HomeMy WebLinkAbout20071266.tiff 5iivs-25 COLORADO DMSIQ*[ OF WATER RESOURCES
ss 818 Centennial Bldg., 1313 S pan St., Denver,Colorado 80203 0 py
(303) 8695881
489
r") WELL PERMIT NUMBER ___18204,3_ - -
APPUCANT DN. 1 CWT. 82 WD 2 DES.. BASIN MD
Lot A Book: Filing: SubdM
APPROVED WELL LOCATION
WELD COUNTY
MARK& CYNDI SALTHOUSE NW 1/4 NE 1/4 Section 29
13500 WCR 6 Twp 1 N RANGE 66 W 6th P.M.
FT LUPTON CO 80621
DISTANCES FROM SECTION LINES
(303)654-0355 100 Ft. from North Section Line
PERMIT TO CONSTRUCT WELL 2540 Ft. from East Section Une
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 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 and Pump Installation 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 17.
(pa, Approved pursuant to CRS 37-92-602(3)(b)(i) and policy of the State Engineer under the following canditio
4) The use of groundwaterfromtllw wee isihtdted to ordinary household purposes inside one single family dwelling,
watering of four(4)large domestics anMvls artd the Irrigation of not more than 8,000 square feet of horns gardens
and lawns, as recommended by the Division of Water Resources to the cowry commissioners.
5) Production Is limited to the Laramie-Fox Hilts aquifer which corresponds to the Interval between 725 feet and 975
feet below ground surface. Plain casing shall be Installed and properly sealed to prevent production from other
zones.
6) The maximum pumping rate shall not exceed 15 GPM. •
7) The annual amount of ground water to be withdrawn shall not exceed 0.75 acre-feet.
8) This well 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.A cif, 3 f t tl
,MOVED 1 •
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BY
Receipt No. 0373374 DATE ISSUED SEP 22 1994 EXPIRATION DATE SEP E�2 2 1996
2007-1266
, i,,Ra vo. WELL CONSTINCTION AND TEST F1EPORT w. .u..:Jr*
;;1 1 STATE OF COLOPA ., OFFICE OF THE STATE ENGINEER -
I t1 WELL PEPMIT NUMBER * J _ 693 t
(-)2 :c'4I YFR •JARAct$) ///3/Ye3 %--- Y/VPi c I-/ t '-
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3. .`4ELL L3CAT'CN AS CRILLEO: NA./
114 4— 114, Sec. .A9 T.tip. / L L . Range 'QLL L
a�SANCES FR LINES:
.__... . . T frrxrtOM NSEC. T S . ire.
and
11L3 R. tr^m E '`..p,sec. rr►c rF ----- ---- ------_
St t!SipNtc;QN: LOT BLOCK FtUNONNff - -
1 ST0EET AOC-PESS AT WELL LCCA;0 N: r�
i 4.i GROUND SURFACE _LEVA j:ON it, oRiLUNG M "'•+OO POPP/e/ -- •
I i OAT= C^+.tOt-r o A.` < .NW TOTAL 7EPTH (A it- :EP~H CCMP±= O 94 .., I .
it- GEOLOCstC LOG:- -- - ---- a -401,,ErdM. In.) F-n VT- ?t7 l?
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1110.1• H M MsSr9Y �Tvo.. Wm. :01a. maw Lcxadon� f _ _Y
---I— 4------:...1:,‘------ - •
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`{•, A. C'Vic ' T. PLAiN CASINO•
I- ,- /01 s.W4,1-4•- OO fin) iir d tail Sliei From(ft) To Rj-
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4D '_ ,Sr-E .Me_. , _G' .41Ir+
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8. t iLT3r1 PACK: 3 PACKER PLACEMENT:
h '7�'C2 ,5�/,,tom i
'7/(/1- c:/. 1.40 a ‘'id,(1)L) Material Tice f/eg/: �P
Size
Irler,aa OP Cth
_ t0. aRCU " o REC4R0:
anal Amount Density Ir terval Pt streetac�.�pAKS: • t G21 -a wv
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14, GISI4FECTION: '"was Ant. Used e . . p
iii7:'� 'z„ T_ c ATA: `J Check !aox if Test Cate is SUtmitted on Sub !emer tan Form.
ST NG 'tETHOO /.t' `
i Sratic Level I}. "?ate/Tiara measured / 9_y .5'. 9Q , Prt3ductlon Pate �J gum.
rP'erna.lig 'ev9f (t. Oatert a Measured_ AZ91/ 4/.',311 , Ts%length (3'1re.) igli
h 3. T-aroo raid d»atat.nwAs .u.wan rd loom,Ive aort!o,M.I1e.d nd tit Stop a.uw le Tr 1v aabdqa(Pummel lo s.a1I0R£44101 pato ctt&to adir
at r s�71Mle',fowl,n.iumpr mow, in to second . • ins 1..u-• 'as 4 ciao t .f _
CONTRACTOR _ �r► E. . , L $J � '�+
If MaillegAddresa • _._ .. l:.����l:"/ ! ---, 1t
L
air •�+1•N.ie ;Pieria type or Wing Slgnatur. I Oatr
414; f''/ G !�wr' ) ='' ,- 2, /‘ 7S-..._:-
I
'' ' "a• PUMP INSTALL MN AND TEST REPORT t Pa.Ollie the odic ,
Cvt•32
atop 1 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1. WELL PERMIT NUMBER IB ?)q,3
DP-R\
OWNER NAME(S) /72/7/,76- y` .i1 '/-/// "
MaiIfng Addrsss ` _
City. St Zip LL/Dtt'1J ( -47Z)(p-..-2/
Phone (3f ) /a `a.
a.WFLL.LOCATION AS CRILI*E I Nets 1/4 Nj 1/4, Sec c::.-0 ,Twp - i /171ros Ma &[I-- z/....'
DISTANcEs.FR'QM sec_ ut sr. _ . _ __ . _ �-- t
- .._
_ ii y? ft from jV ePY Soc. tine. and c O/� R from &/237— sew line.
, a :tea
SU9CMS ON: - LOT 3LOC,( FrUN4{UNIn__
STPEET AOCPESS AT WELL LOCATION:
4. i=".,VP �`ATA• Type t_XZ4 °r ta;'ation Completed J.)&2? : „i /1
Pump M.4-r factuter X --L. 1/X`,k/7/`" . Pump iodei No.
--- . Ces►gn GPM /11--- at RPAt : -4"------ r Votte (:).2,36- J Fug Arz !
F1 p Intaka 2pth-- 3 -- Feet O c32,- S: .,._ . .
----- .�3 - �Cc. rtrt , ..ti-e-- 1 :riches, i4rtd- --[ �.�C..
aCCff?^NA` 'PIFORA9enr+y Fna P►naac r^F ATCfl '714 AT T .. ..nom, . -_
TUPSNE Cfar ER TYPE: 0 Electric 0 Engine E Other
Lesign 'cad reet, Number of - . Shalt size sr►ctrea.
S. OTI'E13 EOt.,+sat.lcM; . _. ..
Ax re Ir'EtaI'e d Q yes O No, Ctrtfca Caput t. . '.4crttor Tube Irste d Q Yea O No, Cepth
Pow w s+er M'+�. iiielif ..- _
k4arer P fltdC t O 3ailcns, CI Thousar.d °a'1}one, f rJ Acre flet, O Stirfrrong Reedy i
& TE$T D.*TA: O Ch. t 1 T data y sib:r. ed , Supplemental Fomt -
Date c�
Trytat We4 C epth —
q T me •
Static Level L 3�} Rats {GF. r /L1
Cate MeatureC Pumping Ls _ .-58U
7. O
DIStl C N: Ty� /47///7/ Amt. Used - -
1 'r�o
'A/3111'
analysts available,. 0 Y911.1No
9. Remarks
-, agews.
10. 1 Pave rE'*j the s?atent®rM made grain and know thlt contents :flOW9Cif, and that they am true to my knowledge,
[Pursuant to section 24-4-104 (13)(a) C.R S., ;he making al 'also statements gaff motes puny h Ole second
deg5ae and a punishable as a cuss 1 misdemeanor.]
_ �- 453/ L Nth.-CJ
CONTRACTOR 4 t � .�i'�� �'I a y �.�
Mailing Adds ' ie R / ' c. t Re/L�5 ,., ,.
roTtilIitiS (Pleas* tYp or WWI Signature �� - Qom, . -at) Z977-littk)
HSP106P APPLICATION FOP !NL'! L 1 :.'lA'.. ... t:WAGL:: DISPOSAL ,;Y::'I'1 M NO. G-94034
WELD 0:+.;N' s E—.I.' '!. I%!�.�'r`sf 'PMLt'3 �' NEW APPLICATION
ENV.1R0NMEI•iie';, :.ERVI+:'E3
1517 16TH AVENUE J:.''', iRE1!.LLY . +:`,!'1 t_i(.'F';::'s 1
DVNER SALTHOUSE, MARK ADDRt.:" 1 ,! AI'_'L e; I 1 ; 303) 654 -03
ADDRESS OF PROPOSED SYSTEM WCR 0 & _
FT I.! 1=T.>U
IEGAL DESCRIPTION OF SITE: RUG -;F•:
SUBDIVISION: -" L+: +: ) F;' :'•1- ' 0
JSE TYPE: RESIDENTIAL HOUSE
SERVICES: PERSONS 4 BATHROOM.:. 1 i:::1. 4.:l:; ACI h_'.`
BEDROOMS 3 BASEMENT PL1_1MF I:, '•a+.:! trtr.::'ER SUPPLY . F WEL,+_.
APPLICANT ACKNOWLEDGES THAI' THE COMPLETE flES ' T'Hi; AFPL1'..'ATI+_JN :: CONDITIONAL
JPON FURTHER MANDATORY AND ADDITIONAL 'I'F: 'I;:, h1 REI'uhT:' AS HAY BE REQUIRED BY THE
WELD COUNTY HEALTH I.DEPARTMENT TO BE MALE ANL 1•Uht4I'3;IEL BY ` HE API LIc!ANT OR BY THE
WELD COUNTY HEALTH DEPARTMENT FOR PURI-L, ;L:.J •..-1/ THE EVALUATION uF THE APPLICATION;
AND THE ISSUANCE OF THE PERMIT 1S SU1?.:lE:' TO ::'.kH TERMS ANE, ►-ONDIT'IOUS AS DEEMED
NECESSART TO INSURE COMPLIANCE WITH MULL.; AWE' I:Et.'ULATIONS ADOPTED !.!NDER ARTICLE
10, TITLE 25, CRS 1973, AS AMENDED. THE AI:': L t•.;ANT CERTIF.IE: THAT THE PROPOSED
SYSTEM WILL NOT BE pOCATED WITHIN 49u F'1:L'I' t' A +'t►MMi'N •.'I'Y ShWA';E :2,YSTEM. THE
UNDERSIGNED HEREBY CERTIFIES THAT ALL -:TATEMFU'.F'' MADE, INFORMATION AND REPORTS
SUBMITTED HEREWITH AND REQUIRED TO BE ::r I MJ` rCI: BY THE APPLICANT !,ICE. OR WILL BE,
REPRESENTED TO BE TRUE AND CORRECT 't'•.: 'r! of MY KtoWW::tgx AN! 1:ELIEF, AND
rDESIGNED TO BE RELIED ON BY THE WELL COUt'T1 HEALTH DEPARTMENT IN EVALUATING
SAME FOR PURPOSES OF I SSUI N+; THE F'E RU I T A.•1 t.1 El Poi% HEREIN. 1 EI.1RTHER UNDER-
STAND THAT ANY I'+'ALSIFICAT1uN Oh FIT ;1;LT•IE,EN'''' !I2N HAY kt:.J'L.'I IN ':'III:: DENIAL OF THE
APPLICATION OR REVOCATION OF ANY PERM 1F' :RANT,,D LA: EID UPON :;;AID APPLICATION AND
Ill LEGAL ACTION FOR PERJURY AS PFUVIL}EL` 1:f LAW.
APPLICAT ON FEE 1265.00 m RK
RECD BY 4 CINDY SALAZAR /J(&e_,;,, - 1 Q ( 4,'} _______+ 7/08/94
ItiTE 07/08/94 ,C+WNER/AGENT SIGNATURE DATE
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No 4 r,�
P" If Weld County Health Department
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A. L ' ENVIRONMENTAL HEALTH
A' AI 151716TH AVENUE COURT
1 ' ,r 1 GREELEY.COLORADO 80631
(303)353-0635 d� • 1
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e:?' Dale — 199
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a 'fleceiv.: dl .. of / r. .. G.
t Address A C
A AMOUNT S / ‘3_ (3/)
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PAID ON
IN FULL .CCOVNf
♦ 41
SI
$ _ Weki County t ealth—depattnle t
C MONEY
s� " 3 'a a ¢Nei ,,:, CHECK', .0- 3 DRAFT ORDER I fY ;
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9 4170-212
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