1s. DEPRESSION
F L a.'c
Static Water Level Prior to Test g
Length of Test-' ' Hours r .
•tained yield (Metered) GPM ''-
Pumping Water Level •
Remarks
► -rrr
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 he has read the statement made hereon; knows the content
thereof,and that tfesanielis:true of his own knowledge.
Signatclre ,iLr_n .ke L x o License No. 66
State of-Colarado, County of Of I rrn.,/ SS
Subscribed and sworn.to before me this a day of al.e .:ic<%L/ , 19..1.r.
My Commission Expires June 2
My Com,missidri expires: /;y �I�nt ,
• Notary-Public : -t .r , -� trr_4l/
FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must b. an original copy on both sides and signed.
WHITEAND GREEN copies must be filed with the Sato Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller.
I
lYRJ-,=74 COLORADO DIVISION OF WATER RESOURCES
101 Columbine Bldg.,1845 Sherman St.,Denver,Colorado 80203 REC�IV�D
• PERMIT APPLICATION FORM 4 L
Application must 011.43;1---t
be complete where (X )A PERMIT TO USE GROUND WATER
applicable. Type or (X7( )A PERMIT TO CONSTRUCT A WELL �� g -g
print in BLACK FOR: ('X. )A PERMIT TO INSTALL A PUMP > Era
INK.No overstrikes 14
or erasures unless ( ) REPLACEMENT FOR NO. _
initialed.
( )OTHER
1„Litille SS
7-- (1) APPLICANT-mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN /.1,,,
NAME Lyle ii,. Shap 1 ey Receipt No. 7 U 3 W'5 / tar
STREET Basin Dist.
CITY Stoneham Colorado 80754
(Sts.) - - - (ZIP) CONDITIONS OF APPROVAL
TELEPHONE NO. 735 2272 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
veld right or preclude another owner of a vested water
County right from seeking relief in a civil court action.
i'. ; ''4 of the SE 'ti,Section 25
APPBOVEO PURSUANT TO CRS 1973. 87-92-604
Twp la j, Rng. 57 _IL, 6 _ P.M. '13)(b) (II) AS ME ONLY WELL ON A
TELCT
OP 35 ACRES OR MORE DESIGNATED A3 QO
(3) WATER USE AND WELL DATA ACRES IN iVese-Se 5710- e
,
• Proposed maximum pumping rate(gpm) 15
Average annual amount of ground water APPROVED PURSUIM' TO CBS 2973, 37-320401
to be appropriated (acre-feet): 2 FOR THE WATERING OF LIVESTOCK ON A P1*
Number of acres to be irrigated: N one OR NUM' up
Proposed total depth(feet): 800 ft
Aquifer ground water is to be obtained from:
Shale
Owner's well designation Well / 1
GROUND WATER TO BE USED FOR:
( ) HOUSEHOLD USE ONLY-no irrigation (0)
( I DOMESTIC(1) ( ) INDUSTRIAL (5)
(XXLIVESTOCK (2) ( ) IRRIGATION (6)
( I COMMERCIAL (4) ( I MUNICIPAL (8)
( ) OTHER (9) APPLICATION APPROVED
PERMIT NUMBER JUN 8439
(4) PRILLER DATE ISSUED JUN 14197b
i Nib
Name Stewart Ilrylling Co EXPIRATION DATE JUN 141978
street R. .R. 1 18897 Hwy 6 3lt4c4►e
City Sterling Colorado 80751 pt, (STATE E LINE
• (Stile) (zits
p)
Telephone No. 522 14 54 Lic.No. 66 _ BY
I.D. �6/2E(/ COUNTY 6<-___
^, TEBELOW
(5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED
which the.water will be used must be indicated on the diagram below. by distances from section lines. s
Use the CENTER SECTION (1 section, 640 acres)for the well location. .?_E[s t
t + - + - +- + - -+ - + - + ? ?ai ft E4 Trf sec.line:
• , - (nwtA or mulls) _.
I 44 1 MILE.6200 FEET -1) I 44)7 ft.from Eat st or west)
set.line
+ ± + + + + ± LOT BLOCK FILING u
i I SUBDIVISION
+ —
+ — 1 NORTH SE TION LINE - ± - ±
(1) TRACT ON WHICH WELL WILL BE
I I I I LOCATED owner Lyle Shapley
NORTH
{- }- z - -{- - + ± No.of acres 160 .Will this be
0 I I m t the only well on this tract? YI s
+ 1 ± a 4- - +
(8) PROPOSED CASING PROGRAM
019
I 6 I I X r 1 Plain Casing
z 1
+ + - - - + f 5 in.from 0 ft.to 700 ft.
I I I
in.from ft.to ft.
_fit- casing
it- — -f- — SOUTH SECT] lI — _4_ —
I I I I 5 in.from 700 ft.to 800 ft.
+ + + + -I- -I- -I- -I- -I- in.from ft.to ft.
I I I I (9) FOR REPLACEMENT WELLS givedistance
� + - + and direction from old well and plans for plugging
-) - ' '-
- - -I- — 4— - +- - + it:
The scale of the diagram is 2 inches= 1 mile
• Each small square represents 40 acres.
WATER EQUIVALENTS TABLE (Rounded Figures)
,Prt acre-foot covers 1 acre of land 1 foot deep
—
1 cubic foot per second(cfs)...449 gallons per minute 19Pm)
IA land ly of 5 will require approximately 1 acre•foot of water per year.
1 acre-foot...43,560 cubic hat...326,900 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): Lyle Shapley No.of acres: 160
Legal description: PTE . SEz. Sec 25, ION, 57w, A Pl.,, 1'tald t'CMntVr Colorado -
(11) DETAILED DESCRIPTION of the use of ground Water:Household use and domestic wells must indicote type of disposal system
to be used.
T,iveetnrk wP1]
(12) OTHER WATER RIGHTS used on this land, including wells.
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 KNOWLEDGE.
SIGNATURE APPLICANT(SI
re#7----"-
•
Use additional sheets of paper if more space is required.
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