HomeMy WebLinkAbout20041080.tiff Form No. OFFICE OF THE S I ATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203
(303)866-3581
WELL PERMIT NUMBER 252773 -
APPLICANT DIV. 1 WD 1 DES. BASIN MD
,
•
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 NW 1/4 Section 28
CAREERS WORLD WIDE Township 2 N Range 64 W Sixth P.M.
9791 BRIGHTON RD UNIT B DISTANCES FROM SECTION LINES
HENDERSON, CO 80640- 330 Ft.from North Section Line
1245 Ft.from West Section Line
(303)227-1309 UTM COORDINATES
CHANGE/EXPANSION OF USE OF AN EXISTING WELL Northing:4440509 Easting: 537437
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 assure the applicant 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) 4e 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)(I)and the policy of the State Engineer dated 4/23/86 under the following
conditions.
..) Approved for the use of an existing well constructed under permit no.206879. Issuance of this permit hereby cancels
permit no.206879.
5) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-602(1)(c),
for a commercial business related to training people in the operation of tractor trailers and heavy equipment. Water from
this well shall not be used for lawn or landscape irrigation or for any other purpose outside the business building
structure.
6) Production from this well is restricted to the Laramie-Fox Hills aquifer.
7) The maximum pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed 1/3 acre-foot(108,600 gallons).
9) Approved as the only well on a tract of land of 40 acre(s)described as part of the NW 1/4 of Section 28,Twp.2 North, Rng.
64 West, 6th P.M.,Weld County, reference attached exhibit"A".
10) 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less than 2%of the total amount of water withdrawn is returned to the same stream system in which the well is located.
11) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all
diversions must be maintained by the well owner(recorded at least annually)and submitted to the Division Engineer upon
request.
12) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE:To ensure a maximum productive life of this well,perforated casing should be set through the entire producing
interval of the approved zone or aquifer indicated above. J141C0 q'g/o3
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APPROVED j� r K
JMW
State Engine - By 111.4
Receipt No.0512364 DATE ISSUED 09-08-2003 XPI; TIC' "-
2004-1080
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER of cot
Division of Water Resource
a� of
Department of Natural Resources Sr7r tpl
1313 Sherman Street, Room 818
Denver,Colorado 80203 +ie,a ._
Phone (3031866-3581 —FAX 1303. 866-3589
Tuesday, June 24, 2002, Go ernens
www.watecstate.co.us Governor CAREERS WORLD WIDE CHECK# Greg E.Watcher
Executive Director
CIO TERRY DOUGLASS Hal a Simpson,RE.
State Engineer
9791 BRIGHTON RD UNIT B DIV: CNTY: LOCATION:
HENDERSON CO 80640 1 62 S28 T2N R64W
•
REQUEST FOR WELL PERMIT APPLICATIONS, FEES AND RELATED DOCUMENTS
TO AVOID ADDITIONAL DELAYS, PLEASE REVIEW YOUR APPLICATION(S)TO ASSURE THAT ALL ITEMS ARE
COMPLETE AND CORRECT. INCOMPLETE APPLICATIONS CANNOT BE FULLY EVALUATED AND WILL BE RETURNED
FOR CORRECTION
We are returning the attached document(s) and your remittance, if included, since the material(s)cannot be
processed without receiving the proper documents and/or the correct fee.
• Applications for Well Permit- $440 each
Applications to Register and Replace an existing Unpermitted Well - $440 each
Ei Applications to Replace an Existing Permitted Exempt Well - $200 each
LI Applications to Replace an Existing Permitted Non-Exempt Well Permit- $200 each
• Non-Exempt Correction of Location - $ 150 each
Exempt Correction of Location - $150 each
Monitoring Well Applications - $150 each
❑ Application to Register an Existing Well - $300 each
• Request for Extension of a Non-Exempt Well Permit - $200 each
❑ Late Filing Fee for Filing a Statement of Beneficial Use or Notice of Well Completion - $30 each
• Other type of Application
CHANGE IN USE. EFFECTIVE AS OF JULY 1, 2003 OUR PERMIT TOTAL DUE= $440.00
FEES WILL GO UP TO $480.00.
• f From ARLENE D. BOONE
Please make your check payable to the State Engineer and submit these documents with the required filing fee.
IF YOU HAVE QUESTIONS CONCERNING THIS MATTER, PLEASE CALL THE GROUND WATER INFORMATION DESK OF
- THIS OFFICE AT(303)866-3587.
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Brighton,CO 80601
CAREERS WORLD WIDE 82-7036 3070 83.
9791 BRIGHTON RD UNIT 6 303-227-1309
HENDERSON, CC 80640 6/26/2003
SAY TO THt
ORDER JF STA1E ENGLNNEER $ **440.00
Four Hundred Forty and 00/100*************************************************************************,,****** . .
DOLLAR
STATE ENGLNNEER
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STATE ENGINNEER 6/26/2003
440.00
CAREERS WORLD WID 440.00
Form No. OFFICE OF THC'TATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
8'9 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 886.3581
1207
WELL PERMIT NUMBER 206879
APPLICANT DIV. 1 CNTY. 62 WD 1 DES. BASIN MD
Lot: Block: Filing: Subdiv:
APPROVED WELL LOCATION
WELD COUNTY
MARTY L CUTLER NW 1/4 NW 1/4 Section 28
BOX 782 Twp 2 N RANGE 64 W 6th P.M.
BENNETT CO 80102-
DISTANCES FROM SECTION LINES
(303)644-3730 330 Ft. from North Section Line
1245 Ft. from West Section Line
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDMONS 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 the permit does
not assure the applicant 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 acres described as part of the NW 7,
of Section 28, Twp. 2 North, Rng. 64 West, 6th P.M.,Weld County, being more particularly described on the attached Exhibit A.
4) The un-permitted shallow, pvc pipe well, not currently in use on the tract, must be plugged and sealed according to the Water
Well Construction Rules within ninety (90) days of completion of this well. The enclosed Well Abandonment Report form must
be completed and submitted to affirm that the old well was properly plugged and sealed.
5) The use of ground water from this well is limited to ordinary household purposes inside not more than three single family
dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches, and the irrigation of not
over one acre of home gardens and lawns.
6) Production from this well is restricted to the Laramie-Fox Hills aquifer which corresponds to the interval between 590 feet anc 910
feet below ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
7) The maximum pumping rate shall not exceed 15 GPM.
8) The return flow from the use of the well must be through an individuai 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.
9) This wel! shall be constructed not more than 200 feet from the location specified on this permit.
Note: To insure a maximum productive life of this well, perforated casing should be set through the entire producing
interval of the approved zone or aquifer indicated above.
Note: The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be less
than the 100 years upon which the amount of water in the aquifer is allocated, due to anticipated water level
decline ?-7 /2/z/5 7
OWNER'S copy
-has%
APPROVED
JSGY
tote Englner DEC 0 5 1997 BY DEC 0 5 1999
Receipt No. 0422390 DATE ISSUED EXPIRATION DATE
FORM Not PUMP INSTAL .T1ON AND TEST REPORT For Office Use only
ewsn
iota. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1. WELL PERMIT NUMBER 206879
2. OWNER NAME(S) MARTY L. CUTLER
Mailing Address P.O. BOX 782
City, St. Zip BENNETT, CO 80102
Phone (303 ) 644-3730
3. WELL LOCATION AS DRILLED: NW 1/4 NW 1/4, Sec. 28 Twp_ 2 NORTH , Range 64WEST
DISTANCES FROM SEC. LINES:
330 ft. from NORTH Sec. line. and 1245 ft. from WEST Sec. line.
(norm or sown) teas!or wes)
SUBDIVISION: LOT_BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION: •
4. PUMP DATA: Type GOULDS SUBMERSIBLE Installation Completed 01-22-98
Pump Manufacturer GOULDS Pump Model No. 10GS2 .
Design GPM 13 at RPM 3450 , HP 2 , Volts 230 , Full Load Amps 11-13 .
Pump Intake Depth 480 Feet. Drop/Column Pipe Size 1 Inches, Kind P.V.C.
ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM:
TURBINE DRIVER TYPE: C Electric ❑Engine ❑Other .
Design Head feet, Number of Stages , Shaft size inches.
5. OTHER EQUIPMENT: rr��
Airline Installed El Yes❑No, Orifice Depth ft. . Monitor Tube Installed u Yes❑No, Depth ft.
Flow Meter Mfg. r— Meter Serial No. .
Meter Readout ICE Gallons,Gallons, Thousand Gallons,CIAcre feet, ❑Beginning Reading .
6. TEST DATA: ❑Check box if Test data is submitted on Supplemental Form.
Date 1-22-98 1-22-98
Total Well Depth 750 lime 1:00 P.M. 3:00 P.M.
Static Level 280 Rate (GPM) 15 15
Date Measured 1-22-98 Pumping LW. 360 360
7. DISINFECTION: Type 14TH Amt. Used 20 OZ.
8. Water Quality analysis available.❑Yes IX No
9. Remarks _
10. I have read the statements made herein and know the contents thereof, and that they are true to my knowledgi
[Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the secon
degree and is punishable as a class 1 misdemeanor.]
CONTRACTOR A.GREGORY DREILING Phone (970 ) 867-7160 tic. No. 1207 .
Mailing Address 14473 M.C.R. R FORT N]QRGAN. 0701
Name/Title (Please type or print) Sign re A' i Date
A.GREGORY DREILINMONTRACTOR X l // �j �" � ' 03-18-98
, t -t , /
WELL CONSTRUCTION AND PuMP INSTALLATION BY THE WELL OWNER
You may construct the well and/or install the pump yourself if the well is for your own use, is on property
you own, and is constructed or pumping equipment is installed with equipment owned and operated by you. It is
your responsibility to complete and submit the Well Construction and Test Report, Form Number GWS-31 and/or
^ the Pump Installation and Test Report, Form Number GWS-32. These forms are available from our offices. The
well must be constructed and the pump installed in accordance with the well construction standards of the State
Board of Examiners of Water Well Construction and Pump Installation Contractors.
The Water Well Construction Rules are available from Division of Water Resources offices for a fee of $5.00.
The Rules cover the minimum requirements for well construction, pump installation, disinfection, plugging and
sealing and include contractor licensing regulations. If you are constructing your own well or installing pumping
equipment, it is recommended that you obtain a copy of these Rules for reference.
RULE 12 WELL TESTING
12.1 General -The provisions of this rule establish minimum standards for the testing of water wells. Every
well constructed for the purpose of producing ground water shall be tested to determine:
a. a stabilized yield for the well; and
b. the production rate of the equipment installed when the well is placed into service.
12.2 Well Yield Test - The yield of a well shall be determined as a stabilized production rate where the
withdrawal rate and the drawdown do not change by more than 10 % during the last hour of the test. The test
shall demonstrate that either:
a. the well is capable of producing the permitted pumping rate for the well; or
b. that the maximum yield of the well is less than the permitted production rate.
12.3 Responsibility for Well Yield Test - Well construction contractors are responsible for performing the
well yield test and submitting the test data to the State Engineer. If the construction contractor also installs the
production equipment, the well yield test may be combined with the production equipment test, provided that the
test meets the requirements of Rule 12.2. The construction contractor may forgo the well yield test if he can show
that a licensed pump installer will perform the well yield test with the permanent production equipment within thirty
(30) days of completion of construction of the well. If the pump installation contractor performs the well yield test,
he/she shall submit the test information on the Pump Installation and Test Report.
12.4 Production Equipment Test - The production equipment installed in wells shall be tested to ensure it
is functioning as designed. The test shall demonstrate the production capacity of the equipment as actually
installed in the well. It is the responsibility of the person installing the pumping system to ensure that the
production from the well complies with the conditions of the permit.
12.5 Responsibility for Production Equipment Test - Pump installation contractors are responsible for
testing the production equipment installed in a well upon completion of their work. If the well construction
contractor determined the well yield and submitted a report, the pump installer need not perform another well
yield test. If the pump installer does not perform a well yield test with the permanent production equipment, he
shall perform a production equipment test and report the data (results) to the State Engineer on the Pump
Installation and Test Report.
Wells to be plugged and sealed must be plugged in accordance with of the Water Well Construction
Rules. A Well Abandonment Report, form number GWS-9 must be submitted to confirm plugging and sealing of
the well. This form is available from our offices. The general Rule for plugging and sealing wells is printed below.
The specific rules are found on the reverse side of the Well Abandonment Report form.
RULE 16 STANDARDS FOR PLUGGING AND SEALING WELLS AND WELL EXCAVATIONS
16.1 General - The plugging, sealing and abandonment of all wells, monitoring and observation wells,
monitoring and observation holes and test holes that are no longer intended for use, and the plugging, sealing,
and abandonment of dry holes, collapsed or unusable boreholes, and other incomplete wells or excavations is
necessary to prevent contamination of ground water and the migration of water through the borehole. It is the
ultimate responsibility of the well owner to have an existing well properly plugged, sealed and abandoned. The
well construction contractor or authorized individual is responsible for notifying the well owner in writing of these
plugging requirements.
COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST(1/2001)
DEPARTMENT OF NATURAL RESOURCES
GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS
Applications must be completed legibly, in BLACK INK. ALL ITEMS in the application must be completed. Incomplete
applications may be returned to the applicant for more information. Applications are evaluated in chronological order.
Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer
generation. Reproductions must retain margins and print quality of the original form.
FEES: This application must be submitted with a $60 filing fee. (An exception is a $20 fee for an application to replace
or deepen an existing permitted small-capacity commercial or exempt commercial well, if completed in the same aquifer.)
Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources, and Visa or
MasterCard (card number and expiration date must be provided on a separate attachment). Fees are nonrefundable.
USES: This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot,
geothermal, recovery wells, and other uses not otherwise noted in the following list:
RESIDENTIAL use wells—Use of form GWS-44 is required
LIVESTOCK watering on a farm, ranch, range or pasture (not feedlots)—Use form GWS-44
MONITORING/OBSERVATION wells—Use form GWS-46
GRAVEL PITS—Use form GWS-27
REGISTRATION of an existing well—Use form GWS-12(must have been in use prior to May 8, 1972)
ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form)
1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address
where all correspondence will be sent.
2. Check all boxes that apply.
3. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin
determination of water right, the case number or determination number must be indicated. If applying to replace or
change the use of an existing well,the permit number of the existing well must be indicated.
4. The county, Y. of the ''% section designation, section #, township, range, principal meridian, and distances from section
lines for the proposed well must be provided. (An option to providing distances from section lines and the 'A of the Y,
section designation is to provide an accurate GPS location in UTM format. The required GPS unit settings must be as
indicated on this form.)
5. Complete all boxes and provide a complete legal description of the parcel of land on which the well will be located.
6. Check all boxes that apply and attach a detailed description of the uses applied for.
7. Complete all boxes.
8. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will
be used. If agricultural irrigation is a proposed use, provide a map of the land area with proposed irrigated areas
accurately drawn, including section numbers and section lines. A list of all other wells or water rights used on the
described land must be provided.
9. The well must be constructed by a Colorado licensed well driller, an authorized individual in accordance with the Water
Well Construction Rules,2 CCR 402-2,or under the"private driller"provision as defined in CRS 37-91-102(12).
10. An ORIGINAL signature must be on the application. The individual signing the application must be the applicant or an
officer of the corporation/company/agency identified as the applicant. An authorized agent may sign the application, if a
letter signed by the applicant is submitted with the application authorizing that agent to sign on the applicant's behalf.
IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources
Ground Water Information Desk (303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley
..—. (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683), Montrose (970-249-6622), Glenwood Springs (970-945-
5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to our web site at http://www.water.state.co.us
for general information,additional forms,and access to state rules or statutes.
Form
No. GWS-7 EXEMPT PERMIT INFORMATION SHEET
03/02 STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-3581 Fax (303) 866-3589
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-92-602
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully read the conditions of approval on your well permit. The conditions and the information on this
information sheet must be complied with in order for the permit to remain valid.
THE PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. The well must be constructed and
evidence of it's construction must be received by this office in the form of a Well Construction and Test report from
the well construction contractor confirming that the well was constructed prior to expiration of the well permit. The
well permit number is located in the upper right hand corner of the permit, and the expiration date is located in the
lower right hand corner. The expiration date of the permit may be extended one year at a time at the discretion of
the State Engineer for good cause shown. If an extension of time is necessary to construct the well, a written
request for the extension of time must be received by this office prior to the expiration date of the well
permit. In the request, you must provide the well permit number, your name and mailing address and the
reasons why the well has not been constructed and when it will be constructed. No fee is required for this
type of permit extension.
Water well construction and pump installation contractors are specifically licensed in Colorado to perform these
specialized tasks. It is illegal for contractors who do not hold these licenses to construct wells and/or install pumping
equipment in or on wells. The well must be constructed and the pump installed by contractors with current license(s)
issued by the State of Colorado unless exempted as described on the reverse side. Please ask to see their
license(s). Backhoe Operators and Licensed Plumbers may or may not hold the respective Well Construction and/or
Pump Installation licenses. Please be aware of this when you contract to construct the well and install pumping
equipment. The well construction report including a test of the well yield must be submitted to the office of the State
Engineer within sixty (60) days of completion of the work or within seven days after expiration of the permit,
whichever is earlier. The pump installation report including a pumping system test must be submitted within sixty
(60) days of completion of the work. The contractor(s) must provide you with a copy of the work report(s) filed with
the State Engineer. The Well Construction and Test Report, Form Number GWS-31 and the Pump Installation and
Test Report, Form Number GWS-32 are available from the Division of Water Resources offices. Additional
information regarding well construction, pump installation, required testing and well plugging and sealing regulations
are found on the reverse side of this sheet.
You have been provided with at least two copies of the well permit. Keep a copy for your records. There is
also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller
license number on the application, or two additional copies have been enclosed. You may make additional copies
for the well construction contractor if you select one different from the one indicated in your application.
The original permit is on file in the Denver office Records Section. Copies may be obtained for a fee of 50 cents per
page. Statutes require that any change of mailing address or ownership be reported to the State Engineer. Form
number GWS-11 is used both by new owners to report ownership changes and current owners to report address
changes.
If you have questions, contact the Denver Office, or the Division Office in the area where your well is located.
Division 1 Division 2 Division 3 Division 4
810 9`" St. 2n°Floor 310 E.Abriendo Ave Ste B 422 4th St 1540 E. Niagara
Greeley, CO 80631 Pueblo, CO 81004 Alamosa, CO 81101 Montrose, CO 81402
(970)352-8712 (719) 542-3368 (719)589-6683 (970)249-6622
Fax(970) 391-1816 Fax(719)544-0800 Fax(719)589-6685 Fax(970)249-8728
Division 5 Division 6 Division 7 Denver Office
Direct mail to Box 396 Direct mail to Box 773450 701 Camino Del Rio Ste. 1313 Sherman St. Rm. 818
Glenwood Spgs CO 81602 505 Anglers Dr. Suite 101 205 Denver, CO 80203
50633 U.S. Hwy 6& 24 Steamboat Spgs, CO Durango, CO 81301 (303) 866-3581
Glenwood Spgs., CO 81601 80477 (970)247-1845 Fax(303)866-3589
(970) 945-5665 (970)879-0272 Fax(970)866-5417
Fax(970) 945-8741 Call first Fax (970)879-1070
GINS-31 WELL CONS...(JC flON AND TEST REPORT For Crllce Use only
Ions STATE OF COLORADO, OFFICE OF THE STATE ENGINES
1. WELL PERMIT NUMBER 206879
2. OWNER NAME(S) MARTY L. CUTLER
Mailing Address P.O. BOX 782
City, St Zp SENNETT._CO 89102
Phone ( 303 ) 644-3730
a WELL LOCATION AS DRILLED: NW 1/4 NW 1/4, Sec. 28 Twp. 2 NORTH , Range 64WFST
DISTANCES FROM SEC. LINES:
330 It from NORTH Sec. line. and 1245 ft tram WEST Sec. line. OR
norm or soumi
SUBDIVISION: LOT BLOCK F1UNG(UNI7)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft DRILLING METHOD MUD ROTARY
DATE COMPEL g L:j 01-21-98 . TOTAL DEPTH 750 ft. DEPTH COMPLETED 750 fi.
5. GEOLOGIC LOG: 5. HOLE DIAM. (In.) From (ft) To (ft)
Depth Description of Mate crypt Sze. Color,Water Location) 8 0 750
000-005 TOPSOIL
005-010 SANDY CLAY
010-047 GREY CLAY/VV/RUSTY STRFAKS 7. PLAIN CASING
047-605 GREY SHALE OD (in) Kind Wall Size From(ft) Tc(ft)
605-750 SANDSTONE STREAKS AND SHALE LAM.4-1/2 STEEL 188
PERF. CASING: Screen Slot Size: .030
4-1/2 STEEL .188 - 628 750
8. FILTER PACK 9. PACKER PLACEMENT:
Material SILICA Type
Size 10-12
Interval 540'-750' Depth
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: CEMENT20/SACK6/GAL. 540'UP TREMIE LINE
PUMPED
11. DISINFECTION: Type HTH Amt Used 20 OZ.
12. WELL TEST DATA: ❑Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test
TESTING METHOD AIRLIFT
Static Level 280 ft Date/Time measured 1-21-98 9:00 A.M. , Production Rate 25 gpm.
Pumping level 1R0 ft. DateTme mpas,tred 1-21-98 11:00 A.M. .Test length (In) 2
Remarks
la I have read the stoma-ft made heroin and know the contents thereof, and that they am true to my knowledge.[Pursuant to Section 244-164(13)(ai
CAS..the making at false statement herein constitutes perjury in the second degree and is punishable as a dass 1 miademeanor.l
CONTRACTOR A.GREGORY DREILING Phone .970) 867-7160 Lic. No. 1207 .
M in A d 14473 M.C.R. CO 80701
Name/ride (Please type or print) Sign re / Date
A.GREGORY DREILINCONTRACTOR X (/ . 03-18-98
Colorado Division of Water Resources
1313 Sherman St.Rm.818
Denver,CO 80203
1303)866-3581
http://water.state.co.usidefauk.htm
GUIDELINES FOR COMMERICAL DRINKING AND SANITARY WELLS OUTSIDE A DESIGNATED GROUNDWATER BASIN
For all commercial drinking and sanitary wells :
1. The use of the water diverted is limited to drinking and sanitary facilities only in an individual commercial business. No uses
outside of the building would be permitted.
2. The pumping rate shall not exceed 15 gallons per minute.
3. The return flow from the use of the water must be discharged to the same stream system in a location so as to not injure any
vested water right.
In addition:
For commercial wells put to beneficial use for drinking and sanitary purposes on and after May 8. 1972:
4. The proposed well must be the only source of water for the property. No other water supply source or system can be available
to serve the property. An affidavit by the applicant affirming this situation must accompany the application. In addition, for
property located within the boundaries of a water supplier, an affidavit from the supplier affirming that the property cannot be
or will not be supplied water by that entity, must also be submitted with the permit application.
5. The well must be the only well on the site.
6. The parcel on which the well would be located, must be:
la) Thirty-five 135) acres or more in size. A legal description, in the form of a metes and bounds description or a
surveyor's map of the parcel must accompany the permit application.
•
lb) If less than 35 acres, the parcel must have been established prior to June 1, 1972 or must be exempt from the
definition of a subdivision pursuant to Section 30-28-101(10)(c) and (d), C.R.S. A copy of a deed describing the
parcel and dated before June 1, 1972, or a copy of the signed county resolution exempting the parcel, must
accompany the permit application.
For lots in subdivisions approved on and after June 1, 1972, the recommendations made by this office in the water
supply review process will be honored.
7. The amount of ground water diverted shall not exceed 1/3 acre-foot annually (108,600 gallons). The applicant must support
the application with evidence that the proposed use will not create a demand greater than 1/3 acre-foot.
8. The consumptive use of the water shall not exceed 10% of the volume of ground water diverted. An approved septic tank and
non-evaporative leach field is an acceptable discharge method. Other types of disposal systems must be evaluated to
determine the amount and location of the return flow.
9. A totalizing flow meter must be installed on the well. Permanent annual diversion records must be maintained by the well
owner and submitted to the Division of Water Resources annually or upon request.
For existing commercial wells put to beneficial use for drinking and sanitary purposes prior to May 8, 1972:
4. The well must be the only commercial well serving the business.
5. The amount of ground water diverted shall not exceed one (1) acre-foot annually (325,900 gallons). The applicant must
support the application with evidence that the proposed use will not create a demand greater that one (1) acre-foot.
6. The claimed date and use must be supported by a written field inspection report prepared by personnel from the State
Engineer's Office.
7. A totalizing flow meter may be required to be installed on the well, and permanent annual diversion records be maintained by
the well owner and submitted to the Division of Water Resources annually or upon request.
CONDITIONS STATEWIDE VARY- MEETING THE ABOVE CONDITIONS DOES NOT GUARANTEE THE ISSUANCE OF A PERMIT
^
GWS-57
11/99
aI SEWAGE DISPOSAL SYSTEM LOAN INSPECTION REPORT
•
Domestic Water Consultants, Inc.
3031 West 133rd Ave. • Broomfield. CO 80021 • 303.465.0806 • 303 423 6149 • Fax 303.423.5918
PRESENT OWNER Mary L. Cutler
:1AILING ADDRESS P.O.Box 782 Bennett ._ Colo. 80102
ADDRESS OF PROPERTY TO BE INSPECTED 26216 Weld Co. Rd. 1118 Keenesburq,CO.
COUNTY Weld STATE OF COLORADO
LEGAL DESCRIPTION : NW a OF THE NW a OF SEC. 28 TWP. 2 N RANGE 64 W
SUBDIVISION : N/A LOT BLOCK FILING
SITE INSPECTION: Permit #0-790174 DATE OF INSPECTION ,Tan 12 2000
( I ) Properly permitted : x YES NO
( 2 ) Soil conditions at time of inspection : x DRY WET SNOW DAI
( 3 ) Type of system: Septic tank and leach field
( 4 ) Tank size: 1 , 000 gals No. of compartments 2
( 5 ) Tank lid condition: nK
( u ) Tank operating level : OK-at this time
_._. __ - ' s/baffles : OK
( a ) Typo of Tee ' s :- , pvC
( L, ) _ _ach field surfacing sewage : YES X i0
( 1U ) Sc . of bedrooms : 3 or system capacity :
` ±.' STATUS : SYSTEM APPEARS TO BE OPERATING OK AT THE TIME OF THIS
INSPECTION.
SEPTIC TANK TNSPFCTTON Scim and some sludge observed inside the outlet
tee and discharge pipe, however liquid level was OK at this time. Under-
side of li _flows some deterioration, but still OK
WE RECOMMEND BOTH COMPARTMENTS RE PIMPED AT THTS TIME..__
LEACH_FIELD TNaRECTTON• Field was randomay_prnhed and found dry Maximum
.._ - fiald_ capacity could not he determined at this time
!;umes _ - Consui_oants , Inc . nor any of its agents or employees under take
or asssmo ad liability to the owner of the above property , to any purchaser
of the :,hose property or to any lending agency making a loan to the above pro-
purty in connection with either its examination of the property or in the re-
port .
_his :::suection was conducted solely for the purpose c: detecting health ha-
s urLis caso_...vole at the time of inspection , and does act constitute a warranty
that Lao system is without flaw or that it will continue to function in the
future . Inspections requested during periods of rain, snowcover, or when a re-
sidence is unoccupied may be of questionable lue .
..-•. 5 _-- Jan. 12„2000 SIGNATURE: C- 0/ p /Kt
Gfr-�"
Domestic Water Consultant
FORM NO. I SUPPLEMENTAL TEST REPORT Fo, :r,,n — ,
Gus-3v i
11/9C I STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
L WELL PERMIT NUMBER _ 206879
2.I OWNER NAME(S) Mary L. Cutler
Mailing Address P.O.Box 782
City. St. Zip _ Bennett, Co. 80102 _ _
Phone t 1
3. WEL_ LOCATION AS DRILLED: N 1/4 NW 1/4, Sec. 28 TwP- 2 -_ Ra.ge 64 W .I
DISTANCES FROM SEC. LINES:
330 ft. from NOrth Sec. line. and 12_45 ft. from West Sec ,:•e
trl>rrn or SOu!h) (east or wa511
I ISUBDIVISION: N/A LOT 3:.OCri FILING(UNIT)
STREET ADDRESS AT WELL LOCATION: 26216 Weld Co. Rd. 18 Ke•.nesburg, CO.
4. STATIC WATER LEVEL: 338 ft., Date Jan. 12,00 , Time 9 : 00 _m.
Measurement Method: Sonic w•�11 probe . Length of airline (if used) N!A ft.
5. PUMP: Type Submersible _ Horsepower 2 , Setting 48Q. feet
Power source 230v AC _ , Discharge pipe 1 . 25 in..Di::charge r'•ess&,•e 25. _-____ps;.
6. PLOW METER: Manufacturer Sensus . Type in line
Diameter 3/4 inches, Average pumping rate 8 gpm., Volume purnoec c.:ring test 904 g a l s .
{ 7. TEST DATA Date of Test 1 /12./00 -• .. Recuvery Data
Tiwe Pumping Level Dra:..Down Pumping rate Pumping Pressure ' ne Water Level
i ! ;fee;, (fee: (gpm) (psi) feet)
j f 9 : 22 _.338 1 : : 15 404
�' 9 : 25 -366 28 8. 1 30 11 : 17 403 PUMP OFF
I
19 : 37 397 _ 9 8 30 11 : 18 390
I 9 : 50 -401 33 7 . 5 30 11_09 382
10: t5 388 CI•ikNGED Hv:•1RANTS 10 10
r 110 : 26 _402 �4 _ 8 25
10 : 30 403 ..5 7 .75 25
1 1 10 : 38 _ 4g4 6 7 .75 �..5- - -_
11 : 08 404 (;6 7.75 25
11 : 15 404 66 7 . 75 25
31 .;S1r•:FECTiC•,,:. Type 11TH !ranules _ Amt. Used 2 ( ,_-11::iQr sample col l ect, d
9.1 hater Oual:v analysis available. Yes ❑ No Sample collected E:t pr•_.ssure tank
t t
n0I Remarks DII_C CERTIFIES 7.75 Gpm SUSTAINED YIFT,T) AT 404FT.. PUMPTKc' T,EVET, AT
I I THE TIME OF THIN TEST. ___ .
E Flow rate and drawdow_ stabilized during test .
Pressure tank and Pump control box is _
located in a yau1. .�_ Sp electric
•
dis-connect switch ex' sts_ One should he iristal led near pressure tank_
h 1. I nave read :he statements mad'f lerein and know the contents thereof, and .hat n:,:-/ are true to my knowledge.
[Pursuant to Section 24-4-104 (1:: 3) C.R.S., the making of false statements hi••er: •. .•tst:tutes perjury in the secon
degree and .3 pur.ahaUle as a c:.!:a I misdemeanor.]
�:ONTRACTOR DOMESTIC WA`1' ?R CONSt1T,TANTS, TNC_ Phone (30 ; • .171.4,114q Lie. No.J PA1 •
Mailing Address 3031 W. 1337-3 Ave . _ Broomf-ield, Colo_ 8.0020 _
!T
Name:Titie fPiease type or print) 1 Signasd e j - • Date
� �
Lloyd W. Eichacker,Vi�..:,.s `Pres. f` .:...%;.0,9,,....--y*: jr 4". :< r� '/.• • Jan. 12 , 00
I
FROM : D«IC INC FAX NO. : 303423591E Jan. 14 2000 05:46PM P2
-. ,. y900,01-14 Li:ea babas P'.31!N1
PACFI tLPB a FAD DIY. 303 344 99'93
Laboratory and Radaticn Services Division Lab ID No: 000100688.001
• stop Lowry Boulevard. Denver CO 80230-6928
•
- . us Mae:PO sex 17123,Denver CO.80217 Collection No: 3
cew.w o.www (30:,)892-SC90 fax(303)344.8969.
N., 44ftb
W e..mwmt
SAMPI E SITE _ .. SAMPLE INFf;),1;bt�T10N .: ` : . •• •
PWSIC$: WA Collected: 1/12/00 10:30:00 AM
Sample Location: Received: 1/12100 1:39:19 PM
26218 WELD CO.RD, 8.KEENESBURG RapoAed•: 1/13r00 12:32:28 PM
Cdlecied By: GE Matrix: Weber.DrinIdnp
wP000840 PICKUP
DOMESTIC ATEA CCNSVLTANTS
3031 W 13 AVE.
BROOMFI 0,CO 80200
(303)423.61
-.- AReation: _._... —. .., Purpox: R eviler.Reeld:
Test Parameter Method Result Units
Total Cotiforms. PA Tot31 coliform SM 9223 COLIFORM ABSENT OR LESS
THAN ONE (Cl) INDICATES A
MICROBtOLOGICALLY SAFE
SAMPLE
Total Coliforms, PA E coli SM 9223 E. COLT NOT DETECTED
LARS Internet Addres : httpJiwww.Ddphe.state.co.us9rArhom.htm
Rat 2x1261.Re.3'27150
•
COLORADO DIVISION OF WATER RE.. JRCES Office Use Only Form GWS-45(1/2001)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST.,RM 818,DENVER,CO 80203
phone—Info:(303)866-3587 main:(303)866.3581
fax:(303)866-3589 http://www.water.state.co.us
GENERAL PURPOSE
Water Well Permit Application
Review Instructions on reverse side prior to completing form.
The form must be completed In black ink.
1.Applicant Information 6. Use Of Well(check applicable boxes) _ _
Name of applicant Attach a detailed description of uses applied for.
L//a/CC"'5 ,e1 LLj /"te/�e. 0 Industrial 0 Other(describe):
Mailingg address
9 dr //�� �{`,/.,.`, //�� e ( )
! / / fieflivtr , ! lyf aft 9 ❑Municipal
OWN / Ste Zip code 0 Irrigation
Efr.Cew� C cele/e.' p.Commercial
T eplxxre a
yjj7� c.�G 7.Well Data (proposed)
(Re, )..g.I?7—R�C Maximum pumping rate I Annual amount lo be withdrawn --
2.Type Of Application (check applicable boxes)
❑ Construct new well f�Use existin well - /wpm ' 5 ____acre-feet
9 Total Eeplh - Aquifer
❑ Replace existing well 0 Change or increase use Cofeet
❑Change source(aquifer) 0 Reapplication(expired permit) 7
0 Other: 8. Land On Which Ground Water Will Be Used
3. Refer To(if applicable) A. Legal Description(may be provided as anattachment):
_. able.
Wen permita I Water Court case
Designated Basin Determination N I Wellname ortt '
4. Location Of Proposed Well (If used for crop irrigation,attach a scaled map that shows irrigated area.)
County
11�� B. #Acres C. Owner
air 1cx Nr,, 1/4ofthe ,( I Ul _1/4
Section i Township Nor S I Range E or IN Principal Meridian -_ . -
1, lip❑ ! ❑6,iyi pp. D. List any other wells or water rights used m this land:C9‘ 7 L2Distance of well from section lines(section lines are typically not property fines)
—7n FL from EN❑S 12 V FLrrom❑ESIW
s-r +] 9. Proposed Well Driller License#(optional):
For replacement wells only—distance and direction from old wee to new well
10. Signature Of Applicant(s)Or Authorized Agent
feet direction • The making of false statements herein constitutes perjury In the second
well location address if applicable)li ) degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
a_ (��O�� 4,� / K J { 24-4-104(13)(a). I have read the statements herein,know the contents
Optional: GPS well location information in UTM format ee 11 V thereof and state that they are true to my knowledge.
Required settings for GPS units are as follows: Sign here(Must be original sgriaWre) Date
Format must be UTM I
•
Zone must bel3 •
ZNorthing -- --
Units must be Meters _ _ Print name Datum must be NAD27(COMM Easting - - -
Unit must be set to true north Office Use Only
Were poiNs averaged?DYES 0 NO I
-
USGSmapname DwR map no. Surface elev.
5. Parcel On Which Well Will Be Located
A.Legal Description(may be provided as an attachment): Receipt area only
I ___
B.N of acres in parcel C.Owner WE
I
WR
D.Will this be the only well on the parcer❑YES ONO(if no-list other wells) CWCB
TOPO
E. State Parcel IDN(optnnal): MYLAR
SB5 DIV___ WD__ BA MD
Colorado Division of Water Resources ' ' A; .-.-ion Receipt No.
1313 Sherman St.Rm.818
Denver,CC?80203 Applicant's Name: r/A r
(303)866-3581
http:///water.state.co.us/default.htm 7' ' t// Any q S�
COMMERICAL DRINKING AND SANITARY WELL WORKSHEET /
Name and Type of Business Cu,r p tells t ym7Qh J) coo F ;��1 ���Lc lF'/ y-:_to
1. Is this application for a new well?
Yes
♦� No If no, is this application for a change of use for an existing well?
)C Yes Permit Number of well (if applicable)
No For wells used for drinking and sanitary purposes prior to May 8, 1972, a field
inspection of the well to verify historic uses is required. See form GWS-12
Registration of Existing Well for further information.
2. Is another source of water available to the property? (i.e. water district or another well)
—}-Yes If yes, indicate what this other source is (name of water district or well permit number)
7� No
3. Type of disposal system:
I'K Septic tank/absorption leach field
I Central System (district name:)
I Vault (location sewage hauled to:)
Other(attach copy of engineering design)
4. Water Demand Calculations (for average factors for water demand see below)
Pe 4)CP? Waive /5 pkeTI961 c .c.01`. ew-i cue/),
Employees
Number of X Number of Gallons X Number of Days = Gallons per Year
Employees per Employee per Day Employee Works per Year
X X r 50,3 = q/on° A
Customers
Number of X Number of Gallons X Number of Days Business = Gallons per Year
Customers per Day per Customer is Open per Year
1 X 6-- X 300 _ 22/3-00 B
Other Uses (Note: No uses outside of the building would be permitted for these types of wells)
Type of Use X Gallons per Use per X Days per Year = Gallons per Year
/1:YvIt 3CA;ibs, DaL
arrest, X 7n x 3G-5- = c
gs 5 5-C7
Total amount of water required:
= Gallons per Year
(A+B+C)
For wells used for commercial drinking and sanitary purposes on and after May 8, 1972, the total water demand cannot exceed
108,600 gallons(1/3 of an acre-foot)per year. -'
For wells used for commercial drinking and sanitary purposes prior to May 8, 1972,the iota)water demand cannot exceed
325,900 gallons 11 acre-foot) per year.
General Guidelines for Water Demand in Gallons per Day
Day Workers at Offices-15 gallons/person/day
Food Service Establishments(with toilet and kitchen wastes)-10 gallons:patron/day
Churches(does not include food service)-5 gallons/seat/day
Overnight Lodging-50 gallons/customer/day
On-Site Proprietor of Overnight Lodging(i.e.on-site owner of a Bed&Breakfast)-80 gallons/person/day
Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject. GWS-57
11/99
May 08 02 03: OOp 970 392 1816 p. 1
• STAlE OF COLORADO
WATER DIVISION ONE
OFFICE OFW THE STATE ENGINEER
�`
Division of Water Resources "'g•
Department of Natural Resources
t07€)
810 9'"Street,2n°Floor
Greeley,Colorado 80631
Phone(970)352-8712 Bill Owens
Fax(970)392-1816 Governor
httD://waterstate.co.us/default.htm Greg E.Welcher
FAX COVER SHEET Executive Director
Hal D.Simpson,P.E.
State Engineer
PLEASE DELIVER THE FOLLOWING PAGES TO: Richard L.Stenzel
Division Engineer
TO: T2rrui IJbL3kS
OFFICE: J
FROM: �XX t tai
DATE: YY\C( S?,
TOTAL NUMBER OF PAGES INCLUDING COVER SHEET: 5
IF YOU DO NOT RECEIVE ALL OF THE PAGES AS INDICATED OR QUALITY IS L NACCEPTABLE,
PLEASE CALL US BACK AS SOON AS POSSIBLE.
TELEPHONE: (970) 352-8712
FAX NUMBER: (970) 392-1816
MESSAGE:
May 08 02 03: 00p 970 392 1816 p. 2
•
AN 171979 I
IN THE WATER COURT IN AND FOR
ac'm dl
WATER DIVISION I, STATE OF COLORADO
Case No. W-14-74
IN THE MATTER OF THE APPLICATION,'.)
' FOR WATER RIGHTS OF .`PVC.` ) FINDINGS AND RULING
OF THE REFEREE
VANTAGE LAND AND INVESTMENT ) AND DECREE OF
•
CORPORATION ) THE WATER COURT
) •
IN WELD COUNTY
THIS CLAIM, having been filed with the Water Clerk, water
Division I, on June 5, 1974, and the Referee being fully advised in
th�mises, does•hereby find:
All notices required by law of the filing of this application
•
have been fulfilled, and the Referee has jurisdiction of this application.
No statement of opposition to said application his .been filed,
and the time for filing such 'statement has. expired.
All matters contained in the 'application having been reviewed,
and testimony having been taken where such testimony is necessary, and
such corrections made as are.indicated the evidence presented herein,
IT IS HEREBY THE RULING OF THE WATER REFEREE: -
1. The name and 'address of the claimant:
•
Vantage Land and Investment Corporation
Charles H. Conner, President
24082 East 16Cth Avenue
Brighton, Colorado 80601 •
2. The name of the structure:
•
Cooksey. Reservoir
�•^� 3. Original Decree:
W-14,. decreed July 28; 1970 for 14 acre feet storage for
irrigation with an appropriation date of January 1, 1969,
conditional. The Decree was made absolute for stockwatering
J. use.
A. The sworn 'statement of the applicant shows that Vantage
Land and Investment Corporation is the successor in interest
to Lyle V. Cooksey and Vernon L. Cooksey and that 14 acre
feet from said Reservoir have been used _for irrigation •
purposes.
•
19459
May 08 02 03: OOp 970 392 1816 p. 3
C e No. W-14-74
•
Page 2
DR)
WHEREFORE, the Water Referee rules that the conditional
water right awarded in W-14 on July 28, 1970 is hereby made absolute.
DATED this /7 day of . Q2o4tr•,. , 19 %9 .
THOMAS J. ARON, JR.
Water Referee, Division I
State of Colorado
THE COURT DOTH FIND: NO PROTEST WAS FILED IN THIS MATTER.
THE FOREGOING RULING IS CONFIRMED AND APPROVED, AND IS HEREBY MADE THE
JUDGMENT AND DECREE OF THIS COURT.
Dated: -/C!/"1G1 /979
•
J DGE ROBERT A. BEHRMAN
Water Judge, Division I
State of Colorado
•
•
•
19460
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