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Home My WebLink About20092997.tiff 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-0400011 Sec/Twn/Rng: 25-02-64 Status: ISSUED Owner: REIS TONY & SHERRY Applied: 01/13/2004 Applicant: BARVISTA HOME CENTER/RONZAND PETER Issued: 01/27/2004 Permit Type: RNEW C=ommercial,R=Residential+NEW,REPair,VauLT Finaled: 17/i L /0 it Parcel#: 1305-25- - - ll( Location: 29825 CR 398 Legal Description: Installer: it\S UA 1 k 1 kj Ser V i G`e i Description: MODULAR Commercial: N Residential:Y Acres: 7 #of Persons: 2 Basement Plumbing: Y #of Bedrooms: 4 Bathrooms - Full: 3 3/4: 0 1/2: 0 Water Public: N Water Source: Water Private: Y Cistern: N Well: Y Well Permit#: 253316 liolation Rate: 72.7 Limiting Zone: 8 ft 0 in Description: GROUNDWATER Ground Slope: 1 Dir: SE Soil Suitable: (Y/N) N Engineer Design Required: (Y/N) Y In 100 Year Flood Plain: (Y/N) N Minimum Installation Chambers Septic Tank: 1250 gallons Absorption Trench: 0 square feet or Absorption Bed: 3200 square feet Actual Installation Septic Tank: rasa gallons Absorption Trench: square feet Absorption Bed: &9'fta square feet �{& Design Type: caa aas`zr- NOTICE The issuance of this permit does not imply compliance with other state,county or local regulatory or building requirements,nor shall 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 non transferable and non refundable. The Weld County Department of Public Health and Environment reserves th< 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. E iro tal Health Specialist Date Form:S_FINAL 2009-2997 • WELD COUNTY BOARD OF HEALTH ENGINEER DESIGNED SYSTEM REVIEW PROPERTY OWNER: Tony and Sherry Reis PERMIT NO.: SP-0400011 (New) LEGAL DESCRIPTION: PT: SECTION:25 TOWNSHIP: 2 RANGE: 64 SUBDIVISION: LOT: BLOCK: FILING: SITE ADDRESS: TBD WCR 398, Keenesburg FACILITY: Residential 4 Bedroom home ACRES: 7 PERC RATE: 72.7 SOIL: Unsuitable WATER SUPPLY: well LIMITING ZONE: at grade, clay; 8', groundwater XXX ENGINEER DESIGN (3.5) EXPERIMENTAL DESIGN (3.14) ENGINEER: High Plains (Todd Schroeder) ADDRESS: ESTIMATED FLOW: G.P.D. 900 PRIMARY TREATMENT: Standard tank CAPACITY: 1250 gallons DISPOSAL METHOD: Absorption/ET bed SIZE: 3200 square feet REQUEST FOR VARIANCE: STAFF COMMENTS: The system is adequately sized for the proposed load. STAFF RECOMMENDATION: Approval ENVIRONMENTAL PROTECTION SPECIALIST: Deborah Blandin REVIEWED BY BOARD: 01/27/04 B.O.H. DECISION: APPROVED: ✓ DENIED: TABLED: • Chairman Weld County Board of Health O:IPAMUsds Shells\boh engineer review.doc • • I Form No. OFFICE OF THE STATE ENGINEER GWS-25' COLORADO 13 DIVISION 13 Sherman St.,Denver, OF WATER 818 Centennial• 3 (303)866-3581 - LIC WELL PERMIT NUMBER 253316 DIV. 8 WD 1 DES. BASIN 5 MD 9 APPLICANT APPROVED WELL LOCATION WELD COUNTY NW 1/4 NW 1/4 Section 25 CRAIG&TAMMY ANDERSON Township 2 N Range 64 W Sixth P.M. 7956 CR 59 DISTANCES FROM SECTION LINES KEENESBURG, CO 80643- 250 Ft.from North Section Line 1110 Ft.from West Section Line (303)732-0800 UTM COORDINATES PERMIT TO CONSTRUCT A WELL Northing: Easting: 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 ensure 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 37-90-505. 4) Water from this well may be used for domestic purposes inside 1 single family dwelling(s),and the watering of the Illowners own large non-commercial domestic animals. 5) The pumping rate of this well shall not exceed 15 GPM. 6) The annual withdrawal of ground water from this well shall not exceed 1 acre-foot. 7) The irrigated area shall not exceed 1 acre of lawn and garden. 8) Production is limited to the Laramie-Fox Hills aquifer which is located 595 feet below land surface and extends to a depth of 865 feet. Plain casing must be installed and grouted to prevent the withdrawal of ground water from other aquifers and the movement of ground water between aquifers. 9) The depth to the top of the Laramie-Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from zones immediately above the aquifer,plain casing and grout shall extend through the lowermost coal and/or carbonaceous shale that overlies the Laramie sand portion of the aquifer. 10) This well must be constructed within 300 feet of the location specified on this permit. 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. PROVED aliMigin~ State Engineer By Receipt No.0515914 DATE ISSUED 10-06-2003 EXPIRAT N 10-06-2005 • • COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(0612006) DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST,RM 818,DENVER,CO 80203 phone—info:{303)866-3587 main:(303)866-3581 fax:(303)866-3589 http://www.water.state.co.us0 'JUL1 �nhn GENERAL PURPOSE 009 WATER RESOURCES Water Well Permit Application STATE ENrEEP Review instructions on reverse side prior to completing form. COL., The form must be completed in black or blue ink or typed. 1.Applicant Information 6. Use Of Well(check applicable boxes) _ __ Name of appricant Attach a detailed description of uses applied for. Less dustrial Otheesc... - .,7 ❑Municipal X7e6/676417a/ C7.5C' 9' ❑Irrigation �? � .�/� Gam'_ 39V_ . i Sta Zip code Commercial Ted e / _(//yri i E.m we ... �F'v _ ... _.... .. 7.Well Data(proposed) -- - ----- -- / 1 (Optional) ... _ .. .. ") 7.5'.V) }�� c�LS Ni d, /` Maximum pumping rate Annual amount to be withdrawn l( 2.O3 �j (�! ,i gpm 2.Type Of Application(check applicable boxes) __—.__.___ __ __,_• --•_,._.•._` ©I U' acre-!eel T;,tai depth Aquifer ❑ Construct new well }$Us • g welt ..4-2 �/ ❑Replace existing wet hange increase use feet ❑Change source(aquifer) pplication(expired permit) 8. Land On Which Ground Water Will Be Used ❑Other: Legal Description(may be provided as an ettaohmem) 3.Refer To(if applicable) wen permit 4 wale.Court case a � 33 Izec �xe��r eE 34-e! 5/71-Its l Designated Basin Determine if if _ Well name or C "144 l .,99e2-C. 39 weld r` 4. Location Of Proposed Well - - - — (If used for crop irrigation,attach a scaled map that shows Irrigated area.) County --------- ------ .. ._. eSection //1f/P+ / N tI�tf4 of the N fV 114 A. a Acres B. OnerL S^l .. p_ ge - .. cal Meri_ .._.. ..4 _.4.-.�perry ,?pis Township N a S Ran E a W Principal Meridian •_ �� ) W❑ ' / ❑ig[ j / �` C. List any other weds or water rights uses on this lams d ry Sri O el ii,/Do 119 03 distance of Wes from section lines Ise(:tlsrl*nee are typically not property arias) 1/e4 Well Ft.from ❑$ 0 Ft.from❑E w 7- ..._�.S�.._..-. -_-�!`�--...__-,��-f _ __ •---__..... .._ ..._�_ . 9. Proposed ell Driller License#(optional):�x�� For replacement wells only-distance and direction from old well 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(Include City,state,Zip) k if well address is same as in item 1. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. i 9-S. ...7-..5--`,L;c-/e 3 el c 24-4-104(13)(a). I have read the statements herein,know the contents J` thereof d state that they are true to my knowledge. �'2] �J� __ -..5..- v-be --- - u ... .-. '�`>`L.7� �/ �. i_ _�---._-...- .------._-.-- Sign h si on al signature) Date Optional: GPS well kocat' in rmation in UTM format You must check GPS unit for required settings as follows: �i9 6`2.09 Format must be UTM n e 8 ti 1e —-- _.-pZonel2orDZone13 7 Units must be Meters Fasting /7'/7j-�( t -f s [.�i�✓/�l�w/ Datum must be MADe3 Office Use OnI Northing — .—...._......... ..... _. . -..._.. .... .._. .. Unit must be set to true north USGS map name • DWR map no. Surface elev. Was GPS unit=meted for above? O YES Remember to set Datum to NA083 5.Parcel On Which Well Will Be Located Receipt area only - - (PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description may be provided as an attachment): .pr N w Li 25-- Z-G.,4-1 t- /4 Trans Number;;it$419ali P ivy Ex dtrt 12.E - 3q i 5 .: i oS : 7/31/2009 9:09:08 AM Mike Corrigan('15) 9b 2. .39 6 C=,/' lei • Total Trans Amt:$1013.00 CHECK Cheek Number: 1186 (Sr eittgc.4.,. e.t _ _-C .Arneatt Si ,ot1... B. u of acres in pa7 W E el C. Owner �jC �+/�/` WR •.D Witt • this be the only well on this par el YES ❑NO tif no.list other wells CW CB T0P0 E. state'Parcel IDe(optional); MYLAR S85 DIV WD 8A MD • • • STATE OF CO, WATER RESOURCES 131;3 SHERMAN, 81H FLOOR DENVER, CO 80203 Phone: ;103-866-3581 Fax: 303-866-2'223 Sales Receipt Transaction #: 364.1956 r►me; 9:09:09 AM Cashier met: Register #: 1 item========== ===============Description Amount 14 Newt• pi -. . ..$100 GO Tutu! $100.00 CHECK#1156 Tendered $100.00 Change Due $000 tank you • • Colorado Division of Water Resources Application Receipt No. 1313 Sherman St.Rm.818 Denver,CO 80203 Applicant's Name ___— (303)866-3581 http:/twater.state.co.us/detault.htm• SUPPLEMENTAL INFORMATION FOR SMALL CAPACITY COMMERCIAL WELL PERMIT APPLICATIONS (For Wells Located Within Designated Groundwater Basins) Small capacity commercial well permit applications are evaluated pursuant to the provisions of CRS 37-90-105, which allows for Ong well in gig commercial business. Pending approval, the use of this proposed well for a commercial business having another small capacity commercial well is prohibited. This supplemental information form is necessary in order to determine whether your application qualifies within the provisions of this statute. Please answer the following questions using type or black ink. If additional space is needed, identify the question number on a separate sheet, then attach to this form. This form must be signed and dated below. 1. Name the type of business this proposed well will serve. e 6f��_,i ///,3 211,?r [�c.ji^ell/-74,1_, 2. Will you own and operate this proposed well and the commercial business )/e5 • If not, please explain who will own and operate this well and the business served by this well? _ 3. Do you qualify as one commercial business as defined under CRS 37-90-105(1)(c)(ll)(see below for referenced statute). e.S. 4. Do you c6rrently have a valid permit for any other small capacity commercial well inside any Designated Ground Water Basin in Colorado? /) f • • If so, please provide the permit number(s) of any valid permit(s)you have. I (we) have read the statement made herein, know the content thereof, and state that they are true to my (our) knowledge. [Pursuant to section 24-4-104 (13Xa) C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a Class 1 , .. �misdemeanor.r.]] Name/Title (pri or type): / ?-7 "j, :� y L� c 627s-. '7 ,J,c.��' -- �> fry ��C'-,�C„,'il�, Signatur . 9 ._-- L4 Date: 7 Z) c i Under CRS 37-90-105- Small Capacity Wells, paragraph(1)(c)(II)reads as follows: To qualify as a "commercial business" under this paragraph (c), the business shall be: (A) A business that will be operated by the well owner and that will have its own books, bank accounts, checking accounts, and separate tax returns; (B) A business that will use water solely on the land indicated in the permit for the well and for the purposes stated in such permit; (C) A business that will maintain its individual assets and will own or lease the property on which the well is to be located or where the business is operated: (D) A business that will have its own contractual agreements for operation of the business; (E) A business that agrees not to transfer a permit issued under this paragraph (c)to another entity that also holds a small capacity commercial well permit under this paragraph (c); and 0 (F) A business that agrees to notify any potential buyer that such buyer shall notify the state engineer of any change in ownership of such business within sixty days after any such change in ownership. GO/S-58 12/00 ID • Colorado Division of Water Resources Application Receipt No. 1313 Sherman St Rm 818 Denver,CO 80203 Applicant's Name (303)866-3581 http:/twater state.co.us/defautt.htm • COMMERCIAL SMALL CAPACITY WELL WATER USE BREAKDOWN WORKSHEET (For Wells Located Within Designated Groundwater Basins) Name and Type of 7 // / Business /Y—i Tcfll r7reu117, •Ic , 01-At''' ) /)c; 6lcxr,i/ /�j')(/t"7i.7 1. Is this application for a new well? Yes ,> No If no, is this application for a change of use for an existing permitted well? X Yes Permit Number of well(if applicable) a 5 3 3/ Q No For wells used prior to May 8, 1972 see form GWS-12 Registration of Existing Well tot further information. 2. Type of disposal system: Septic tank/absorption leach field Central System (district name) Vault(location sewage hauled to:) Other(attach copy of engineering design) ,' 3. Water Demand Calculations (for average factors for water demand see below) Employees Number of Employees ' X Number of Gallons per X Number of Days Employee = Gallons per Year Employee per Day Woricsper Year I X /5 • X , c. n�3 = 61 ,c (� A • Customers I Number of X Number of Gallons per - X Number of Days Business = Gallons per Year Customers per Day _ Customer is Open per Year X 3 o ~X O2&Io = 5/ cc�o B Outside Square Feet of X Number of Gallons per X Number of Days landscape = Gallons per Year Irrigated Landscape square foot per day _ is irrigated " /4O X IQ X !D = / 4 9 C Other Uses-Provide breakdowns for all other substantial water use(i.e. veterinary clinic, green houses, etc.) Type of Use I X Gallons per Use per X Days per Year I = I Gallons per Year vH Day 4,411 q lfCl?,cl X few X .. e)C' _ _ _.may 0oa D d Total amount of water required: 9Z ?Cie-) gallons per year t✓ (A+s+C+D) sin,/c Ai'`/�y 1O&.&e//ii - /3,rr r '002-8 acre-ft per year At/✓ems (1 acre-ft= 325,851 gallons) For all small capacity commercial wells: 7;9T/ p/r a‹,/,4?/≥- ii 1. The pumping rate shall not exceed 50 gallons per minute and may be further limited by Water Management District Rules. • General Guidelines for Water Demand in Gallons per Day Day Workers at Offices-15 gallons/person/day Food Service Establishments(with toilet and kitchen wastes)-10 gallons/patron/day Churches(does not include food service)-5 gallons/seat/day Overnight Lodging-50 gallons/customer/day Landscape Irrigation—45 gallons/1,000 square feet/day On-Site Proprietor of Overnight Lodging(i.e.on-site owner of a Bed&Breakfast)-80 gallons/personlday Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject. GWS-61 03/03 COLORADO DIVISION OF WATER RESOURCES GWS-E DEPARTMENT OF NATURAL RESOURCES 03/03 GUIDELINES FOR DETERMINING SMALL CAPACITY COMMERICAL WATER CONSUMPTION INSIDE /I • DESIGNATED GROUNDWATER BASIN 2. The amount of ground water diverted shall not exceed 5 acre-feet annually except where Ground Water Managemi District Rules allow up to 80 acre-foot annually. 3. The return flow from the use of the water must be discharged to the same stream system in a location so as to not inji any vested water right. 4. The well must be the only commercial well serving this business and may only serve this business. 5. The parcel on which the well would be located, must be: (a) Thirty-five (35) acres or more in size (A legal description, in the form of a metes and bounds description o surveyor's map of the parcel must accompany the permit application); (b) If less than 35 acres, the parcel must have been established prior to June 1, 1972, if less than 35 acres, or m be exempt from the definition of a subdivision pursuant to Section 30-28-101(10)(c) and (d), C.R.S. (A copy c deed describing the parcel and dated before June 1, 1972, or a copy of the signed county resolution exempt the parcel, must accompany the permit application); or (c) Located in a subdivision approved on and after June 1, 1972. (The recommendations made by this office in I water supply review process of that subdivision will be honored.) 6. A totalizing flow meter must be installed on the well. Permanent annual diversion records must be maintained by I well owner and submitted to the Division of Water Resources and the local Ground Water Management District applicable)upon request. • • CONDITIONS STATEWIDE VARY-MEETING THE ABOVE CONDITIONS DOES NOT GUARANTEE THE ISSUANCE OF A FERMI JAN-26-04 MON 05: 11 PM 'VISTA HOME CENTER LLC FAX NO. .36570409 P. 02 Form "~ -STATE OF COLORADO •_•^•. For Office Ute Only ^. ..._.-7 • No. OFFICE OF THE STATE ENGINEER GWS-11 816 Centennial Bldg., 1313 Sherman Si, Denver.CO 80203 06/00 (303)0663581 Fax(303)86B-3589 CHANGE IN OWNERSHIP/ADDRESS ..r-;VEi CORRECTION OF THE WELL LOCATION - Insert the Well Permit Number a 5 53316____,....... *I,Fhpav ea ?ft flit cr "M r Name.address and phone of the person dairtpag. v_ elsttig of the wAlf: C NAME(S)AN1�e.H tSlflent B e t . Si 6 1.��_� / �� /� If your well has an absolute water rigbt,decreed • Mailing Address f by the court and the well is not registered with the State Engineer,eater the Water Cowl Cane City,St Zip 7647<-2,777/7 Ve 1'at ACCIn Number/Civil Action Number and well number // as decreed. Phone eL) �a7-e5 7/Co _ _ This form is filed by the named Individual/entity claiming that they are the owner of the well permitted as referenced above. This filing is made pursuant to C.R.S.X374`0443. _ WEfL LOCATION: County W c-\ ck Owner's Well Designation (Address) (City) (State) (Zip) • ,,,W_1/4 or the Wa-1 114,Seca�, Twp._a_.56 N. or❑S., Range (4 _❑E.or U W., P.M. Distance frQm Section Lines 457) Ft. From"] N. or Q S., I //0 FL From[]E.or W.Line. I Subdivision Name Lot ,Block , Filing/Unit • r--- above listed owner(s) ( )say(s)that , she(they)own the well described herein. The existing record is being amended for the following reasons: Change in name of owner O Change in mailing address ❑Correction of location for exempt wells permitted prior to May 8, 1972 and non-exempt wells permitted after • May 17, 1965. Please see the reverse side for further information regarding correction of the well location._ , I(we)claim and say that I(we)(are)the owner(s)of the well described above and that the commencement of^^ extraction of ground water from this well,lawfully made under the well permit,occurred on the date indicated,and that the statements made herein are true to my (our)knowledge. Please print the Signer's Name&Title Si re(s)oft new owner. � > Date / It is the responsibility of the new owner of this well to complete n the form. Signatures of agents are original letter of agency signed by the owner is attached to the form upon its receipt.9� acceptable if an For Mee list Only y - -- -thi �. .__� 4:I. PSI ID. WELL CONSTS 1ON AND TEST REPORT • For ariw Use GVitS32 Iov. STATE OF COLORADO,OFFICE OF THE STATE ENGINEER 1. WE L PST NUMBER A533 Ito • 2.OWNER NAME(S) ;ran d-T ("'(1y Rtv. CZSON d Milling Address \5l o C.n o rA ?i.. R n 7 m, City, St.Zip Feet.)- 3uQ(- o eat.& 3 I Phone )-T33-NaCn t U,.L a WELL LOCATION AS DRILED: 1 ) 1/4 14. 01/0.Sec. o`er. Twp. a 1•1 ,Range W-i. lC . DISTANCES FROM SEC. LINES: art R from Kielytk Sec. Om. and I l 10 it.from 5 . kne. OR mom norm _ SUBDIVISION: LOT BLOCK FILING(UNIT) . STREET ADDRESS AT WELL LOCATION: 4. .GROUND SURFACE ELEVATION R DRILLING METHOD O-CF1Ry DATE COMPLETED f \kea-4 LA r}-4 . TOTAL DEPTH -I50 t DEPTH COMPLETED -1a5 R 5. GEOLOGIC we: 6.Hain(in.) From 01) To O 15(ft) Depth CesaiptIon d WSW(Type,art Wear Location) K� Lr-1. mop. L C(a a5-k & ( - (S,-Leo (a r T.PLAIN CASING Ltn- y(( .J►L Sm1d woo Mild WalSize From(R) T1-�� KLLQ-teNt. ___4 ._ 51 :el .In t_ stW f5D-Usl rate u& i-a.nc1 4S3-QV E ‘0It. 441.1-481 PERF.CASING:Sawn Slot Sae:3IIb • 4M- 52M 1% S1z'r 1 .i n (.45 1st% 514-�--i;k c< k 5t2-LQo-( d '-oIL._ Stake TODD idyl nr (t - a FUER PACK: 9.PAIR PLACEMENT: Materiel Type KAber Sae interval _ Depth 0 4160 (,95 r 141 GROUTING RECORD: Man Density Interval placement REMARKS: f 8 2s.s. 7-to J 9 /s6 Yitr yso ,b /5a ‘001-61/20.5. *n S 11. D ECTI0N: Type j -T 4a Amt. Used 5 ou ri c e 5 12 WELL i to i DATA: ❑Check bort H Test Data is stinted on Form No.GWS 39 Supplemental Wag Test. TES1WG METHOD Ada stave Level a. Datefline measured n'o.r y Dd , Production Rate. /S apn. Pumping level R Date/Time measured ('ice 44 04 .Test length(hrs.) 7 445 , Remarks 13. I taw reed the+'-Merull matte Wain and thaw the contents tared,end that they am tea to my knowledge.POwnurt to section a44SM(13)(a) C.AB.,the waking of lie st rrwta herein enratiltda palely in the second degree and is puiehake as a ales t niedawerrora CONTRACTOR Agk.noAa et:IR-,yani Phone(719 )925-,$3V tic. No./2Sr . • Marina Address Po (1 /029 El mat, Le as �t , Name/rale(P Type or print) Datei 2G-0T CRD‘jeq} EAs4uxaoel li • NMI NM . PUMP INSTALLA71ON AND 7EST REPORT For omo•Use only 4442_ raw ' : STATE OF COLORADO, OFFICE OF THE STATE ENGINEER _. ;.,.,_ ; • 1. WELL paw NUMBER a53311, JUL 2 2004 • 2. OWNER NAME(3) CIS-4.14 ICI n- t ffl rn ANNE 2 WW % -css Malang Address r1C15(Q Cc. r `'sTrei " -�• Cty,St DP W JESR1 vat, lit o�� a.:a. Phone(.-n) --race- r i rn 3. WELL LOCATION AS DRILLED: Nu21/4 Nu) 1/4.Sec. ate, Twp. a �i Range Lek �. DISTANCES FROM SEC. UNES: o S tt.firm (�Q R( Sec. line.and l 1►c' flan tlw Sec. ine. tnaa�mac SUBDIVISION: LOT BLOCK FIUNG(UNTT) STREET ADDRESS AT WEIL LOCATION: ' 4. PUMP DATA Type l(3 Installation Completed_ %JtAJv . 5 uy Pump Manufacturer R i. Pump No. w . . Design GPM RPM Pump e Depth h sas Feet,Drop/Column IAm1 P Pipe Size _i Kind C "-taw V ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM: , TURBINE DRIVER TYPE: ❑Electric O Ergi e [ Ottrer Design Head ni lest, Number of Stapes , Shat eke inches. 5. OTHER Anne installed O No,Orifice Depth R. . Monitor Tube Instated O Yes O No,Depth ft Flow Meter Mtg. Meter Serial Na • Meta Readout]Gallons,O Thousand Gatkats,O Acre lees,O Beginning Rearing a TEST DATA: O Check box i Test data is admitted on Supplertnertal Form Date ..i tirrt,y • Total Wei Depth `1 Tine _ (t+Static Level Hale Date Measured 4 Pimping LvL `i 14t 7. DISINFECTION: Type R114 Amt Used tali) a water Quality anal/sit available.O Yes i!l No a Remarks • la I have read the statements made herein and know the contents thaac t, and that they are true to my knowledge. (Pursuant to Section 244-104 (13)(4) C.R.S., the making d false stetanents herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] �" es ^ceo vW L ki-i. �`-C f `lleCi-�lrc I tic. No.tI Mangi TOR ' �L1( � - L.J ( q • • MaiW,r�t�g'"A�dct4ss x (lR0 1RTa it .� A�1(15 r-, / Site 7L, / 27aJ LOCATION: NW1/4 OF NW1/4 OF SEC. 25, T.2N. , R. 64W. (250 NSL, 1110 WSL) LOCATION IS WITHIN THE LOST CREEK DESIGNATED GROUND WATER BASIN Ground Elevation: 4940 Number of Acres: 7 • ELEVATION DEPTH TO ANNUAL NET APPROP STATUS AQUIFER BOT. TOP SAND BOT. TOP A-F UPPER DAWSON ---- ---- ---- ---- ---- ---- --- LOWER DAWSON ---- ---- ---- ---- ---- ---- --- DENVER ---- ---- ---- ---- ---- ---- --- UPPER ARAPAHOE ---- ---- ---- ---- ---- ---- --- LOWER ARAPAHOE 4757 4879 50 .4 183 61 0. 60 NNT JLARAMIE-FOX HILLS 4075 4346 133 .6 865 594 1 .40 NT note: E indicates location is at aquifer boundary and values may be more approximate. • Hello