HomeMy WebLinkAbout20082247.tiff "` WELL CONS�CTION AND TEST REPORT For Office Use only
rOS 31
�"10/94 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1. WELL PERMIT NUMBER 196791
•OWNER NAME(S) Gerald. Allen Ewing
Mailing Address 405 N. Whitcomb
City, St. Zip Ft. Collins, CO 80521
Phone ( 970) 493-2685
3. WELL LOCATION AS DRILLED: SE 1/4 SW 1/4, Sec. 29 Twp. 9 N , Range 67 W
DISTANCES FROM SEC. LINES:
810 ft. from south Sec. line. and 1920 ft. from west Sec. line. OR
(norm or sown; teast or west
SUBDIVISION: LOT BLOCK FILING(UNIT) .
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Standard Rotary .
DATE COMPLETED 9-16-96 . TOTAL DEPTH 660 ft. DEPTH COMPLETED 660 ft.
5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft)
Depth Description of Material (Type,Size,Color,Water Location) 11 0 20
8 20 660
0 - 2 Topsoil
2 - 37 Small gravel & Rock
37 14 Rusty, buff colored clay 7. PLAIN CASING
143 - 144 Hard limestone OD (in) IGnd Wall Size From(ft) To(ft)
144 - 446 Gray shale with some very 6 5/8" steel .250 1'above 20
lightly cemented sandstone 4 1 2 pvc .250 5' 520
streaks
446 - 515 Dark gray colored sandstone
• 515 - 6.50 Light gray 'colored sandstone PERF. CASING: Screen Slot Size: .02
650 - 660 Hard, gray colored shale 4 1/2 pvc .250 520 660
a FILTER PACK 9. PACKER PLACEMENT:
Material Gravel Type
Size 1/M C'
Interval 180' - 660' Depth
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: Cement 20 cuft 6 gal 0 100'
Bentonite 3 cult 7 gal 100 180
11. DISINFECTION: Type H.T.H. Amt Used 12 ozs.
12. WELL TEST DATA: ❑Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
TESTING METHOD Bailor .
Static Level 250 ft. Datelrme measured 9-16-96 , Production Rate 8 _gpm.
Pumping level 280 ft. Date/lime measured 9-16-96 • ,Test length (hrs.) one .
Remarks
I have read the statements made herein and know the contents thereof, and that they are true to my knowledge.(Pursuant to Section 244164 (131(a)
C.R.S.,the making of false statements herein constitutes perpay in the second degree and is punishable as a class 1 misdemeanor.]
CONTRACTOR Leh Dril 11ng. Inc. Phone ( 970 LS3472868 tic. No. 21
Mailing Address P.O. Box Ault, CO 8061G
Name/Title (Please type or print) S I Date
.i v Rin n T.wa)+_ .Tr. - Prwcirtwnt �� v-t Q_^va
2008-2247
=25 COLORADO DMSION OF WATER RESOURCES •
818 Centennial Bldg., 1313 Sherman St, Denver,Colorado 80203
(303) 866-3581
21
•
WELL PEANUT NUMBER 148791
APPLICANT DIV. 1 CNTY. 62 WD 3 DES. BASIN MD
Lot: Block: Filing: Subdiv:
APPROVED WELL LOCATION
WELD COUNTY
GERALD ALLEN EWING SE 1/4 SW 1/4 Section 29
405 N WHITCOMB Twp 9 N RANGE 67 W 6th P.M.
FT COLLINS CO 80521-
DISTANCES FROM SECTION LINES
(970)493-2685 810 Ft. from South Section Line
1920 Ft. from West Section Line
PERMIT TO CONSTRUCT A WELL
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDRIONS OF APPROVAL
1) This well shaH 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 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 80 acres described as the
E'h, SW 1/,, Sec. 29, Twp. 9 N., Rng. 67 W., 6th P.M., Weld County.
4) The use of ground water from this well is gmited to ordinary household purpoccs inside up to 3 single family
dwelfrtgs,the protection,the watering of poultry, domestic animals, and livestock on farms and ranches,and the
irrigation of not over one (1) acre of home gardens and lawns.
5) The maximum pumping rate shall not exceed 15 GPM.
6) The return flow from the use of the 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 permit.
2O. 7h. 7-23 —F4
R\u Eh
a OP`I
•
APPROVED
MAM ,ilte z • 4-' 1°
_2777/ 271M11,---
Receipt No. 0402572E DATE ISSUED J U L 2 5 1996 EXPIRATION DATE jut 2 51998
4
WELD COUNTY HEALTH DEPARTMENT
1517 16TH AVENUE COURT, GREELEY, CO 80631
•
(970) 353-0635 EXT 2225 FAX (970) 356-4966
Permit # : SP-9600445 Sec/Twn/Rng: Status: ISSUED
Permit Type : KNEW C-commercial, R=residential r NEW, REPair, VauLT
Applied: 08/15/1996
Parcel No: 0453 29 Issued: 08/27/1996
(40 LUCfZ (6(j Finaled:
Location: illuaLY\-
Legal Desc :
APPLICANT EWING GERALD ALLEN
OWNER EWING GERALD ALLEN Phone : (970) 493-2685
405 N WHITCOMB, FT COLLINS CO 80521
SEPT-INSTL SELF Phone : (970) 999-9999
X, GREELEY CO 80631
Description: MODULAR HOME
Commercial (Y/N) : N Residential (Y/N) : Y Acres : 80 . 00
Number of Persons : 3 Basement Plumbing (Y/N) : Y
Number of Bedrooms : 3 Bathrooms-> Full : 2 3/4 : 1/2 :
Water Public (Y/N) : Utility Name :
ler Private (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y
Water Permit No: 196791
Percolation Rate : 10 . 5 Limiting Zone : >08 ft 00 in Desc :
Ground Slope : Dir: Soil Suitable (Y/N) : Y
Engineer Design Req'd (Y/N) : N In 100 Yr Flood Plain (Y/N) :
Minimum Installation
Septic Tank: 1000 gal Absorption Trench: sq. ft .
Absorption Bed: 711 sq. ft .
Actual Installation
Septic Tank: toc-o gal Absorption Trench: sq. ft .
Absorption Bed: 136; sq. ft .
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 Health Department 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 Health Department.
X it41. Iv//(ictE
En ironer ntal Specialist Da e
•
WELD COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL PROTECTION SERVICES DIVISION
1517 16TH AVENUE COURT, GREELEY, COLORADO 80631
f'
353-0635
NOTICE
•
his individual sewage disposal system has been inspected and appears to have been
installed in accordance with the regulations regarding individual sewage disposal
systems in Weld County, Colorado.
APPROVED
Owner Location
Permit No. Date Environmental
Specialist
19-4170-162
•
Hello