HomeMy WebLinkAbout961604.tiff � :rti :��
� Zot�-7S 566 �� STATE OF COLORADO � YY � �
AUG 2 4J DIVISION OF WATER RESOURCES ��'
Index No. 259 / OFFICE OF THE STATE ENGINEER APR26196z
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Use IDWD 1-1--
MAP AND STATEMENT FOR WATER WELL FILING
Registeredq 2 667 -
i PERMIT NUMBER 30531 .
Know all men by these presents: That the undersigned Vantage Arras
claimant(s), whose address is 6301 West Is!it h , City Whantri Age ,Colo 90033
states: Claimant(s) is (are) the owner(s) of well No. 30511 located as shown on the map below; the
total number of acres of land owned by him (them) to be irrigated from this well is --_— ; worl
was commenced on this well by actual construction 19th day of April 19 ; the
tested capacity of said well is 20 (gpm) (cfs), for which claim is hereby made for dnineati c
purposes; that the average annual amount of water to be diverted is ---- acre-ft. ; and that the
aforethentioned statements are made and this map and statement are filed in compliance with the law.
j State of Colorado -7,,e—es-s-
) ///� .-+- /J, I
i County of ) ss Claims (s)
Subscribed and sworn before me this day of , 19
I
My Commission expires
Notary Public
MAP
THE WELL SHALL BE LOCATED WITH REFERENCE TO GOVERNMENT SURVEY CORNERS OR
MONUMENTS, OR SECTION LINES BY DISTANCE AND BEARING.
- feet from (North or South) section line
feet from (East or West) section line
IF WELL IS FOR IRRIGATION, THE AREA TO BE IRRIGATED MUST BE SHADED OR CROSS-
HATCHED.
The square below will be used to indicate the location of the well and the irrigated land.
I I I I I
I I I l
I I I I 1 WELL LOCATION
- - - t - - F - - r - - r r - 62
I I ' I I Weld Coun
1 I s I 1
I I 1 I I NW 1/4 SW 1/4, sec. 17
I' I 1 I I
- - - T — — I- — — r - — — — — T - - - - - r — —- T. 1N , R. A5w . , A P. M
I t I ; I 4- - Ground Water Basin
s I i t i Water Management
s I s s I District
- - — T - - I' r T - - - r - --
e I e e s Domestic wells may be located by the
_ - -1— I_ --t-- I _--1--. 1 mi. BLOCK following: LOT 10 ,
i I i i i VAWPAfR ACRPS SUBDIVISIC
- - - + - - � - - + - - - - ' - - r - - + "i I i ' I i 6301 West 4th
i I i ' i Wheatridge, Colo. 80033
r I I 1 I i I •C--•
ACCEPTED FOR FILING IN THE OFFICE OF THE STALE ENGINEER HIS
DAY OF , 1 961604
State Eng4eer
ell
J-5-66 �
ATE OF COLORADO iJu !r_!2 nr'��rr
• / / A PERMIT TO USE GROUND WATER Jtl —
IS
APPLICATION FOR: fl A PERMIT TO CONSTRUCT A WELL AP"
1 �
/ / OTHER iii
Application must be completed satisfactorily before acceptance " '$i
qq77
,iJii�i()0
PRINT OR TYPE LOCATION OF WELLAIL NEED
61-
APPLICANT Vantngs ACTes COUNTY Weld
Street Address 6101 West With NW It SW k, sec. 17
:ity & State Wheatridge . Colo. 80011 T. 7N , R. AAW , 6 P.M.
Jse of ground water domestic Ground Water Basin
Owner of land on which well Water Management
is located Pittman District
Number of
acres to be irrigated ---- IISF DIAGRAM ON THE BACK OF THIS SHEET TO
_egal description of LOCATE WELL.
irrigated land ----
)ther water rights on
this land -_-- Driller Holden & Holden No. 1
Dwner of irrigated Driller's
land ---- Address Hudson, Colored() 806!.2
Aquifer(s) ground water is to be obtained
from surface // , aiwe. 7 r; /V-c< G `
ESTIMATED WELL DATA 1 Signature 4f Applicant
st. quantity of ground water to be claimed: CONDITIONS OF APPROVAL
Est. Max. Yield PO GPM or CFS
Est. average annual amount to be
used in acre-feet --
Storage capacity __ AF
Anticipated start of drilling 4-19 1967
Hole Diameter:
9" in. from 0 ft. to 75 ft.
in. from ft. to ft.
Casing:
Plain Ko in. from 0 ft. to 55 ft.
in. from ft. to ft.
Perf• r4_in. from K5 ft. to 75 ft.
in. from ft. to ft.
PUMP DATA: Outlet '
Type submergthe HP 1/LL Size 1* 9616°4
This application approved This application approved
PERMIT NUMBER 211521 CONDITIONAL PERMIT NO.
APR Z 0 (Permit good for one (1) year after date
DATE ISSUED 1967 of issuance)
QDATE ISSUED
*d�
State Engineer
Chairman Ground Water Commission
s.
by ' by
in,..n
•
LOG AND HISTORY
WELL LOG WELL DATA
Ground Elevation Date Started 1 -l9-67
Type Drilling Ro+ara Date Completed 4-19-67
Water Hole Diameter:
From To Type of Material Loc. Perf. 9 in. from 0 ft. to 7c ft
in. from ft. to ft.
in. from ft. to ft.
1 6 Sand CASING RECORD
6 314. Clay Cemented from grnwal pack
34 14.1 Gravel Plain Casing
41 43 Clay Size sl., kindctAPTrom fl ft. to_55._ ft
43 57 Gravel
57 60 Clay Size_, kind from_ft. to ft
60 66 Gael
66 68 Clay Size—, kind from_ft. to ft
68 75 Shale
Perforated Casing
Sizes , kind_galtfrom_55 ft. to m_ ft
Size—, kind_from— ft. to ft
• Size_, kind_from_ft. to ft
TEST DATA
Date Tested 4-19-67
Type of Pump ciihmergi hl A
Length of Test hailed rot, P hrs_
Constant Yield 20 gr.,
Drawdown 3tI
PUMP DATA (To be filled in)
Type of Pump snhmergi hl A
Outlet Size 1 A
Driven by Pl erf:ri r
Horsepower 1/4
Use additional paper if necessary to complete
log and attach. DEPTH TO WATER
WELL DRILLERS STATEMENTT0TAL DEPTH 7A'
State of Colorado ) ss
County of
Holden Pr An-hint) being duly sworn, deposes an
says: he is the driller of the above described well; he has read the above map and statement, knows th
content thereof, and the same is true of his own knowledge.
License No. 1 —
Subscribed and sworn to before me this day of , 19—
My Commission expires , 19_.
Notary Public 961694
FORM TO BE MADE OUT IN QUADRUPLICATE:
Original WHITE (both sides) G Triplicate GREEN Copy must be filed with the State Engineer within 30-days after well is completed.
Duplicate PINK copy is for the Owner G YELLOW copy for the Driller. WHITE FORM MUST BE AN ORIGINAL COPY ON BOTH
SIDES AND SIGNED.
GLOVER'S DRILLING - -
7261 Weld Co. Rd. 31 3 7 6 4
FT. LUPTON, COLORADO 80621
ROE DATE aORDER
(303) 857-2041 ORDER TAKEN BY WBTOa6B ODDER MEADER
-''y,,, Z,2 g.
TO A � ❑DAY WORK ❑CONTRACT ❑EXTRA
� j qr C t. A/JLt�i.9'R. . J .roerw.fiMw�eel
•1 !� .JOB LOOAndf
Joe mow
QTir /9P'
TERMS:
OTY. MATERIAL PRICE AMOUNT DESCRIPTION OF WORK
■ , 1_ ._ t'. 754cre
)o chat. *As, tor- 004,1 ■
/.i LAAA. lJoN< G ovc
?woe e
/hit /.t/, AI/ce-,aSv $ 49d ■ jA.v
WELL TEST DATA WITH PERMANENT PUMP •
Date Tested pee /9 /99a-
Static Water Level Prior /to Test ■ OTHER CHARGES
Length of Test of / Hours ■ -
tained yield (Metered) /S GPM ■
Pumping Water Level ■Remarks AE/e y— ,,-,firs Alit s- ■
// ■ TOTAL OTHER
OU-r, k i/V y 64./d W e%L ��ro pva,tc2( ■ LABOR HRS. RATE AMOUNT
/ 5gif4h.s,vs /acs 7-y, 3.5
/Nafe .
■■-■ TOTAL LABOR
DATE COMPLETED TOTAL MATERIALS ) TOTAL MATERIALS
TOTAL OTHER
Work ordered by ---���/}}yyy pp n a
C� tt/„__t{,, /�� TAX
Signature L�J{Y'ttWWlI1IVV TOTALI hereby acknowledge the satisfactory completion of the above described work. 35 PI
961G P4
4)
THE LOCATION OF THE PROPOSED WELL SHALL BE SHOWN ON THE DIAGRAM BELOW. THE LOCATION
WILL BE INDICATED BY THE DISTANCES FROM THE SECTION LINES, OR THE DISTANCE AND BEAR-
ING FROM GOVERNMENT SURVEY CORNERS OR MONUMENTS.
IF WELL IS FOR IRRIGATION, THE AREA TO BE IRRIGATED MUST BE SHADED OR CROSS-HATCHED.
Domestic wells may be located by the following:
Lot 6 FBy�lockg No. 3 Street Address 6301 W s th
or
Ventage Acres City Whpa dgm, Cnln. R0033
Subdivision
The diagram represents nine (9) sections. Use the center square (section) to indicate
the location of the well .
4
A
X "1
__L
•
THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE-MILE
9616(14
SiAMDARD BACTERIOLOGICAL WATER TEST
1�/fVim+ l` Iu VELD COUNTY HEALTH DEPARTMENT. 1517 167E ►YENS COORS V� ^
GULLET. COIDRADO 50631, PROMS: 353-0635
i 1 RFtIi17s
l�, y f/-1
Suple Taken: Wte 1:`��p, Tiaest Supplyf I7(�'� I ' �/ Haabfane Filter: Colifore/100.1 le
\ XI V & ALL. ,i1''! lCAO
Street MO[ess County Direct Verified — Adjusted
ri
‘)(14
` J(
Sampler x(!1'.4 �i� � pp. Pseutlmnes aesusineu 0 CO
Free Chlorine
Residual Staphylococcus aureate
Type of Supply Source Type of Sample/Test:
( ) Community ( ) Surface ( ) Routine ( ) Pool ilea:[ required due to =
( ) Non-Community ) Well ) Recheck ( ) Whirlpool ""
(.Private (Z' ( Request ( )
( ) ( Contract t
1� l_ it 1f` SASSING AREA CI®QSTAT «„
Return Report To: Mae `jCt VV` 4;.0(r71A,.)r 1I !t7:- pH --a
Address Free Chlorine ipp.
e 5-
City State Zip Total Chlorine —Pp.
Date Raced
Specimen Nab.rS..)S2 Total Alkalanity
Date Tested See reverse for collection instructions/definitions Other
Date Reported
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