HomeMy WebLinkAbout20091363.tiff a
Form No. OFFICE OF THtTATE ENGINEER •
GWS-25 - COLORADO DIVISION OF WATER RESOURCES
, 818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203
(303)866-3581 LIC
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• WELL PERMIT NUMBER 220787 - _ _
APPLICANT DIV. 1 WD 1 DES. BASIN MD
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APPROVED WELL LOCATION
WELD COUNTY •
DONALD W HUTCHISON SE 1/4 SE 1/4 Section 26
10685 WCR 118 Township 10 N Range 67 W Sixth P.M.
CARR, CO 80612-
DISTANCES FROM SECTION LINES
300 Ft. from South Section Line
(070)637 2623 300 Ft. from East Section Line
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
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) 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 40.00 acres described as the SE 1/4,
SE 1/4, Sec.26,Twp. 10 N,Rng.67 W,Sixth P.M.,Weld County.
The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than
three(3)single family dwellings,the irrigation of not more than one(1)acre of home gardens and lawns,and the watering
of domestic animals.
5) The maximum pumping rate of this well shall not exceed 15 GPM.
6) The return flow from the use of this well must be through an individual 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.
7) This well shall be constructed not more than 200 feet from the location specified on this permitco?7.L74,
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$qegilneeeer E 185 D SEP 29 1949 EXPIRATION DATE EP 29 2001
ceipt No.0448533B DATE S
2009-1363
t.,, �,, WELL CONSTRUCTION AND TEST REPORT For office use only
10/94 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1. " WELLt`PERMIT NUMBER 220787
eOWNER NAME(S) Wade Lutz
Mailing Address 54435 WCR 23
City, St. Zip Carr, Co. 80612.
Phone ( 970) 897-2720
3. WELL LOCATION AS DRILLED: SE 114 SE 1/4, Sec. 26 Twp. 10 N , Range 67 W
DISTANCES FROM SEC. ONES:
3 09 ft. from South Sec. line. and 300 ft. from East
r west Sec. line. OR
tn
orth or sour (east
SUBDIVISION: LOT BLOCK FILING(UNIT) .
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Rotary •
DATE COMPLETED 12-29-99 . TOTAL DEPTH 50 ft. DEPTH COMPLETED 42 ft.
5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft)
Depth 'Description of Material(Type,Size,Color, Water Location) 8 7/8 0 42
0-3 . Top soil
1-27. Sand & gravel. /Line to rock -
27-50 White sand
7. PLAIN CASING
OD (in) Kind Wall Size From(ft) To(ft)
6 5/8 Steel . 188 +1 20
5 PVC . 211 20 22
PERF. CASING: Screen Slot Size: . 035
5 PVC . 277 22 42
8. FILTER PACK: 9. PACKER PLACEMENT:
Material Gravel Type
Size 3/8
�'
Depth
Interval 20-42
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: Cement 3 SK. 1 . 86 0-20 Poured
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11. DISINFECTION: Type I-ITH Amt. Used 1#
12. WELL1TEST'DATA: ❑Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
TESTING METHOD _Da,i,led
Static'Level 20 ft. Date/Time measured 12-29-99 , Production Rate 15 gpm.
Pumping level 22 ; ft. Date/Time measured 12-29-99 , Test length (hrs.) 3
Remarks ' '.
13. I have read the statements made herein and know the contents thereof,and that they are true to my knowledge. [Pursuant to Section 24-4-104 (13)(a),
WC,R.S„the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.]
ONTRACTOR R & R Well & Pump INc. Phone (970 ) 353-3118 uc.'No. 857
Mailing Addr P.O. box 577 Greeley, Co . 806.32
Name/Title (Please type or print) Signature _ I Date
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Oi COO DEPARTMENT OF NATURAL RESOURCES
ti* o) DIVISION OF WATER RESOURCES
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�„ M� Bill Ritter,Jr.
rn Goveor
Harris D.Sherman
Executive Director
Dick Wolfe,P.E.
Director/State Engineer
James R.Hall,RE.
Division Engineer
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January 20, 2009
Shannon Lutz
54435 WCR 23
Carr: CO 80612
Re: Use of Well with Permit No. 220787
Dear Ms. Lutz:
This letter is to confirm our conversation of Friday January 16, 2009 that your well with
permit number 220787 is permitted for use in three single family dwellings, watering of up to
• one acre of home lawn and gardens, fire protection, and the watering of domestic animals.
I understand that you raise and show dogs and that you currently own and water ten dogs
from this well. This use is allowed by your well permit and no change to the permit is
necessary. I also understand that, at times, dogs not owned by you will be present on your
property for breeding or other purposes. You indicated that you already have a truck with a
water tank on it so that you may haul water from another source for the dogs not owned by
you. The Colorado Division of Water Resources has no objection to this as long as the
dogs not owned by you are not watered from your well and the source of hauled water is
legally available for such use.
Please contact me if you have any questions.
Sincerely, � �(
David L. Nettles, P.E.
Assistant Division Engineer
DLN:dIn\WeldCtyWell220787LtrA.doc
Cc: Well Permit File
• Water Division 1 • Greeley
810 99 Street, Suite 200 •Greeley, CO 80631 • Phone: 970-352-8712 •Fax:970-392-1816
www.water.state.co.us
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX (970) 304-6411
"Permit #: SP-9900575 Sec/Twn/Rng: 26-10-67 Status: ISSUED
Owner: LUTZ WADE AND SHANNON Applied: 11/10/1999
Applicant: LUTZ WADE AND SHANNON Issued: 11/15/1999
Permit Type: RNEW C=Commercial,R=Residential+NEW,REPair, VauLT Finaled:
Parcel #: 0303-26- - -
Location: 55015 WCR 23 CARR/26 10 67
Legal Description:
Installer:
Description: HOUSE
Commercial: N Residential:Y Acres: 20
# of Persons: 4 Basement Plumbing: N
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit #: 220787
Percolation Rate:697 Limiting Zone: 8 ft 0 in Description
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) Y
•ngineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 522 square feet
or Absorption Bed: 711 square feet
Actual Installation
Septic Tank: / 2 5 L.) gallons Absorption Trench: square feet
r -
Absorption Bed: 7.3 4 square feet
Design Type: ,
NOTICE
The issuance of this permit does not imply compliance with other state, county or local regulatory or building requirements, nor shall it
act to certify that the subject system will operate in compliance with applicable state,county and local regulations adopted persuant to
Article 10,Title 25,CRS as amended,except for the purpose of establishing final approval of installed system for issuance of a local
occupancy permit persuant to CRS 1973 25-10-111 (2).
This permit is not transferable. The Weld County Department of Public Health and Environment reserves the right to impose
additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the
final inspection of the completed system by the Weld County Department of Public Health and Environment.
Environmental Health Specialist Date
Form:S_FINAL
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