HomeMy WebLinkAbout20093094.tiff • WATER WELL INFORMATION
WELL PERMIT # 96966 11/14/1978
WELL PERMIT # 96967 11/14/1978
(ABANDON 11/4/2004)
WELL PERMIT # 60734 F 11/4/2004
•
•
2009-3094
02/25/2004 16:33 ELPR OMPLIRNT SUCS -r 913038663565 • 1,40.156 002
aeu-75•75
?et Ill6 6E
COLORADO DIVISION OF WATER RESOURCES
• 'MP( OP BIB Certennlal.Blde., 1313 Sherman St. .t 90F6m3�
POINT IM;LOCO In
COP.,Or "CCEPTEO Ornvrrr Celinedr 80203 •
En
emy nCNT salt'I) •
OM REQUEST. STATE OF COLORADO AFFIDAVIT
55.
COUNTY OF WEL()
_STATEMENT OF BENEFICIALUSE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
— LATE REGISTRATION •
PERMIT NUMBER 9494G LOCATION OF NELI •
/THE AFFIANTIS) saermie Li e14'& i Cnspb._ ceuus WEL°
whole moiling
oddre s s is 2. N. TNetiA9Pt SC w a+w tat M. s.ar....
Cott' A0 9A S ..P. J/ .V , a^ ea. faLte e,.
being duly sworn wean oath, deposes and Joys That he (they) is lore) the owners) of the well described hereon, the well is
locoed as described above, ar distances of /7/R foes from the .162[r2i--d_ section line and /400 feet from Ihr
I...-. .. snv-.t
I)fQSr section line; water horn this.well was,fir St applied la a beneficial use for the putpose(s) described herein en the
day of OCTOB.BR 19.31,; the moiimum sustained pumping rota of she well is _.C.gallons oar minute, the pumping
rare claimed hereby is _•gallons per minute; the'Noel depth of the well is /DD leer; the overage annual amount
• of water to he diverted is 2.c acteleet; for which claim.is hereby mode ler flange. aawtwe.eps&er.F sal:tsi;s
e. Fhb,€Jeusr-r-� purpose(s);the legal description of the land tin which the water from this well is used is
S `S ts.. S / L — /1-1/ 2- 44 - W / Alsoeouet7Ty laioetr1 a of which
0 acres ore irrigated end which is illustrated on the mop en the reverse side of this form; that this well was completed in
compliance with the permit creme *Sot; this statement of beneficial use of ground wirer is filed in compliance with low; he
(they)has (hove) rood 1 stote m ado batten; knows the content thereof; and that the same are true of his (their) knowledge.
(COMPLETE REVERSE SIDE OF THIS FORM)
Signotund s)
Subscribed and warn EOM OFFICE USE ONLY
�y' i
to before me on this d-Sytgoy of ,(l.� �. 1P'r�"/
(/ Cowl C....No'
My Commission expires: Oy-/�y Do0
•ua ap
C
:4t, WA. IN a a rA [sv6c -=S' .t, /aid est to'r23 7.. - • C...
Rp`TCf::CO NG BY THE STATE ENGINEER OF COLORADO
. LLOWINOcONDlTIONS;WANT
•• wais Us, .
s4
tP•Y f` ,' � M..
A 2. r.• ,.'•'�.f
C'Y'
• •
Dori FoCiNEFR
J WRJ-25.75 S 41 (/RECEIVED
� '� ` COLORADO DIVISION OF WATER RESOURCES NUV 141978
TYPE.OR • 818 Centennial Bldg., 1313 Sherman St. yf
PRINT IN BLACK INK.
AUR Mina
Y OF ACCEPTED Denver, Colorado 80203
TEMENT MAILEDGU
REQUEST. STATE OF COLORADO AFFIDAVIT
55.
COUNTY OF Weld
X STATEMENT OF BENEFICIAL USE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
LATE REGISTRATION
PERMIT NUMBER 96966 LOCATION OF WELL
Colorado Interstate Gas Company (A
THE AFFIANT(S) Division of Coastal States Gas) co.., Weld
whose mailing
address is P. 0. Box 1087 SE PI,Ise NW ., section 5
City Colorado Springs, Colorado 80944 Two. 11 N , Rng. 66 _ W PM
Is..rcl 'zip) IN DR S1 Er 0, WI
being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well is
located as described above, at distances of 1710 feet from the north PVT l section line and 1900 feet from the
biomVp DA west section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the 1St
(CA'? on vc,TI
day of October , 19.2a; the maximum sustained pumping rote of the well is 15 gallons per minute, the pumping
rote claimed hereby is _ 15 gallons per minute; the total depth of the well is 900' feet; the average annual amount
•water to be diverted is 24 acre-feet; for which claim is hereby mode for Exempt Industrial
purpose(s); the legal description of the land on which the water from this well is used is
Part of the N1 . Section 5. T11N, R66W of 6th P.M. . Weld County. Colorado of which
0 acres are irrigated and which is illustrated on the mop on the reverse side of this form; that this well was completed in
compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he
(they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge.
(CQMPLETE REVERSE SIDE OF THIS FORM)
_ ({'�1-�fl l l tip l H
Si gnotuCe(5'/" --�sl\., J lx-s*^"tl cs^�lt f
5ubscvibed_cnd sworn 1 /� a� FOR OFFICE USE ONLY
to beforelne Oh-lilts' 19'"day of ? '-1A/ l , 197A
l` Coon Cosa No.
Myl;'ommisaian.expires ' February 1 , 1982
l,r•.1 _ Prior. _ Mo._ Day Yr.
i.
e,pao e. - -
.. „ eua Div. / Cly. 62
ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO
PURSUANT TO THE FOLLOWING CONDITIONS: 5n. se / u. IA. u.
Well Use'Se
Disr.V/. _ Boa in Mon. Dis. •
• .
earl STATE ENGINEER BY
.
•
• Well drilled by Stewart Drilling Company Lic. No, 66
Permanent
Pump installed by Am West Well & Pump Inc. Lic. No. 676
1r' Badger Model SC-ER-C
Meter Serial No. 14306515 ® Flow Meter Date Installed 11-22-78
Owner of land on which
water is being used Colorado Interstate Gas Company
THE LOCATION OF THE WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE
AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW.
This diagram represents nine (9) sections. Use the CENTER SQUARE
(one section) to indicate the location of the well, if possible.
I I I I I 1
— + — + — .+ — + + — + —
I I I I I
— + — + — -I- — + — + — + —
NORTH SECTION LINEI I {
NORTH•
+ - L
+ -
IIILX
a + r
W I I 1
SOU�H SECTION LI1IE
J
- + - + - + - + + - -
- .-,
I I I I I I, r.
THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE-MIL E
— + — + — -F + + + '
( I ---11 M i le;-'-, ,
WATER EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covers 1 acre of land 1 foot deep. -
1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm).
1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons.
1,000 gpm pumped continuously for one day produces 4.42 acre-feet.
•
100 gpm pumped continuously for one year produces 160 acre•feet.
(WHITE AND PINK COPY PINK COPY WILOL BE BE FRETURNED TOILED WITH E STATE ENGINEER
OWNER)
• •
Form STATE OF COLORADO
No. OFFICE OF THE STATE ENGINEER
GWS-09 821 Centennial Bldg., 1313 Sherman St., Denver,CO 80203 RECEIVED
06/00 (303)866-3581 Fax(303)866-3589
WELL ABANDONMENT REPORT N0V 0 4 2004
Type or print In black Ink.
WATER RESOURCES
96967 STATCOENOCINEER
Well Permit Number of the well being plugged •9V
Individual/Company responsible for oluoaina and sealing the well.
NAME(S)DREILING DRILLING COMPANY, INC.
Mailing Address P O BOX 638
City,Si.rip FORT MORGAN,CO 80701
Phone( 970 ) 867-7160
ACTUAL WELL LOCATION: County Weld
Properly Address
(Address) ((Citty) (Stale) (zip)
NW 1I4 of the NE 114,Sec.5,Twp. 11 ® (N.or❑S.,Range 66 1 I E.or®W.,6 P.M.
Distance from Section Lines 750 Ft.From ® N.or❑S., 1660 M.From®E.or❑W.Line.
Subdivision Name Lot ,Block ,Filing/Una
I(we)report that an existing well was plugged and sealed for the following reason(s):
® The well was plugged and sealed as required under Well Permit Number 60734 F
OThe well was not in use and was plugged and sealed.
❑ Other(please explain)
The date the well was plugged according to the Water Well Construction Rules was 9/1/04
The well was plugged with the following materials placed at the indicated intervals:
Amount and Type of Material Method of Placement Interval
16,200 lbs of 3/8 Gravel POURED from feet to feet
5 yards Concrete POURED from feet to feet
from feet to feet
from feet to feet
Intervab or easing removed/ripped in feet from 400 feet to 500 feet
I (we)have read the statements made herein, know the contents thereof, hat t are true to my(our)knowledge.
Please print the Signer's Name&Title Si at 9r. 1 Date
A.GREGORY DREILING,PRESIDENT �(
DREILING DRILLING COMPANY,INC X
11-02-04
It is the responsibility of the well owner to have the well properly plugged and sealed.The Well Construction Contractor is
responsible for notifying the owner of this requirement.
•
02/25/2004 16:33 ELPRS•MPLIR4T SVCS a 913038663589 • NO.156 003
vat.g5.t5 R-er.— -$ 96,67
COLORADO DIVISION OF WATER RESOURCES # 90060.33
• TYPE OR BIB Centennial Bldg., 1317 Sherman St.
PRIMP ,N DLACF One
COPY OF ACCEPTED Denver. Colorado 80201
ST Al Ent AT NAILED
Or. QEOUES1. STATE OF COLORADO SS AFFIDAVIT
COUNTY OF SU)
STATEMENT OF BENEFICIAL USE OF GROUND WATER
1C AMENDMENT OF EXISTING RECORD
LATE REGISTRATION
PERMIT NUMBER ? 9L7 LOCATION OF WELL
THE AFFIANT(S) &Alnraan LI*4 -r 6aC Cospm.1t :o.•Ir . WSLO
.hne moiling
address Is 2 N. MOAAA SC $el rnr WI F, kti e.,
city . Colonio Sretsl _ ._ 1.O.. Rogn1 t.,, JI... N. .Err. ' .a w• 1.0
•
row, fifbeing duly sworn upon oeth, deposes and soy' Ito) he Obey) is (we) the owners) of the well described hereon, the well ,s
located os described above, at distances of 1900 feet from the 1r46rat ._ section line and 2O40 feet lrom the
WKST' section line; wore, from Ibis.well was first applied to a beneficial use far the purpose(s) described herein on the at
toy of 0a4efetttr t r 19.21; the makimum sustained pumping tore of the well is _gallons per minute. the pumping
rote claimed hereby is , se) sailor's per minute; the total depth of the well is 900 lot; the average annual amount
• of water to be diverted is tO acre-lest; for which claim is hereby mode far 4a. Pease.y ;ae ,, nn➢fyks.
s Ore frwteed:x purpose(s); the legal description of the land an which the water from this well is used is
Sec.ra , r /1-1/, X' (,(s' Ij4/ , ifLJ�4D tramp, Celletad. of which
_acres ore irrigated and w is illustrated on the map an the reverse side of this form; that this wall was completed in
compliance with rho per ii oppr Therefor; this stotoman, of beneficial um of ground water ;s Filed in compliance with low; he
(they) has (hove. read r slo s mode hereon; knows the content thereof; and that the same arc true of his (their) knowledge.
(COMPLETE REVERSE SIDE OF THIS FORM)
Signature's)
Subscribed and con FOB OFFICE USE DtlLY
to before me on his�14"day of t9. 5/
- Cart No
My Commission expires: . O/C 9-"dontZ'f
o _Der _..r
ee
• f d�J
`•!C ,. .\ d4),,,7t 1.Lite I37dles rL stns D,.. C,,.
`'' ACgDP'tED.FOILING BY THE STATE ENGINEER OF COLORADO
OR pSUANTTo:f,tFOLLOWINGCONDITIONS: 5•r __ , 'r. _..___ R
•
vS
• (�g�\E'v 'ery __ en., M. p.,, __._.
O
rFOF COV .,
•
W11.025-75 • t._
Gt- ~` ' COLORADO DIVISION OF WATER RESOURCES RECEIVED
fYPE DR 818 Centennial Bldg., 1313 Sherman St. f NOV 1 41978
INT.IN BLACK INK_
PY OF ACCEPTED Denver, Colorado 80203
ATEME NT MAILED
N REDues T. STATE OF COLORADO I Ar
SS.
COUNTY OF Weld r Sr----
X STATEMENT OF BENEFICIAL USE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
LATE REGISTRATION
PERMIT NUMBER 96967 LOCATION OF WELL
Colorado Interstate Gas Co. (A
THE AFFIANT(S) Division of Coastal States Gas) county Weld
whose mailing
address is P. 0. Box 1087 SE n of the NW u, Section 5
City Colorado Springs, Colorado 80944 Two. 11 N , Rne. 66 _ W 6th PM
Is..e[1 (Ur) IN OR sl IF OR WIC
being duly sworn upon oath, deposes and says that he (they) is (ore) the owner(s) of the well described hereon; the well is
located os described above, at distances of 1900 feet from the north section line and 2040 feet from the
IRORte RI ROLM°
wesj section line; water from this well was first applied to o beneficial use for the purpose(s) described herein on the 1St
(CAST OR west)
day of October , 1978 ; the maximum sustained pumping rote of the well is 15 gallons per minute, the pumping
rote claimed hereby is _ 15 gallons per minute; the total depth of the well is 900 feet; the average annual amount
water to be diverted is 24 acre-feet; for which claim is hereby made for Exempt Industrial
,purpose(s); the legal description of the land on which the water from this well is used is
Part of the Nk, Section 5, T11N, R66W of 6th P.M. , Weld County, Colorado of which
0 acres ore irrigated and which is illustrated on the mop on the reverse side of this form; that this well was completed in
compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he
(they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge.
T�-�) (� (CO�M�IPLETE REVERSE SIDE OF THIS FORM)
Siggnature(s) -� t/.\r. 5111.0 0uNt�
SuTsscri4ed and sworn ,�i ''nn FOR OFFICE USE ONLY
to before me"-on this /3 day of f 04,49/rn 144) , 197e,,/
\111 Court Case No.
-My Commission-expires; February 1, 1982
Is[gel _� „ ^ la
J /C Pner. Mo. Day __Yr.
- I o[.RT e /atue Div. Cty. 620.
ACCEPTED FOR FILING BY 7HE STATE ENGINEER OF COLORADO
PURSUANT TO THE FOLLOWING CONDITIONS: See.__/� — P., h.•
Well Use V
Dist.4.— Basin Mon. Di,. .
•
•
DATE STATE ENGINEER BY
• •
. �.
• Welt drilled by Stewart Drilling Company Lk. Na. 66
Permanent
rump installed by Am West Well & Pump Inc. Lic- No. 878
1" Badger Model SC-ER-C
Meter Serial No. 14306516 ® Flow Meter Date Installed 11-11-78
Owner of land on which
water is being used Colorado Interstate Gas Company
THE LOCATION OF THE WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE
AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW.
This diagram represents nine (9) sections. Use the CENTER SQUARE
(one section) to indicate the location of the well, if possible.
I _— I I -- I I I 1
— + — ± -- + — + + — + —
r I I I
— + -I- + — -1- — + + -t- -E
NORTH SECTION LINE
`
' NORTH
r
me
N III
nEl !
Zr— — m
SOUTH SECTION LIFE
— + — + — + — + — + ____-
THE SCALE OF THE DIAGRAM IS TWO INCHES EalALS ONE-MILE ..
— + — + — — + — -1- — + — _
( , --1� M i I e�--- , ,
WATER EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covers 1 acre of land 1 foot deep.
1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm).
1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons.
• 1,000 gpm pumped continuously for one day produces 4.42 ocre•feet.
100 gpm pumped continuously for one year produces 160 acre-feet.
(WHITE AND PINK COPY TO PINK COPY WILL BE BFRETURNED TO OWNER)
ENGINEER
FORM NO. PUMP INSTALLATION AND TEST REPORT For Office 'EL'�111ED
cNs9z
Iona STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
e. WELL PERMIT NUMBER 60734 F NOV 0 4 2004
2- OWNER NAME(S) Cheyenne Plains Gas •
WATER RESOURCES
STATE ENGINEER
e
COLO.
Mailing Address 2 N Nevada
City,St.Zip Colorado Springs,CO 80903
Phone( 719 1 520-4774
3. WELL LOCATION AS DRILI ED' NW 1/4 NE 1/4, Sec. 5 Twp. 11 N , Range 66 W
DISTANCES FROM SEC. LINES:
750 ft.from NORTH Sec. line. and 1660 ft.from EAST Sec.line.
(north or south) (oast or wean
SUBDIVISION: LOT BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. PUMP DATA. .Type SUBMERSIBLE Installation Completed 10-13-04
• - Pump Manufacturer .- HYDROFLO Pump-Model No. ' -5854019
Design GPM 35 at RPM Vanable Hp 20 , Volts 460 ,Full Load Amps 30
Pump Intake Depth 828 Feet, Drop/Column Pipe Size 3 Inches,Kind Galv steel
ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM:
TURBINE DRIVER TYPE: ❑Electric ❑Engine ❑ Other
Design Head feet, Number of Stages , Shaft size • inches.
5. OTHER EQUIPMENT: -I
Airline Installed❑Yes®No, Orifice Depth ft. Monitor Tube Installed ❑Yes ILVNo, Depth ft.
• Flow Meter Mfg. MICROMETER I Flow Jet l� Meter Serial No. (,/3 yk5O6 .. .w
Meter Readout®Gallons,f (Thousand Gallons,{ 1 Acre feet,❑Beginning Reading 0000
6. TEST DATA: El Check box if Test data is submitted on Supplemental Form.
Date 10-13-04 10-13-04
Total Well Depth 905 Time 12:00 P.M. 4:00 P.M.
Static Level 355 Rate (GPM) 32 GPM 32 GPM
Date Measured 10-13-2004 Pumping Lvl.355 590 ft
7. DISINFECTION:Type HMI Amt. Used 40 oz
8. Water Quality analysis available.CI Yes ®No
9. Remarks Tested Water at 3 soft. This pump is variable-speed drive set at 32 gpm and will hold 35 psi
10. 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 punishable as a class I misdemeanor]
CONTRACTOR A.GREGORY DREIUNG Phon 970) 677160 Lic. No. 1207
Mailing Address P.O.BOX 638 FORT MORGAN, CO 807
,Name/Title(Please type or print)CONTRACTOR Sign ur 1 /PRES. Date
A. GREGORY DREIUNG ORE NG NG C .,IN 11/2/04
FOAM
WO.FOAM, WELL CONSTRUCTION AND TEST REPORT For Office Use only
10111.4 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
3 RECEIVED
. WELL PERMIT NUMBER 60734 F NOV 0 4 2004
2. OWNER NAME(S) Cheyenne Plains Gas
Mailing Address 2 N Nevada WATER RESOURCES
STATE ENGINEER
City, St. Zip Colorado Springs,CO 80903 COLO,
Phone( 719 ) 520-4774
3. WELL LOCATION AS DRILLED: NW 1/4 NE 1/4,Sec. 5 Twp. 11 N , Range 66 W
DISTANCES FROM SEC. LINES:
750 ft. from N Sec. line. and 1660 ft.from E Sec. line. OR
(north or south) (east or west)
SUBDIVISION: LOT BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION 5883 ft. DRILLING METHOD MUD ROTARY
DATE COMPLETED 10/8/04 TOTAL DEPTH 1020 ft. DEPTH COMPLETED 905 ft.
S. GEOLOGIC LOG: 6. HOLE DIAM. (in.)From(ft) To(ft)
Depth Description of Material(Type,Size,Color,Water location) 30 0 15
0-13.5 Sand-Gravel and Rock 15 15 465
13.5-125 Brown Chippy Clay with Sand slits 101/4 465 925
125-160 Sand and Gravel
160-210 Brown Clay 7. PLAIN CASING
210-330 Brown Clay with Sand,Gravel and Rock OD (in) Kind Wall Size From(ft.)To(ft.)
330-365 Brown Clay _ 16 STEEL .250 +1 15
365-435 Brown Clay with Sand;Gravel and Rock r '• 10 3/4 - STEEL .250 +1 465
435-500" Stky Clay Brown "6 STEEL 250 +2 620
c00-565 Multi-Colored Clay Sandstone " 65/8 • STEEL. .250 Varied as 905
585 • •Grey Shale Coal STK -PERF.-CASING: Screen Slot Size •.030 •
900 Grey Shale with Sandstone layers.. _ - - ' - 6 5/8 " sr-sr SCREEN 1000 rr c.a. 620 . 660
900-1020 Grey Shale -._. 6 5/8 sr-sr SCREEN tone rr pm 690 710
6 5/8 sr-sr SCREEN loan rr c.a 750 • 770
6 5/8 srsr scREEN inn rr Ca 840 900
8. FILTER PACK 9. PACKER PLACEMENT:
Material SILICA SAND Type
Size 10-20
Interval 580-1020 Depth
• 10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: CEMENT 56 Sack 7 GAL 460-up TREMIE PUMPED
CEMENT 26 Sack 7 GAL 580.ap TREMIE PUMPED
11. DISINFECTION: Type HTH Amt. Used 40 oz
12 WELL TEST DATA: I I Check box if Test Data is submitted on Form No.GWS 39 Supplemental Well Test.
TESTING METHOD Submersible Pump
Static Level 355 It. Date/Time measured 10-9-04 , Production Rate 69 . gyn..
Pumping level . • 650• ft:DateR"ime measured . 10-9-04 . - ' .'Test length(hrs.)
..
13. 1'have read tlostatements merle toreimand know the mordents thereof,and that h_ey are true to my knowledge.Ipu,cuiint to Section 2H-104(13)(a)
C.R.S.•the asking of lake statements herein corsteutes perjury in the second degree and is punoheble as a class t misdemeanor.] '
. CONTRACTOR A.GREGORY DREHING,PRESIDENT ph ►970 t: 7-7160: Lie. No. 1207•
Mailing Address • • , ' , Jr '
me/Title(Please type or print) C0NTRACTORA. Sig l lur "4-/PRES. Date
GREGORY DREILING DRE G LING CO.,INC. 11/02!2004
FORM NO. PUMP INSTALLATION AND TEST REPORT For omo.UM OMy °ECFI)VED
Gwsa
10194 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER NOV 1 '
. 1. WELL PERMIT NUMBER 60734 F 2011!
/ �, S
2- OWNER NAME(S) Cheyenne Plains Gas • C Mailing Address 2 N Nevada0 Fra:,,,ER
,
City, St.Zip Colorado Springs,CO 80903
Phone f 719 1 520-4774
3. WELL LOCATION AS DRII LED; NW 1/4 NE 1/4, Sec. 5 Twp. 11 N , Range 66 W
DISTANCES FROM SEC. LINES:
750 ft.from NORTH Sec. One. and 1660 ft.from EAST Sec. line.
(north or south) (east or we-)
SUBDIVISION: LOT BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. PUMP DATA. .Type SUBMERSIBLE Installation Completed 10-13-04
Pump Manufacturer HYDROFLO Pump Model No. 5S34019
Design GPM 35 at RPM Variable HP 20 Volts 460 Full Load Amps 30
Pump Intake Depth 828 Feet, Drop/Column Pipe Size 3 Inches,Kind Galy stir
ADDITIONAL INFORMATION FQR PUMPS GREATER-�TlHAT 50 GPM:
❑ l
TURBINE DRIVER TYPE: Electric ❑Engine I I Other •
Design Head feet, Number of Stages , Shaft size inches.
5. OTHER EQUIPMENT:
Airline Installed❑Yes®No, Orifice Depth ft. Monitor Tube Installed ElYes`' No, Depth ft.
• Flow Meter Mfg. MICROMETER Flow Jet Meter Serial No. 43 �/F?]pie
Meter Readout®Gallons,I lThousand Gallons,El Acre feet,❑Beginning Reading 0000
6. TEST DATA: ❑Check box if Test data is submitted on Supplemental Form.
Date 10-13-04 10-13-04
Total Well Depth 905 Time 12:00 P.M. 4:00 P.M.
Static Level 355 Rate (GPM) 32 GPM 32 GPM
Date Measured 10-13-2004 Pumping LvI.355 590 ft
7. DISINFECTION:Type HTH Amt. Used 40 oz
B. Water Quality analysis available.Elves ®No
9. Remarks Tested Water at 3 soft This pump is variable-speed drive set at 32 gpm and will hold 35 psi
10. 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 punishable as a class I misdemeanor.]
CONTRACTOR A.GREGORY DREILING Phon- 970) 67-7160 Lic. No. 1207
Mailing Address p.o.BOX 638 FORT MORGAN,CO 807 /
• NameRtle (Please type or print)CONTRACTOR Sign- urj/ i ( t /PRES. Date
I A.GREGORY DREIUNG DR r NG[r ' LING C .,INC. 7 11/2/04
• • Qrn
'°"a"°' WELL CONSTRUCTION AND TEST REPORT For OmcaUaeonty
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER Nov 21�0�
1313 Sherman St.Rm 818 Denver.CO 80203
• Pittifitcil
WELL PERMIT NUMBER 60734 F sr-
2. OWNER NAMES) Cheyenne Plains Gas1(l`v\//�,Mailing Address 2 N Nevada
City, St. Zip Colorado Springs,CO 80903
Phone ( 719 ) 5204774
3. WELL LOCATION AS DRILLED: NW 1/4 NE 1/4, Sec. 5 Twp. 11 N , Range 66 W
DISTANCES FROM SEC. LINES:
750 ft. from N Sec. line. and 1660 ft.from E Sec. line. OR
(north or south) (east or west)
SUBDIVISION: LOT BLOCK FILING (UNIT)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION 5883 ft. DRILLING METHOD MUD ROTARY
DATE COMPLETED .10/8/04 TOTAL DEPTH 1020 ft. DEPTH COMPLETED 905 ft.
S. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To(ft)
Depth Description of Material(Type,Size,Color,Water Location) 30 0 15
0-13.5 Sand-Gravel and Rock 15 15 465
13.5-125 Brown Chippy Clay with Sand sacs 101/4 465 925
125-160 Sand and Gravel
160-210 Brown Clay 7. PLAIN CASING
210-330 Brown Clay with Sand,Gravel and Rock OD (in) Kind Wall Size From(f1) To(ft.)
330-365 Brown Clay 16 STEEL .250 +1 15
365-435 Brown Clay with Sand,Gravel and Rock 10 3/4 STEEL .250 +1 465
435-500 Stky Clay Brown 6 5/8 STEEL .250 +2 620
500-565 Multi-Colored Clay Sandstone 65/8 STEEL .250 v....4 as 905
Grey e o PERF. CASING: Screen Slot Size: .030
900 Grey Shale with Sandstone layers 6 5/8 sr-sr scream moo rr con 620 660
1020 Grey Shale 6 5/8 n.sr SCR KEN ueo rr cm. 690 710
6 5/8 srsr SCREEN too,n co. 750 770
1
6 5/8 sr.sr SCREEN rota IT Ce. 840 900
8. FILTER PACK 9. PACKER PLACEMENT:
Material SILICA SAND Type
Size 10-20
17 Interval 580-1020 Depth
jrn 10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: CEMENT 56 Sack 7 G,u,
sup TREMIE PUMPED
CEMENT 26 Sack 7 GAL 580ap TREMIE PUMPED
•
11. DISINFECTION: Type 11TH Amt. Used 40 oz
12 WELL TEST DATA: LI Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
TESTING METHOD Submersible Pump
Static Level 355 ft. Date/ lime measured 10-9-04 Production Rate 69 gpm
Pumping level 650 ft. Date/Time measured 10-9-04 , Test length(hrs.) 6
Remarks
13. 1 have read the statements made herein and know the contents thereof,and that they am roue to my knowledge.pursuant to Section 244-104(13)(a)
C.R.S.,the making of false statements herein constitutes perjury In the second degree and is punishable as a class 1 misdemeanor]
CONTRACTOR A.GREGORY DREILING,PRESIDENT Ph 970 7-7160 Lie. No. 1207
Mailina Address 38>1
tarne/Title(Please type or print) CONTRACTOR Sig tur 1 1 N/PRES. Date
•
lir GREGORY DREILING DRE G LING CO.,INC.9 11/02/2004
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• •
• SEPTIC INFORMATION
PERMIT # 820024G 2/12/1982
PERMIT # SP-0400219 4/12/2005
PERMIT # SP-0800235 2/5/2009
Weld County Environmental Hem) services ueoarune
•
• 1555 N. 17th Aven'
�a( •A • Greeley, CO 806:
IIMD�°M,
/�► Phone: (970) 304-64
Septic Permit - Final Fax: (970) 304-64
www.co.weld.co.
Finaled
golication Number: SP-0800235 Status: Ready to Final
App Type: Health\Commercial\New\Septic Applied: 11/25/2008
Applicant Name: WOLFGANG WEGNER Issued: i I Z7j 09 ,
WEGNER HOMES Flnaled: zl51Q 9
4319 KINGSBURY DRIVE
FORT COLLINS, CO 80525 •
Owner Name: COLORADO INTERSTATE GAS CO •
Parcel#: 020305000007-R0265987
Legal Desc: 19642-A A TRACT OF LAND IN N2 511 66 BEG AT A PT 1321'E &S0D06'E 705.5'FROM NW COR
OF SEC THENCE S0D06'E 1939' N89D52'E 2599.76' N02D59'E 1934' N89D54'W 1265.8'THENCE
DUE W 1438'TO BEG SITUS: WELD 000000000
Site Address: 65657 HIGHWAY 85
Ann Specific Info:
1/2 Bathrooms
0
3/4 Bathrooms 0
Application Date 11/25/2008
Associated Building Permit
Associated Building Permit Number
Basement Plumbing No
Full Bathrooms 2
Location Description 65657 HIGHWAY 85
Number of Bedrooms 0
umber of Persons 4
ther Water Supply Utility •
Parcel Acres 40
Private Water Supply Well
Private Water Supply Permit Reference
Number
Public Water Supply No
Public Water Supply Utility
Repair Reason Type New
Septic Permit Expiration Date
Waive Fees No
Waive Fees Comment
Year Installed
EHS Perc Test (Site):
Engineer Design Required Yes
Engineer Evaluation Received
Engineer Job Number
Engineer Letter Received No
Ground Slope
In 100 Year Flood Plain No
Limiting Zone Feet 7
Limiting Zone Inches 6
Limiting Zone Qualifier Equal To
Percolation Rate Qualifier Equal To
Percolation Rate Value 26.2
Slope Direction
Soil Description
Soil Type Suitable Yes
Variance Required No
LD COUNTY DIII_RTMENT OF PUBLIC HEALTH ANDENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE(970) 304-6415 FAX (970) 304-6411 Finaled
limit#: SP-0400219 Sec/Twn/Rng: 05-11-66 Status: ISSUED
Owner: CHEYENNE PLAINS GAS PIPELINE CO LLC Applied: 06/17/2004
Applicant: li BERRY RANDON J Issued: 07/27/2004
Permit Type: CNEW C-Commercial,R'-Residential+NEW,REPair,VauLT Finaled: ii !?
Parcel#: 0203-05- - -
Location: 65627 HWY 85, CARR CO 80612
Legal Description: 19642-A A TRACT OF L AND IN N2 5 11 66 BE
G AT A PT 1321TE& S ^^
Installer: 1719kCt $ ,c v r is Gffer a.
Description: OFFICE
Commercial: Y Residential:N Acres: 10.5
#of Persons:. 12 Basement Plumbing: N
# of Bedrooms: 0 Bathrooms - Full: 0 3/4: 0 1/2: 1
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit#: 60734-F
Percolation Rate: 20 Limiting Zone: 0 ft 0 in Description: COBBLES
�0 o Ground Slope: 0 Dir: Soil Suitable: (Y/N) N
gineer Design Required: (Y/N) Y In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers*
Septic Tank: 1000 gallons Absorption Trench: 0 square feet
or Absorption Bed: 561 square feet
Actual Installation
Septic Tank: Ir.r,o gallons Absorption Trench: square feet
Absorption Bed: -z square feet t
Design Type: 4 .o A . Chamber Model sc
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 25-10-11l l (2).
This permit is non transferable and non refundable. 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\ficontingent upon the final inspection of the completed system by th eld County of Public Health and Enviro nt.
• nvironmental Health Specialist Date
Fam:S_FINAL
WELD COUNTY HEALTH UEYANI inn' 0 �U�7 4_,..1now
+ `� • ENVIRONMENTAL HEALTH SERVICES q Repair
806IZ 151! Hospital Road, Greeley. CO 8003
d 7 353.0540 EXT. 270 BP
i � '' / 5��/ CADDRESS _ ' PHONE
ODRESS OF PROPOSED SYSTEM 3 a..L d) /V i CCZ /-7( `�f
EOAL DESCRIPTha�l QF SITE: PT r" 1 S T_ R___._' 63-G57/ 66"8zS F(dS�2
SUBDIVISION LOT___ , BLOCK , FILING
USE TYPE: RESIDENTIAL __. INSTITUTION
I COMMERCIAL '. , ' OTHER
SERVICES: PERSONS BATHROOMS -LOT SIZE
BEDROOMS BASEMENT PLUMBING WATER SUPPLY
TYPE OF SEWAGE DISPOSAL REQUESTED: r="'Z -' '
Applicant acknowledges that the completeness of this application li conditional upon further mandatory and additional tests
and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the
I- Weld County Health Department for purposes of the evaluation of the application; and the Issuance of the permit Is subject
to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10,
r- Title 25,CRS 1973,as amended.The applicant certifies that the proposed system will not be located within 400 feet of a com-
munity sewage system.The undersigned hereby certifies that all statements made, Information and reports submitted here-
with and required to be submitted by the appllcant'Yre, or will be, represented to be true and correct to the best of my knowl-
edge and billet, and are designed to be relied on by the Weld County Health Department In evaluating the same for purposes
of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial
of the application or revocation of any permit granted based uponpaic appncation and In legal action for perjury as provided by law.
L. t �..
Appucstlon fee (..)
Reed by v", 4f fr i'1A.l,'-.1-' Date - , OwnerlAgent Signature Date
I' • • • • • ♦ it • • * • • •,.'• • * • • • • • • • • • • • • • • • • • • ♦ • • • • • ♦ • ♦ ♦ ♦ ♦ • ♦ • • * R *
FOR DEPT. PERCOLATION RATE_ t "' '0 /ninh WATER TABLE DEPTH > SUSE ONLY 901E TYPE
S-,17 ' £4ni7'S PERCENT GROUND SLOPE C ?L' 9`
REQUIRES ENGINEER DESIGN ( )YES( ) No _ _
• INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
From the application information supplied and the on-site soli percolation data, the following minimum installation specifi-
cations are required:
SEPTIC TANK /j 0170 GALLONS, ABSORPTION TRENCH ,20-47 SO. FT.
ABSORPTION BED 16 8 so. FT.
In addition,this Permit is subject tc the following additional terms and conditions:
This Permit is granted temporarily to allow construction to commence.This Permit may be revoked or suspended by the Wei(
County Health Department for reasons set forth in the Weld County individual Sewage Disposal System Regulations, includini
failure to meet any term or condition imposed thereon during temporary or final approval. The Issuance of this Permit does no
constitute assumption by the Department or Its employees of liability fort liure or Ina u of the sewage disposal system
IC a-1:•f — Date
nvlronment I ecielist
This Permit Is not transferrable and shall become void II system construction has not commenced within one year of its issuance
Before Issuing final approval of this Permit the Weld County Health Department reserves the right to impose additional term
and conditions required to meet our regulations on a continuing basis. Final Permit approval is contingent upon the final it
spection of the completed system by the Weld County Health Department.
SYSTEM CONTRACTOR FINAL INSPEC N -7
SYSTEM ENGINEER Chin/ ?j4SsociaAi- APP O AL �/ Q UV �� ! 7 ��
ev,cc' Aci ms ' o- 2_/i 3 Envlronmhntal ssspeclall t Date
The issuance of this Permit does not imply compliance with other state, county or local regulatory or building requirement
• nor shall it act to certify that the subject system will operate In compliance with applicable state, county and local regulatior
adopted Pursuant to Article 10,Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of f
installed system for issuance of a local occupancy permit pursuant to CRS 1973 25.10.111 (2).
Original-Applicant;Copy-WCHD WCHD—EHS February, 191
ISCALE AS N07EU DRAWN BY CL LUNDY I1 i ^
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