HomeMy WebLinkAbout20092764.tiff ai32 ' _ -
i tivo STATE OF COLORADO, OFF.OF THE"ETATE ENGINEER • wvED
1. WELL PERMIT NUMBER 163306
FE$19'93
OrER NAMES) US Forest Service
ling Address Box 25127 wan�
City, St. Zip Lakewood. Co. 80225 STATE
Phone ( 303 ) 236-9470
3. WELL LOCATION AS DRILLED; SW 1/4 NW 1/4,81K. 9 Twp. 8 N .Range 58 W 6PM .
DISTANCES FROM SEC. LINES:
1500 fL from North
line. end 1100 R from Wears t Sec. line.
SUBDMSION: LOT BLOCK FILING(UNI1)
STREET ADDRESS AT WELL LOCATION:
4. PUMP DATA:Type . Submersible ka.aation Completed Nov. 9, 1992
Pump Manufacturer Red Jacket Pump Model No. 75CN1-12BC
Design GPM 5 at RPM 3450 . HP 3/4 , Vohs 208 230 Full Load Arnim 7.4
Pump Intake Depth 60' Feet, Dip/Cann Pipe Oita 11" . Inches, Kind PVC SOH 80
ADOMONAL R TURBINE DRIVER TYPE:LElecirlc �CEngine t_i Other
Design Head test, Number of Stages , Shalt size Inches.
S. OTHER EQUIPMENT;
Airline Installed 011080 No,Orifice Depth R . Monitor Tube Installed O Yes O No, Depth ft.
Flow Meter Mtg.+�I Meter Serial No.
L Meter Readout Gallons,0 Thousand Gallons, O Acre feet, 0 Beginning Reading
SST DATA: O Check bon h Test data is submitted on Supplemental Font.
Date Nov. 9, 1992
Total Well Depth 100 Time 3 hrs •
Static Leval 20 Rate (GPM) 5
Date Measured 11/9/92 Pumping Lvl. 0
7. DISINFECTION: Type ETU Dry Granular Chlorinator MIL Used 3 Cups
a Water Quality analysis ayailabla O Yes rel No
9. Remarks .
•
ID. 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) C.R.S., the making of false statements herein constitutes perjury In the second
degree and is pudshsble as a does 1 misdemeanor.)
•
CONTRACTOR Stewart Well Drilling, Inc Phone 303 522-1454 Ua Na 1234
Mailing Address 18921 Hwy 6 Sterling, Co. 80751
Name/Tide (Please type or print) Date r5
• Edward Anderson � .Y� 7' L `„r '- r-- �/ /
EXHIBIT
7
2009-2764
• y' . '• STATE OF COLORADO,•CE OF THE STATE ENGINEER • i
1 igo WIGS:VED
1. WELL PERMIT NUMBER 163306
2. OWNER NAME(S) 115 Forest Service FEB1 9'93
Mailing Address Box 25127
`City. St Zip Lakewood, Co. 80225 W
Saggit engoeigEH
Phone ( 303 ) 236-9470 moo..
3. WELL LOCATION AS DRILLED: SW 1/4 NW 1/4,Sec. 9 Twp. 8 N .Range 58 W 6PM
DISTANCES FROM SEC. LINES:
1500 ft from North . Sea Ilne. and 1100 ft from West Sec. line. OR
Nam a soul,) (mot a•*+s0 .
SUBDIVISION: LOT BLOCK FIUNG(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION N/A ft, DRIWNG METHOD Rotary I .
DATE COMPLETED Sept. 14, 1992 .. . TOTAL DEPTH 100 ft. DEPTH COMPLETED 100 It
5. GEOLOGIC LOG: EL HOLE DIAM. (in.) From (ft) To (ft)
Depth Omaakaan d MaarW (TYpm,Blaa C.ks,Warr tmlwd 12 " 0 _ •
•
0 — 2 Top Soil 8" 25 100
2 - 5 Sand & Gravel
- 28 Soapstone
2 - 39 Sand Streaks 7. PLAIN CASING
39 - 43 Soapstone OD (in) IGnd Wall Size From(It) To(ft)
43 - 92 Sand 8" Steel +1 �-
92 -100 Tuff Grey Shale 5)" PVC SCR 80 2y_ 38
PERF. CASING: Screen Slot Size:
5%" PVC SCE 80 38 100
•
S. FILTER PACK 9. PACKER PLACEMENT:
Material Gravel Type
• Size Buckshot
Interval 25-75 Depth
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: Cement N/A • 0-25 Mixed & Pourei
t1. DISINFECTION: Type HTH Dry Granular Chlorinator Amt. Used 3 Cups
12 MI LEA DATA: n Check box if Test Data Is submkted on Supplemental Form
TESTING METHOD Bailer
Static Level 20 ft. DateWTime measured 9/14/92 , Production Rate 6 gpm.
Pumping level 0 ft Date/fime measured 9/14/92 , Test length (hrs.) 3 hrs •
Remarks
•
13. I Mao mad dm brows mods Iambi and law the maw Woof.and that am am Thaw nM badge Mumma is Section 2444104(13J(41 C.0.&,em making
or taYm wawa-aaa MIN cccta .podgy Inglewood dogma and S p,WAuas an de t mudamsa...j
CONTRACTOR Stewart Well Drilling, Inc Phone 303) 522-1454 Lac. No. 1234 '
MailingAddrees 18921 Hwy 6 Sterling,Co. 80751
•)e/Tale (Please type or print) Signature / /,/,/ H
Edward Anderson kz .yam � Ate_ Date 5-I/ ()Ti.
Form km . OFFICE OF THE Jr ENGINEER •
GINS-25 COLORADO DIVI OF WATER RESOURCES
818 Centennial Bldg.. 1313 Sherman St. Denver,Colorado 80203
(303)888-3581
LIC•
WELL PERMIT NUMBER 163306 - -
APPLICANT DIV. 1 CNTY 62 WD 64 DES. BASIN MD _
Lot: Block: Filing: Subdiv:4382F1'20771.
APPROVED WELL LOCATION
COUNTY WELD
US FOREST SERVICE SW 1/4 NW 1/4 Section 9
BOX 25127 Twp 8 N , Range 58 W _6thP.M,
LAKEWOOD, CO 80225 DISTANCES FROM SECTION LINES
236-9470 1500 FL from North Section Line
PERMIT TO CONSTRUCT A WELL 1100 Ft. from West Section Line
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDRIONS 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.
Approved pursuant to CRS 37-92.602(3)(b)Ql)(A) as the only well on a tract of land of 40 acres described as the
SW 1/4 of the NW 1/4 of Sec. 9, Twp. 8 N., Rng. 58 W. of the 6th P.M., Weld County,
4) Approved for the watering of livestock on a farm or ranch.
5) The maximum pumping rate shall not exceed 6 GPM.
6) This well shall be constructed not more than 200 feet from the location specified on this permit.
-1h- 777. 3-Z3-9Z-
�PPROVED: 4® D .
MAM 7TTTvvwt �1Gf '.c_.��_ 'f'i'+.�,c;
Stn.Engineer (Acting) By
Receipt No. 0018787E DATE ISSUED MAR 2 5 1992 EXPIRATION DATE MAR 25 1994
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