HomeMy WebLinkAbout20012384 FORM NO. STATE OF COLC)RAOO Far otics Marti
GINS-11 OFFICE OF Ilse STATE ENGINEER
o��sa • ms owswadr fdda.ats ehsamn St,Dew Wanda soars '3ECC)V!=r
Nan*SSW
PRIOR TO COMPLETING.FORM.SEE INSTRUCTIONS ON REVERSE S DEC 1 21998
CHANGE IN & IS IP%ADDRESS/ LOCATION ST EZVMK
WEEt
WELL PERT *, LNESI acIK OR EROSION CONTROL DAM "
EL mr
1- NEW OWNER
NAMES)......?. !l Ip...FrT.$qnn IGSo b115on_._.__......._...._..__.
MSng Address. „50....R._.1.. IrR 35._..
city,st y, zip i=-l • u� :a. ...,..C.o._...e.Waal._.
Phone L 3 ) 6-.5. __..3.� i..a............ ...
a 'NS CHANGE IS FOR ONE.21-THE FOLLOWING:
,s WELL PERMIT NUMBER._ _,.OL 17
O LIVESTOCK WATER TAPIR NUMBER
O EROSION CONTROL DAM
S�NUMBER.
.._
3. WELL LOCATION, COUNTY._.yy.E • OWNER'S WELL DESIGNA11ON....IX' Vetp ....
...35_..+.._... ,__._Lu>toca..,..._.._.....__....._...,.LU......._.._......._. o al
CC e Mar) arm) Ma
atsw.5.rE.1/4,'4nC�.�,..__TwP,_...L._... N.ar 0 S.,Renge..._cgk.. ❑E.a ®W. ...W.4. P.M.
Distances from Section IAnes................,�/.i! FL tram 0 N.a®S. Line, _...._.._ J0t Ft fun Ear❑W. LRre.
Subdivision Lot......._.._._. .. Bock.._ Filing(Unit)_
4. LLYESTOCKIANK OR-EROSNS CONTROL DAM LOCATION: OOUNIY....__._.._...__..... .................
114, Sec Tom.._.._._ ❑N.xOS.. Range..._. __. DEerOW. P.M.
S. The above Sad owners) ser(s)that he(they)own the structure dasaibad herein.
The existing record is being emended for the Mowing reason(s):
aChange In name at owner. 0 Change In mailing address. 0 Canadian of location
S. I(we)have teed the statsmwffit made herein,know the careens thereof,and state that they are true
to my(Ore)Icnawledge.
(Pursuant to Section 244.104(13)(x)GR.S.,the making ot tales statements herein constitutes penury In
the second degree are to pnmittede as a doss 1 rtesdemeenoq
Name/Tale Meese Ape or piing Slgmmure Date •
Pbsi I i p S. Johnson *Lt._ j. /A.--�° -43
Bennie L. Sohn soh A rm; � '— /a-10-40
FOR OFFICE USE ONLY
ACCEPTED AS A MANOR IN MEM. saes
AND/OR MARJNG ADDRESS.
2001-2384
03
61411.r. _ DEC 311996 x llr
ei
�/ � W
Court Ceske No. W.-1 Co.1_4 Sarin MD Use
. _ rose
9611-d 80/80 d 195-1 E222998EDE S33800S38 N3IYM 40 NOISIAIO-110N4 Wd82:2t t0-22-NMI
v_. l
y,. `v
\
L.�.... . _ I `may il
Well drilled by L . No.
Pump instolled by __ _ — Lic. No.
Meter Serial No. - O Flow Meter ❑ Electric Meter O Fuel Meter
Owner of land on w}tch
water is being used — _ - _ _
THE LOCATION OI= THE WELL MUST BE SHOWN AND THE AREA ON WHICH THE WATER IS USED
MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW.
ibis diagram represents nine (9) sections. Use the CENTER SQUARE
(one section) to indicate t e location of the well, if possible.
11 1. _ I I I - I
-- + -1- + -r- + — -J-- .-- 4- - + --.
t -1-"-- -4 i - ! t +
+ -- + --- }- - + - + -'- } _
NORTH SECTION LINE
NORTH
TLII_
i mite
111
"s
u,
X•d
1 ii
illZ
I SOUTH SEC-1ION LINE
r -I- 4- + - + - + -- f -- + -
4 _ I _ { { I
TI-LE OF E SCALE TAE DIAGRAM 5 TWO INCHES E QLIALS ONE-MIL E
'-- + -•-• + 4 �- 1_.__ + — , — + —
I- ---1, rug i Ie
. WATEP EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covers 1 acre of land 1 foot deep.
• 1 cubic foot p,r second s) .. . . 449 gallons per minute(gpm).
1 acre-foot . . , 43,560 cubic feet . . . 325,900 gallons.
1,000 gpm pumped continuously for one doy produces 4.42 acre-feet.
100 gpm pumped continuously for one year produces 160 acre-feet.
hCb__ COJ In . IC^_. ^,............ - ....... _ .�..,,., .n .,..,... ..w .„••., ......... ... .. .......
w
.14 5-93
MIS FORM MUST BE
subeITtED PRIOR TO COLORADO DIVISION OF WATER RESOURCES
TM?EXPIRATION OFT
PERMIT. TYPs Op - 300 Columbine Bldg., 1845 Sherman St. �j
Pt Its ACCEPTED. Colorado 83203
COPY M ACCEPTED Denver, ,
ON erauES MAILED
53
ON RFOUEST.
?�_ STATEMENT OP BENEFICIAL USE OF GROUND WATER
FOR OPPICE USED _ _ AMENDMENT OP EXISTING RECORD 0?.5�,. "�'
DN.J!._ cis. 1r"
PERMIT NUMBER 68771 +g -tic
e
STATE OF COLORADO
Weld } SS.
COUNTY OF
LOCATION OF WELL
THE AFFIANT(S) Gary Citnnedi Conroy Weld
whose mailing
address is Rte, #2, Box_h≤6 - SE '4 of the SE U.Section 2
City Fort Lupton. __ Solorados 8062E Twp. —____,..,_,D1 ,ane. 66 It Cot
W wl
_• , 6 P.M.
c 1 Fuel 4 fin) _..
being duly swam upon oath, dopos-es and says•fhoi Tie (they) is (aro) The owner(sT'aTthe" weTl 7eseri -hereon; the well is
- located as described above, at distances of 30 feet from the South section tine and 50 feet from the
worn ea sou-n.1
East section line; water hew this well was first applied to o beneficial use for the purpose(s) described herein on the
-Men on spill
.ay of 4-74 , 19_fl; the maximum sustained pumping rate of the nil Is —14—gallons per minute, the pumping
rate claimed hereby is 15 _ gallons per minute; the total depth of the well is 17fi feet; the overage annual amount
of water to be diverted is J. _,acre-feet; for which claim is hereby made for Domestic
_— purpose(s); the legal description of the land on which the water from this well is used is
fl&SEI See. 2i Twp 1: Brng.66 W: 6th P.hi. which totals
10 acres and which is illustrated on the mop on the reverse side of this form; that this well was completed in compliance
with the permit app vod therefor-; this statement of beneficial use of ground water is filed in compliance with law; he(they) has
(have) read the st ements made hereon knows the content thereof; end that the some ore true of his (their) knowledge.
Signature(s) 7e�
yy FOR OFFICE USE ONLY
41-4
'Subscriryd end sworn - ,.19
ro before me-or-this day of �I/1iL!�rr - / Cev1 Casa Na.
- GS Car::.it;Os -Xp 1D:Dm1•er 16,.1974
My Commission expires: ¶h.
toCALl /fQ/.- See-_ %I. N
. - Ne Ai er eyruc i���"` i- See-
Wen Use /
ACCEPTED FOR-'FICING BY THE STATE ENGINEER OF COLORADO p1y1 Eosin Mee-Din.
PURSUANT TO THE FOLLOWING CONDITIONS:
Prior. _ Me. ._Day t'-
DATE
p STATE ENGINEER at
•
nab-4 on/on-.I iOa-I E2Z2998E0E 53080053d dill/A 8O N0ISIttIG-ltOdi heal( i0-ZZ-dyfi
PUMP INSTALLATION EEPORT
Pump Make _Ther ��
Type `
Powered by _____ HP na
a
Pump Serial No. h a WATER
aJ
Motor Serial No. _ W TABLE
J
Date Installed _ i-
W
Pump Intake Depth �_ _ _ __ _ _ _ _^_ __ _ _ y
Remarks " " O
'4. a _-
� A,'
a
.
.
I. wig•
wt •' 714a. I r C
'~lj , .
WELL TEST DATA WITH PERMANENT PUMP 42 C
jS h • 41
pate Tested _ ` CONE OF
I. r.... - CONE
static Water Level Prior to Test_ _ g " ..- 7
Length of Test Hours
Sustained yield (Metered) GPM
Pumping Water Level
Remarks mil•
i- . K
a
CONTRACTORS STATEMENT
The undersigned,being duly sworn upon oath,deposes and says that he is the contractor of the well or
pump installation desert ad'9reon;that he has read the statement made hereon; knows the content
thereof,and that C
r Is ue his own nowledgggee.
Signature a p•�E 'F-C License No. 11$
State of Colorado,County of ®Morgan _ SS
Subscribed and sworn to before me this_9_ day of APr41 , 19____71,
My Commission expires;
_ 1
Notary Publi A -r c
FORM TO et MADE OUT I'M QUADRUPLICATE: WHITE FORM mint be an original copy an both Aida and signed.
maiTF AND GREEN amiss mute be Iliad with the State Engineer.PINK COPY isfor the Owner and YELLOW COPY is far the tNtlter.
P6P-A ROAD d 19c-1 9227999EOt S39900S3M M7IVM ai1 MOISIAIO-wnA4 Wd)7:7I In-77-Atli
- - 11
_ ..,.....I t tad
WR126.72- APR 1074
M
COLORADO DIVISION OF WATER RESOURCES
THIS FORMAIUST of SUBNATTEop / 300 Columbine Bldg., 1845 Sherman St. !mot -.
WITHIN 60 DAYS OF COMPLETI Denver, Colorado 80203 �@
OF THE WORK DESCRIBED.AERE- Ceta,
ON.TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT
INK. PERMIT NUMBER bEt777
WELL OWNER any rannAir — 5w %of the 4$ Kof Sec. 2
7001 E. 5V , C R(X)22 7.-1.---Dl_. R. _IaL.—, Ath P.M.
ADDRESS f.-y, Cn7o
DATE COMPLETED M-^rcia-27 7 , 1934 HOLE DIAMETER
WELL 1.0G —3.-1t.8n.from 0 to 120 ft.
Water
in.from to ft.
From To Tvpe and VOW of Material Loc.
in.from to ft
0 5 sand DRILLING METHOD Rotary
5 21 yellow clay CASING RECORD: Plain Casing
21 35 white clay
35 112i shale Size " & kind r1agt.ic from 0 to 100 ft.
1121 115 coal and sand
115 120 shale Size & kind from to ft.
Size & kind from to ft.
Perforated Casing
Sin SIL& kind pla-5tie. from 10Q to 120 ft.
Size &kind from to rt.
Size &kind from to ft.
GROUTING RECORD
Material Bomar+.
Intervals 0-10 1't
Placement Method ahavol -
GRAVEL PACK: Size hnrknhnt
Interval 10-12Q ft.
TEST DATA
Date Tested _March 28, . 19-7L.
Static Water Level Prior to Test 3A ft.
Type of Test Pump Bailer .
Length of Test 2 bpi;
Sustained Yield littered) IS .GPN
TOTAL (DEPTH 120 ft, •
Use additional pages nm;Ptsary to complete log Final Pumping Water Level AS ft.
PRo-a anion A PAC-I E77799AEOr S!ON00S3N ARIYM 40 NOISIAIO-nfNd itd9b 2i i0-22-MWI
(5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED BELOW
whie?e the water will be user's rust be indicated on the diagram below. by distances from section lines. -
Use the CENTER SECTION (1 secdon, 640 acres) for the welt location.1- c
0 ft.from yc�r.Tti sec.line
f _ t -
4- — -)_„ __ .--- + _- + — -4- — 4-
I <<---.-1 Mr LE.5.01 PEET--------.► [-� _ to to or soon!
I I O O ft.from EMSY _sec.line
Least of west)
} + 4 + + + '1' + LOT RLOCK FILING *
I I y SUBDIVISION
4_ NORSH ION Ma „ + I
1 r l i (7) TRACT ON WHICH WELL WILL BE
LOCATED
w ._.. —
+ _ _ .�.. -}- "F No.of acres �Q _ . Wilt this be
J w ;
I 1 l the only well on this tract? Ycs
— -
t �T a -1 • (8)PROPOSED CASING PROGRAM
II I1 lI Plain Casing
+ 3 _ Tt _ „ - - E .4- T fSS____In.from (# / ft.to 9.,b _ft-
I I I 1 y4 in.from�ft.to /2-C--- ft
4- — -i- - , 1 _ — 4. — 4 Perforated casing ECNIPTI SEG I. LINE I ^in.from- IR.••••I I S ft.to..C-0 ft
-- - + -t- 4- 4- 4 4- l in.trent_ _ ft.to _ ft
1 I I 1 I (9) FOR REPLACEMENT WELLS givedistanee
+ -' + -- + and direction from old well and plans for plugging
4- — 4 4_ - -)- — - -1- it:/J���
The scale of the dagram is 2 inches= 1 mile JV
Each small sausre represent 40 acres.
WATER E CUIVALENTS TABLE (Sounded Figures)
An acre-foot cowers 1 acre of lard 1 foot deep
I cubic foot par second ices,...449 gallons rev minute igpm)
A family of s will require et'ploximetely 1 an-foot of water per year.
...325.900 gallons.
11;00"::::,.'""::::1,T;nured con la one day produces 4.42 awe-teat.
•
ND,W11 WHICH Ott) W I E -
'V IL^ y _ fro iv V No,of acres: /0
Iption:f/' Ld co arr -S s a _IYA)- /6 6 Li- A PA
— AILED Q1SCRIP'(JON of the use of ground wet r
,[must. h'a. ( !:Ate,-41.. Abet,.)
(12) OTHER WATER RICUT$ used on this land, including wells.
Type or right Used for(purpose) Description of land on which used
fLAISIC
(13) THE APPLICANT S1 3TATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE B St OF HIS KNOWLEDGE.
S! TtlRE .4PPLI ANTIS) L
Use additional sheets of paper if more space is rebulred.
PRfr-J ;man el )QC-I C777QQUEfc <TIMfItgN N7IVM UI YOISIAil-10Mf LNg7:71 IO-77-MYW
- — Li
• itl
we -12 COLORADO DIVISION OF WATER RESOURCES `
l) h
101 Columbine Bldg.,1645 Sharman St..Denver,Colorado 80203 --�RECEIVEDC j
PERMIT APPLICATION FORM APR 16+73
Apbe licationcomplete
inert
be where A PERMIT TO USE GROUND WATER
di/—
applicable- Type or ( ) A PERMIT TO CONSTRUCT A WELL iv ATE it gS
FOR: ( A PERMIT TO INSTALL A PUMP srAte f«emsesv
print in BLACK Coto-
I NK-No overstrikes
or erasure; unless I ) REPLACEMENT FOR NO-
initialed-
( )OTHER
(1)APPLI NT-mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN 1'
Cr Arty .rr/
(..s NAME c� �#1-U f Receipt No g.?, 7 S'7 /
STRE::T�7ac�1
C_ i1j?.1 V Basin OW.
-
CITY,C ntraimF e Scst e cob,, QpO9.�2-- CONDITIONS Or APPROVAL,
TELEPHONE NO.(9 l'ir_}J(9.-t This well shall be used in such a way as to cause
no material injury to existing water rights. The
(2) LOCATION OF PROPCfy.ED WPI L 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
County -R-.111.. d — w right from seeking relief in a civil court action.
.___,,SF- % of the S f: %,Section -
il
TwP•-d---- •fill.—6-b-._- �i. _, G P.M. (((///
(3) WATER USE AND WELL DATA
Proposed maximum pumping rQrtr:(win) 1 ---
Average annual amount of grow n J water I _
to be appropriated (eere-feet};___ A
, '
Number of acres to be irrigated:. /V O "
Proposed total depth (feat):, f —
Aquifer ground water Is'to be obtained from: •
Owner's well designation --- -
GROUND WATER TO ilEJ ED EO :
( } HOUSEHOLD USE ONLY no irrigation INDUSTRIAL(5)(0N
(X) DOMESTIC ill
( ) LIVESTOCK (2) ( ) IRRIGATION(6)
( ) COMMERCIAL (41 1 1 MUNICIPAL (8)
( )OTHER (9)- _ PLIC: TION APR VED .�y
PERMIT NUMBER- �h7e Vl ; 7
(4) DRILLER MAY 4
DATE ISSUED_
- MAY 4 19A
Name 1.,)r-_Eitf-6 r-1 EXPIRATION DATE
Street_ __ - - ,
.�.
( A Ets1Gi R)
City nu ci IzIr1'"-- 8
Telephone No. tic.No_— - )�.
1.U.- / COUNTY b- -
WELD COUNTY HEALTH DEPARTMENT / Lid6 8
1555 17th Avenue
Greeley, Colorado
Ph: 353-0540 RECEIPT NO. S
Application for ermit to I stall, Construct, Alter, or Rep an Indivi ial Sewage Disposal Systemg:I_s;-:, q.-c.)
Owner Address � c .15i / — d Phone
Directio o site I o7 Legal Description...15 .Sa-�s7/ 1, 12OO
S— sOi7 3,1
ki" .11,_ ,,,{ General Information
Dept. Use Only
II
13o)ThBedrooms No. Persons 60l Pere. Rate (Avg. of 3) / --57,47,41---,
No: Baths Basement Plumbing !1 r S Soil Type ,54,4,,e0---
Size
of Lot 40 /4 C i e S H2O Table Depth ('4'
H2O supply (if well give depth)_b 1 Z ��/ (� Lot Grade —
Type of sewage disposal requested: .5 op 1-, C Requires Engineer Design Yes x No
Septic tank Sc' Privy Other If yes — reason
Comments:
Installation Instructions:
Septic Tank / ,..5 O Gals. Absorption Field 76-2 Sq. Ft.
on,Other Seepage bed 79 Sq. Ft.
Special Instructions
This system will be constructed and installed in accordance with the above specification and regulations
regarding individual sewage disposal systems in Weld County, Colorado.
This permit shall expire at the same time as the building permit, o , if no building permit is issued, the permit
shall expire 20 days after its issuance, if;on truction has not bee commenced
04.-0/17/Date:
C / 97 Owner:
Applicant:
The plans and specifications as shown are approved pending payment of permit fee.
Date: ��'
Sanitarian: I�G.UJ. ..�yj
The above system inspected and J found to comply with plan and description.
Systems Contractor: Ma-V-}-tom Date: 9 —A 'Z_ e 7
Sanitarian: , je,t1--r /�
n- 'ineer Review:
„(Date) (Signature)
_ O
Permit Fee: $ S
Received by: Date: 7/1
i;Eaerl F-I>��,�1 A,vo szpnc pn r cn , lofr4ci, (00.6,Q)
y
/^V
� 1
I O
I
Hello