HomeMy WebLinkAbout20021136 FORM U.W.6 • _.. .
REV.5-93
STATE OF WYOMING
/'1 OFFICE OF THE STATE ENGINEER
HERSCHLER BUILDING
CHEYENNE,WYOMING 82002 - U1`( ) 6 4*}:i
(307)777-5959
STATEMENT-OF COMPLETION AND DESCRIPTION OF WELL OR SPRING
NOTE: Do not fold this form. Use typewriter
or print neatly with black ink.
PERMIT NO. U.W. 96774 NAME OF WELL (SPRING) PARRILL 112
1. NAME OF OWNER SHARON PARRILL
2. ADDRESS Fa x 5-725
Please check if addrgss has changed from that shown on permit. ❑
City (i/J .1(--Ci/1/l t2.- State (42/. Zip Code erg � Phone No. 633-1-O X-2
3. USE OF WATER: Domestic ❑ Stock Watering❑ Irrigation LI Municipal ❑ Industrial ❑ Miscellaneous k
Explain proposed use (Example: One single family dwelling)
/C '= / . C,GG/GC ica-s e"/ QiF'//_Eiv ,r -7/) .C s¢LES
4. LOCATION OF WELL (SPRING): ,(/L Ya i % of Section -7f , T. j7 N., R.&,{, W., of the 6th P.M. (or W.R.M.),
Subdivision Name Lot / Block
If surveyed, bearing, distance and reference point:
,. TYPE OF CONSTRUCTION: Drilled0( iR 0::4 7- y• Cor»6/7iQ.7jn,i�' Dug g❑ Driven ❑ Other❑
(Type of Rig)
Describe:
6. CONSTRUCTION: Total Depth of Well/Spring -C-3,;2 0 ft. Depth to Static Water Level <--QO ft.
a. Diameter of borehole (Bit size) '1 -7/g inches. (Below land surface)
b. Casing Schedule New[X Used❑
----7/
n diameter from 0 ft. to .5j*.) ft. Material PVC Gage 5°/' 1 7
diameter from ft. to ft. Material Gage
c. Was casing cemented: Yes❑ No a Cemented Interval, From feet to
feet.
d. Number of sacks of cement used type of cement
e. Perforations: Type of perforator used f 1g C77-').-/ C ``
Size of perforations .C35 inches by 3• CC inches. b>` (T-1T 1'ED \
Number of perforations and depths where perforated: ` t'`'t '"
„.2//CC; perforations from .y(on ft. to b AQ .1
feet. ' DEC 0 6 6 r '-
perforations from ft. to feet. V
STATE ENGINEER
f. Was well screen installed? Yes❑ No ' tJlYa,
Diameter: slot size: set from feet to
Diameter: slot size:
set from feet to
g. Was well gravel packed? YesNI No❑ Size of gravel ,, /.,25— '7 , 3751 t,n ce1 r( /nf rd-
h. Was surface casing used: Yesksi No ❑ Was it cemented in place? Yes c5k No❑
7. NAME & ADDRESS OF DRILLING COMPANY Al L/ /staly 5 Gp/c,/
L lJY//i,igi/ byre. C./^.[�.c�zi9i;�; 42,
8. DATE OF COMPLETION OF WELL (including pump installation) OR SPRING (first used) /7: - ,-)C/ - L/5-
9. PUMP INFORMATION: Manufacturer 6 Ot�/cz Type Su-Lm
Source of power /e C- • Horsepower r%> Depth of Pump Setting or intake /7/(�,
Amount of Water Being Pumped '7 Gallons Per Minute. (For Springs or flowing wells, see item 10.)
Total Volumetric Gallons Used Per Calendar Year.
10. FLOWING WELL (Owner is responsible for control of flowing well).
If well yields artesian flow, yield is gal./min. Surface pressure is 1b./sq. inch, or feet of water.
The flow is controlled by: valve ❑ cap ❑ plug ❑
Does well leak around casing? Yes❑ No ❑
Permit No. U.W. 96774 Book No. 746 Page No. 75
2002-1136
11. If spring, how was it constructed? (Some method of artificial diversion, i.e., spring box, cribbing, etc., is necessary to
qualify for a water right.)
12. PUMP TEST: Wasp pump test made? Yes Ne No❑
If so, by whom PAt't5 R16-L.(, SC2 Vie irci2.ti≤ Address "K/4/ Arrc'.J1n.1/ /2r -
Yield: gal./min. with foot drawdown after hours.
Yield: gal./min. with foot drawdown after hours.
13. LOG OF WELL: Total depth drilled ,._5&•0 feet.
Depth of completed well 5.,10 feet. Diameter of well 7 inches.
Depth to first water bearing formation /4o feet.
Depth to principal water bearing formation. Top /J o feet to Bottom `J-2? ) feet.
Ground Elevation, if known
DRILL CUTTINGS DESCRIPTION:
From To Material Remarks Indicate Water Bearing Indicate Perforated
Feet Feet Type, Texture Color (Cementing, Shutoff) Formation & Name Casing Location
L0c-k42 vGL ci/s/ <.ve 6 c/-
S 4,v,1 5 )41 4 (% .ate//2/cz /-11x0- 'z-;;V,
14. QUALITY OF WATER INFORMATION:
Does a chemical and/or bacteriological water quality analysis accompany this form? Yes El No❑
It is recommended that chemical and bacteriologic water quality analyses be performed and that the report(s) be filed
with the records of this well. (Contact Department of Agriculture, Analytical Lab Services, Laramie, 742-2984.)
If not, do you consider the water as: Good❑ Acceptable❑ Poor❑ Unusable ❑
REMARKS:
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is
true, correct and complete.
- / -
Signature of Owner or Authorized Agent Date
FOR STATE ENGINEER'S USE ONLY
DEC 0 R 1996
Date of Receipt 19 /1 l 9
Date of Approval va /ra , ig
it-
Date of Priority August 16 19 94
for to gine•
,
l) /Sec' P_ cry
iriirir. ^ .:I;'; d 8// !6
FORM U.W.5 El :of)p.t•.t
FILING9FEE SCHEDULE STX�TE OF WYOMING
ON REVERSE SIDE OFFICE OF THE STATE ENGINEER �C.; ,IAN 1 irr
HERSCHLER BLDG.,4-E CHEYENNE,WYOMING 82002!1_Pf F A
APPLICATION FOR PERMIT TO APPROPRIATE GROUND WATER
APPLICATION FOR WELLS AND SPRINGS
Note: Only springs flowing 25 gallons per minute or less,where the proposed use is
domestic and/or stock watering, will be considered as ground water appropriations.
FOR OFFICE
l��USE ONLY Temporary Filing No.U.W. pr3— 7-36C
9 PERMIT NO.U.W. 6 7 7 4 NOTE:Do not fold this form. Use typewriter or print neatly with
black ink.
WATER DIVISION NO. / DISTRICT ALL ITEMS MUST BE COMPLETED BEFORE
U.W. DISTRICT `arQ.,t*. Cn,. OZ-t-leleitett APPLICATION IS ACCEPTABLE
NAME AND NUMBER OF WELL or SPRING ve/m,,* /L t.. a�f-
1. Name of applicant(s) _11/11 7-4-P�/ 1-/ Phone: 3o7-63S-o76S
x'
2. Address of applicant(s) P( Off' 25 """( 1 /,per 11-e-11-e- (),)/ g -00 3
(STREET) (CITY) � (STATE) (ZIP)
3. Name& address of agent to receive correspondence and notices SCGf1.Q,
(STREET) (CITY) (STATE) (ZIP) Phone:
4. Use to which the water will be applied:
D Domestic: Use of water in 3 single family dwellings or less, noncommercial watering of lawns and gardens
totalling one acre or less. Number of houses served?
El Stock Watering: Normal livestock use at four tanks or less within one mile of well or spring. Stockwatering pipelines
and commercial feedlots are a miscellaneous use.
❑ Irrigation: Watering of commercially grown crops, (large-scale lawn watering of golf courses,cemeteries,
recreation areas,etc., is miscellaneous use.)
❑ Municipal: Use of water in incorporated Towns and Cities,(use of water in unincorporated towns,subdivisions,
improvement districts, mobile home parks,etc. are classified as miscellaneous use.)
❑ Industrial: Long term use of water for the manufacture of a product or production of oil/gas or other minerals,
(oil field water flood operations, power plant water supply,etc). (Describe in REMARKS)
® Miscellaneous: Any use of water not defined under previous definitions such as stockwater pipelines,subdivisions,
mine dewatering, mineral/oil exploration drilling, reclamation purposes, potable and sanitary
supplies in offices or light manufacturing,animal waste management,etc. Describe miscellaneous
use completely: Sc. AGM,...-ks
❑ Monitor,Observation or Test Well: (Describe in REMARKS)
5. Location of the well or spring: (NOTE: Quarter-quarter(40 acre subdivision) MUST be shown. EXAMPLE: SE 1/4 NW 1/4
of Sec. 12,Township 14 North, Range 68 West.) (Loit /)
04-4.1111 P County,X51/4 NE 1/4 of Sec. a I ,T. / a N., R. 6(p W.of the 6th P.M. (or W.R.M.),
Wyoming. If located in a platted subdivision, also provide Lot , Block of the
Subdivision (or Add'n)of Resurvey Location: Tract ,(or Lot)
6. Estimated depth of the well or spring is 3on feet.
^ 7. (a) MAXIMUM instantaneous flow of water to be developed and beneficially used: 2 S gallons per minute.
NOTE: If for domestic and/or stock use, this application will be processed for a maximum of 25 gallons per minute. For a
spring,after approval of this application,some type of artificial diversion or improvement must be constructed to qualify for a
water right.
(b) MAXIMUM volumetric quantity of water to be developed and beneficially used per calendar year: Yo
Circle appropriate units: (Gallons) CA.cre Fee bA four person family utilizes approximately one (1) acre-foot of water per
year or 325,000 gallons.
8. If use is not irrigation, mark the point(s)or area(s)of use in the tabulation box below.
9. If for irrigation use:
a. Describe MAXIMUM acreage to be irrigated in each 40 acre subdivision in the tabulation box below.
b.0 Land will be irrigated from this well only.
c. ❑ Land is irrigated from existing water right(s)with water from this well to be additional supply. Describe existing water
right(s) under REMARKS.
TABULATION BOX
NE 1/4 NW 1/4 SW 1/4 SE 1/4 TOTAL
TWP RNG SEC NE'L NW'1, SW'I. SE NE NW SW'l. SE V. NE'IA NW'l. SW'I. SE'l4 NE V. NW'la SW'I. SE'/,
I + /J
I/y,�pji I.4.) 2i Lek- ( o co- r'O y O�' N Olt t<o. )
/Ly (4 LA zt L 41 ( Z ocod,o.- OF RPt4,. u✓am?)
10. If for irrigation use, describe method of irrigation, i.e. center pivot sprinkler,flood, etc:
9 c SEE REVERSE SIDE ry �? r
Permit No. U.W. U Book No. r 4 v Page No. I
11. The well or spring is to be constructed on lands owned by Apieke.ct,,,,l
(The granting of a permit does not constitute the granting of right-of'-fay. If any easement.or right-of-way is necessary in
connection with this application, it should be understood that the responsibility is the applicant's. A copy of the agree-
ment should accompany this application, if the land is privately owned and the owner is not the co-applicant.)
12. The water is to be used on lands owned by App Iica-n 4-
(If the landowner is not the applicant, a copy of the agrdetnent relating to the usage of appropriated water on the land
should be submitted to this office. If the landowner is included as co-applicant on the application,this procedure need
not be followed.) NOTE: Water rights attach to the area(s)� and/or point(s)of use.
REMARKS: / r fo..c//il6e5 ,c k/ St✓Ycee t7 1 ,s to e-// ore. cw.+.v/e.o.-71?aa4.
trPc4...Lava,.'r\ l.-6V-y, th'!*reP So-/ad ,4K"I .:1 a.4 o - spo Veda_ h4//U- leUf/n� es-
121144t-it.
6 (On /frc. .. T?( 1e'C , IP' ., / / /// -S
AP IIT ' to Cc 1,'Ct OF re4/a K✓o-n/ /s 0.Lr /y /'N Cele Ad e,
I.
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true,
correct and complete. /�lX O/ /4 , 19T',7/c , /�
Signatureofof Applicant or Authorized Agent Date _
THE LEGALLY REQUIRED FILING FEE MUST ACCOMPANY THIS APPLICATION
DOMESTIC AND/OR STOCK WATERING USES $25.00
(Domestic use is defined as use of water in 3 single family dwellings or less,
n
noncommercial watering of lawns and gardens totalling one acre or less.)
IRRIGATION, MUNICIPAL, INDUSTRIAL, MISCELLANEOUS $50.00
MONITOR (For water level measurements or chemical quality sampling,test well) NO FEE
IF WELL WILL SERVE MULTIPLE USES,SUBMIT ONLY ONE(THE HIGHER) FILING FEE.
THIS SECTION IS NOT TO BE FILLED IN BY APPLICANT
THE STATE OF WYOMING )
) ss.
E ENGINEER'S OFFICE )
fs instrument was received and filed for record on the 16th day of August A.D.
19 94 ,at 4:00 o'clock P. M.
Permit No. U.W. 96774
to tat
THIS IS TO CERTIFY that I have examined the foregoing application and do hereby nt the same subject to the following
limitations and conditions:
This application is approved subject to the condition that the proposed use shall not interfere with any existing rights to ground
water from the same source of supply and is subject to regulation and correlation with surface water rights, if the ground and
surface waters are interconnected. The use of water hereunder is subject to the further provisions of Chapter 169,Session Laws
of Wyoming, 1957,and any subsequent amendments thereto.
Granting of a permit does not guarantee the right to have the water level or artesian pressure in the well maintained at any
specific level. The well should be constructed to a depth adequate to allow for the maximum development and beneficial use of
r- ground water in the source of supply.
If the well is a flowing artesian well,it shall be so constructed and equipped that the flow may be shut off when not In use without
loss of water into sub-surface formations or at the land surface.
Approval of this application may be considered as authorization to proceed with construction of the proposed well or spring.
Construction of well or spring will begin within one(1)year from date of approval. A Statement of Completion will be filed within
thirty(30)days of completion of construction, including pump installation.
Completion of construction and completion of the beneficial use of water for the purposes specified in Item 4 of this application
will be made by December 31, 19 '`' q ,
The amount of appropriation shall be limited to the quantity to which permittee is entitled as determined at time of proof of
application of water to beneficial use.
Witness my hand this ' 7 day of - , tg
y� / Gordon W. Fassett, State Engineer
7C
This permit is for a Miscellaneous use well to be located within the Laramie County
Control Area. However, because the quantity to be appropriated does not exceed
25 gallons per minute, advertising and recommendation by the Control Area Advisory
Board is not required. ,;q+., = i.y v 11.7'? t7y ►/n(' NOTICE 0C EXPIRATION Oi91DJ N P-A i s iI M Ep APR 1. .5
5
APR C..�J _/• C. C0Mt,IENCEMENT MAILED
.--. .,'').':iafph
alkYVwwtw�t `N m ;
ts
�\Rev: 2-82 6LL 'Y .9 NOTE: Do not fold this form. Usc type-
N64 $ a writer or print neatly with black ink.
;._rte ATE OF WYOMING ,,,or..*;: wfe 6 ig,,
OFFICE OF TIIE STATE ENGINEER
PROOF OF' APPROPRIATION AND BENEFICIAL USE OF' GROUND WATER
The owner is responsible for s'u innlling Parts I and II of this form. Part III will be prepared by a State Engineer Representative at time of inspection.
PART I
LVATER DIVISION-_ 1 (2) toy. DIS'ERIUF Laramie Co Control Area
STATEMENT OF CLAIM DATE OF PRIORITY An• st 16, 1-994
PERMIT NO. U.W. 96774
WELL REGISTRATION
-- LOCATION NE _ '/a NE 1/4 of Section 21
NAME OF WELL Parrill #2 _ T, 12 N., R. 66 w.
I. Name of Claimant(s) y ARRONNPPARRTLL (�
2. Address C _QZ]_-_dam/ '‘ c nn N/1 / ,�lp__.� �
`-e Zip Code��'!'G17.
:1. For What Purpose(s) is Water Used? Use: C onialdi-rij,s —_r 4/kl£Ryate First Used 9///7 , 19 94
r Use:E A Flee Date First Used: , 19 _— Use: Date First Used_ , 19
_.
If use is for irrigation, give date irrigation was completed on all lands under this PermiC
PART II
For Irrigation, Industrial, Municipal and Miscellaneous Wells
A plat which has been certified by a licensed professional engineer or land surveyor shall be submitted to accompany this form.The plat shall be in
accordance with Sec. 33-29-I II Wyoming Statutes 1977 or see Chapter V and VI,Manual of Regulations and Instructions issued by the Slate Engineer's
Office. (iMlinimum scale shall be 2"= t nulc.) The map shall be prepared with waterproof black ink on tracing linen or an acceptable equivalent and shall
show on a suitable scale the legal subdivisions, the accurate location of the well or wells, storage facilities,if any,main canals,streams,highways and other
important cultural features. Land ownership will be shown, if there is more than one owner under the permit.
IRRIGATION WELLS
Acreage irrigated under terms of this permit will be clearly shown with a distinctive pattern and a distinction clearly made between lands having an
original .supply and those provided a supplemental supply. Where use is for supplemental supply for lands with a right from another source, indicate the
priority or permit number of the source, the source of supply and the name of the ditch, pipe line or other well. Conveyance system will be shown and
described. Indicate method of irrigation being used.
INDUSTRIAL WELLS
In addition to the information outlined above,industrial users will locate and describe conveyance facilities to the point(s)of use,giving as accurately
as possible the location of points of use. Permits for other sources of water must be identified.
MUNICIPAL WELLS
The plat will show the area of use and show and describe the means of conveyance of the water from the well to the connection with the distribution
system for a municipal water system.
MISCELLANEOUS WELLS
(I) The linen plat for wells where the use is described as miscellaneous and where the yield flow of the well exceeds twenty-five(25)gallons per minute
must show the area of use and describe and show the means of conveyance from the well to the distribution system and/or points of use.
(2) The plat for welts where the use is described as miscellaneous and where the yield or flow is twenty-five(25)gallons per minute or less may be a 79/2
minute United States Geological Survey Quadrangle map in lieu of a linen tracing provided the U.S. Geological Survey Quadrangle map is in
compliance with the following conditions:
(a) The entire United State Geological Survey quadrangle map must be submitted to the State Engineer's Office.
(b) The scale on said quadrangle map must be one to twenty.four thousand.
(c) An identified section corner or quarter corner must be shown on said quadrangle map along with Section,Township and Range.
(d) The section in which the well is located and the section(s) where the area(s) or point(s)of use are located must be subdivided into forty(40)
acre tracts and the well location and area(s)or point(s)of use clearly labeled and described.
I
(e) Said quadrangle map showing the well location and area(s)or point(s)of use must be certified by a professional engineer or land surveyor
licensed to practice within the State of Wyoming.
A "CERTIFICATE OF OWNERSHIP" FROM THE COUNTY CLERK'S OFFICE SHOWING OWNERSHIP OR CONTROL OF LAND(S)
INVOLVED MUST ACCOMPANY THIS FORM.
Under penalties of perjury, I y^ . , Q
d/,e-ccllacer/ee that I have examined this form and to the best of my knowledge and belief it is true,correct and complete.
Signature of Owner or Authorized Agent Date
Date of Receipt: , 19—
dal
PERMIT NO. U.W. 96774
PERMIT STATUS
Priority Date August 16, 1994 Approval Date August 27, 1994
August 23, 1995 - Notice of Commencement on August 22, 1995 received. MICRO Aug 2 5 p-`s
SEP 29 '95FILMEDANNND CF !ONCE
B°FENEF A USE►iA a r E D SEP 1 k 1995
December 19, 1995-Request for extension of time for completion of construction
and completion of beneficial use received and granted until
December 31, 1996. Letter of r lest filed in Miscellaneous
Notices under Permit No. .t Applicant not ' ied of
extension by letter on 4956
DtE OF APPROVAL RICHARD G. STOCKD LE
Administrator, Ground Water Division
eLMED APR 15 iyyt
SEP 30 '96 ^nnrr OF EXPIRATION OF TIME FOP COMPLETION MICRO JAN 2 1 1997
ANL.WMPLETION OF BENEFICIAL USE MAILED FILMED
December 6, 1996 - Statement of Completion on October 20, 1995 received.
November 26, 1996 - Proof of Beneficial use on September 01, 1996 received.
November 26, 1996 - Certificate of Ownership received. See Warranty Deed filed
in Certificate Drawer under "Parrill, Sharon".
MtAt } L k1Yr
.-. .-,
WYOMING DEPARTMENT OF AGRICULTURE
't ` r ANALYTICAL SERVICES
1174 Snowy Range Road
51,5455
t Laramie, WY 82070 Phone: (307)-742-2984
:i. Internet: `,gyp ,ay .c, ,u _ E-mail: .. rt _ i u,_
SERVICE ANALYTICAL REPORT
Lab Number: 34446-34447
Borderline/Clown's Den Date Collected: 04-Oct-01
P.O. Box 5925 Date Received: 05-Oct-01
Cheyenne, WY 82003 Date Completed: 16-Oct-01
Purchase Order No:
Phone No: 307-635-0765 WDA Invoice No 103322
PWS No: 5600785N Amount Due: $ 32.00
Sample ID: See Below Amount Paid: $ 0.00
Analysis: Nitrates Net 30 Days, Payable to: Wyoming Department of Agriculture
PWS # Sample ID Test Name Result Units
5600785N Clowns Den Sink Fountain Nitrate + Nitrite - N 9.3 mg/L
5600785N Borderline Sink �\ Nitrate + Nitrite - N 7.4 mg/L
Prepared By: ' kmh ta,y41--
I hereby certify that the above sample was analyzed by myself or my assistant.
1-- 1Lc,fly≥%_, `
Section Supe isor Kenneth L.McMillam,State Chemist/Lab Manager
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