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COLORADO DIVISION OF WATER RES ICES Office Use Only Form GWS-45(1/2001)
DEWTMENT OF NATURAL RESOURCES '
HERMAN ST., RM 818, DENVER,CO 80203 RECEIVED
NOV c3
phone—info:(303)866-3587 main:(303)866-3581 {
fax: (303) 866-3589 http://w Ww.water.state.CO.US - 8 't401
GENERAL PURPOSE 1, A
Water Well Permit Application N.rr'�E�
Review Instructions on reverse side prior to completing form. $Tr ootA•
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.
'Ro.8.Ze _.T __ #A.Qt2 ._. A_-_Q..AVAAAR..r g ER_____ rg industrial Other (describe):
mailing address
C y� / 0 Municipal
1 SePI /'_iagm.r-_(,04y_ ._..__.______—______._____.— 0 Irrigation
City State Zip code
Pi G i-kre y i S3Q to / ,j Commercial
Telephone a 7. Well Data (proposed)
i 0.3 1 (t SI- 3 a 3 Maximum pumping rate I Annual amount to be wrtndrawn
2. Type Of Application (check applicable boxes) / '
acre-feet
Construct new well ❑ Use existing well -Total depol : Aqu egr
❑ Replace existing well 0 Change or increase use 98 S feet ./....on in f 4 x /1/C 5
❑ Change source (aquifer) 0 Reapplication (expired permit) 8. Land On Which Ground Water Will Be Used
0 Other: A. Legal Description (may be provided as an attachment):
3. Refer To (if applicable) _
Well Permit a Water Court case I
/9"e1/6bDesignated Basin Determination I ) /9"e1/6b
name or I
4. Location Of Proposed Well (If used for crop irrigation, attach a scaled map that shows irrigated area.)
County .. B. I Acres C. Owner
`
' , CL 6 Ai & 1/4 or the IV 0 1/4
r' Section Township N or S Range E or W I Principal Meridian
D. List any other wells Or water rights used on this land:
031 1 ® ❑ [v(o ❑ R]
Distance of well from section tines(section lines are typically not property lines)
3 3/1 Ft.from N 0 s „ [!/d Ft.fro NW 9. Proposed Well Driller License #(optional): L lc
For replacement wells only—distance and direction from old welt 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 applicablel degree, which is punishable as a class 1 misdemeanor pursuant to
C.R.S. 24-4-104 (131(a). I have read the statements herein, know the
Optional: GPS well location information in UTM format contents thereof and state that th are true to my knowledge.
Required settings for GPS units are as follows: Sign u e / lspnature Date
a9 ✓I/`���Format must be UTM I 1 /I -2 / /
Zone must be13 Northing Ai t.eame&title A
Units mutt be Meurs /YO Beer L /5A tiro 6 Al e,. - o e..4./4
Datum must be NAD27(CONUSI Easting ....'51A09,12/24/ $4 0 Al in G Ft,Pr/V gR • Q 60AZ-e
Unit must be set to true north Office Use Only
Were points averaged?OYES ❑NO USGS map name I OWR map no. i Surface elev.
f
5. Parcel On Which Well Will Be Located
A. Legal Description(may be provided as an attachment): Receipt area only
Invoice 1 484866
{E,6 11/28/81 -- 1:88:88 PI
��� Cashier ID:.01
$ 68.86
Check Purchase- 1152
WE
r B. I of acres In parcel I C. Owner — tVLJ'p�
/8. .56, i+e,e6S S'¢/te WR EII1I1���HIBI�� 1 D. Will this be the only well on this parcel?.❑YES a.(if no-list other wells) CWCBI 1
. 6,9a1 R (,off used ) TOPO 1J
E. State Parcel 101 ioptionall: MYLAR
565 DIV -- ' —
2002-1243
MAR-08-02 FRI 01 :09 PM P. 02/02
FROM CCII FAX NO. : 3038592387 Mar. 06 2202 04:49PM P2
Form No. OFFICE OF THE STATE ENGINEER
GW3-2a. 'COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg.,1313 Sherman St.Denver.Colorado 80203
(303)866-3581
LIC
WELL PERMIT NUMBER 056991 -
APPLICANT DIV. 1 WD2 DES. BASIN MC
APPROVED WELL LOCATION
WELD COUNTY
NE 1/4 NW 1/'- Section 31
ROBERT L &SHARON A BAUMGARTNER Township 1 N Range 66 W Sixth P.M.
1564 MANOR WAY DISTANCES FROM SECTION LINES
BRIGHTON, CO 60601- 330 Ft.from North Section Line
2440 Ft. from West. Section Line
(303)659-3223 UTM COORDINATES
t PERMIT TO CONSTRUCT A WELL Northing: Eastjng:
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This wen shalt be used in such a way as to cause no mamma: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 reliefin a civil
=oft action'.
2) The construction of this welt shall be In comphence with the Water Weil Consrruclidn Rules 2 CCR 402-2,unless approval of a variance has
been granted by the State Board of Examinere of Water Well Construction and Pump Installation Contractors:n accordance with Rule 18,
3) Approved pursuant to CRS 37-90.137(4)and the findings of the State Engineer dated gerts_ors 2�7_
4) The use of ground Ovate:from this well is limited to Indusrlal and Commercial.
5) Produ^ion is limited to the Laramie-Fox Hills aquifer which is located 715 feet below land surface and extends to a depth of 975 feet. Plain
casing must be installed and grouted to prevent the withdrawal of ground water from other aquifers and me movement of ground water
between aquifers.
6) The depth to the top of he Laramie-Fox Hata aquifer is approximate- To ensure the exclusion of poor quality water from zones immediately
above the aquifer,plain caving and grout shall extend through me lowermost cord and/or carbonaceous shale that overlies the Laramie sand
Portion of the aquifer.7) The maximum pumping rate of this well shall not exceed 50 GPM.
B) The average annual amount of ground water to be appropriated shall not exceed 4.17 acre-feet
9) The entire length of the hole shall be geophysiagy lamed as required by Rule 9 of the Statewide Nonhbu:ay Ground Water Rules prior to
installing casing.
10) The owner shall mark the w dl in a conspicuous place with well permit number(s).name of the aquifer,and court case nurnber(s)as
appropriate. The owner shall take necessary means and precautions to preserve these markings,
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 DMSion Engineer-upon request
12) This well shall be constructed at least 600 feet from any existing well,completed in the same aquifer,That is not owned by the applicant.
13) This well shall be constructed not more than 200 feet from the'locaton specified on this permit.
14) Pursuant to CRS 37-90-137(9)(6)and the Denver Basin Rules,no more than 98%of the non tributary consumed and the welt owirershdifdemrmetra!e-toto real a Englegmuat water withdrawn of
yaster
withdrawn will be consumed. reasonable-satisfaction-of the•sate Engineer-that ne more apart 98 of the water
15) This well is subject to administration by the Division Engineer in accordance with applicable decrees,statutes,rules,and regulations.
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 declines.
NOTE:To insure a maximum productive fife of this well,perforated casing should be set through the entire produ-lng interval of the
approved zone or aquifer irdlcated above.
•
APPROVED
MTT a $ .
State
jest) No.0484866 Engineer DATE ISSUED IAN 1 b^
J By t
EXPIRATION DATE .JAN
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