HomeMy WebLinkAbout20260611 Permit # SE-9800068
Permit Type: Health/ Residential / Statement of Existing
Situs Street Address 14900 CR 36
Situs City, State, Zip
Sec/Town/Range: 09-03N-66W Application Status: RECORDED
Application Date: 06/29/1998
Parcel # (12 digits) 121109100023-R5313308
Owner Full Name: ANDERSON CHARLES T
Owner Address: 14900 WCR 36
PLATTEVILLE,CO 80651
Owner Phone #: 970-785-6594
Contact Name: ELLISON CARMEN
Contact Address: 1403 WCR 25 1/2
PLATTEVILLE,CO,80651
Contact Phone# 970-690-6209
Information above has been Verified in Accela by employee noted below
76X September 19, 2008 •
Processed by: Date
APS ..1!969 '
WR.1- 3 oil - STATE OF COLORADO
Index NcF .29'a' DIVISION OF WATER RESOURCES •4 f `Y,°l 1p
Iowa
ire' OFI4'!CE OF THE STATE ENGINEER
1 _
Use _ 1t'F01 1 4;?') 1019
Registered MAP AND S"i:ATEMENT FOR WATER WELL FILING 1 : 47, n
PERMIT NUMBER 36151 C/ j7#1 0it c
STATE OF COLORADO ) -.4` WELL LOCATiQN
SSA Jew
COUNTY OF ) Weld County
Know all men by these presents: That the undersigned NE 1/4 of NE ,L. , , sec. 9 ,
Edward and Ruth Fa Dill -. T. 3W R. b6, r 6, . P.M.
Rite •.,� ... .., .
clduLant(s), whose address ig, ,_ � INDICATE WELL,LQCATIQN ON DIAGRAM ,
City Platteville_ , Colorado 806S1 ,stares: NOR1F1' '
Claimant(s) is (are) the owner(s) of the well described hereon; 1 X
1 I
the total number of acres of land to be irrigated from this'well `--1 `�
t l
i s __. __....; work was commenced on this well by actual con- vi l 1. m
rd December I
I,' rn
struction__.-..2.3__.�day of ,19. , I
the yield to be used from said well is 20 (gpm), for ' +_ '_ I
I
II f
which claim is hereby made forte Domestic purposes;
that the oyerage annual amount of water to be diverted Is SOUTH
. -, 'acre-feet; and that the aforementioned WELL SHALL BE LOCATED WITH REFERENCE
TO GOVERNMENT SURVEY CORNERS OR MON-
statements are made ;Ind this map and statement are filed in UMENTS, OR SECTION LINES BY DISTANCE
AND BEARING.
compliance with the..ltaw; ';.:`: ' ' _________-_. _ft. from section line.
X (North or South)
_____- __._.�ft. from section line.
Claimant(s) ` -) i �_ __�
Subscribed before me on this _ . ._day of (East or West)
— — _ ....-_—.__._...... _, 19 ,
Ground Water Basin
My commission expires ..
Water Management
___.._______._-__ District_ .____._.
Notary Public
WELL DATA Domestic wells may be located by the following:
Date Completed December 261 1968 LOT_-__ _ _ , BLOCK
Static Water Level 6a.fart SUBDIVISION ____
Total Depth —_-_ 346 ft. FILING !ET
ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF COLORADO ON THIS
1
-^ �
State Engineer
FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM MUST BE AN ORIGINAL COPY ON BOTH SIDES AND SIGNED.
WHITE copy & GREEN copy must be filed with the State Engineer within 30 days after well is completed. PINK copy
is for the Owner & YELLOW copy is for the Driller,
A
WELL LOG WELL DATA
From To Type of Material Water Rotary
Type Drilling
0 2 Top soil HOLE DIAMETER:
2 17 Clay
17 18 Coal 8 in. from 0 ft. to 124 ft.
18 32 Clay
32 34, . Coal 4 7/8 in. from 124 ft. to 3)16 ft.
34 45 'Shale in. from ft. to ft.
45 47 Coal
1.7 64, Shale CASING RECORD
6I 65 Cap rock Cemented from 5 ft. tD 3.24 ft
65 94 Sandstone 5 ft. pit -'-_ ;" • • ..
94 140 Shale Plain Casing
140 142 Cap rock
31t2 152 Sandstone X Size 5' kindSteolfrom 0 ft. to 1214 ft.
152 168 Shale •
168 169 Cap rock Sizer,. kind__ from ft.` to ft.
169 172 Sandstone X
172 190 Shale Size, kind from ft. to ft.
190 220 Sandstone X
220 240 Shale Perforated Casing
240 270 Sandstone X
270 285 Shale Size , kind from ft. to ft.
285 346 Sandstone X � .: .
346 Cap rock Size kind from ft. to ft.
Si ze_, kind from ft. to ft.
TEST DATA
Date Tested Deograber 27, 1968
Type of Pump Submers.
Length of Test Four hours
Constant Yield 2)0 (GPM
Drawdown to 172 ft.
WELL DRILLERS STATEMENT
Cummins Well Works
being duly sworn, deposes and says:
he is the driller of the well hereon
described; he has read the statement
made hereon; knows the content there-
;..:;-.,^..,.
of, and the same is true of his own
knowledge.
644___- 47r
Use additional paps if n.c.ssary to compl.t• log.
License No. 73
State of Colorado, County of ) se
Subscribed and sworn to before me this day of , 19__
My Commission expires_ , 19 .
Notary Public
W-RJ-5'=68 STATE OF COLORADO DIVISION OF WATER RESOURC
A PERMIT TO USE GROUND WATER 4F41 , (;1319f8
A PERMIT TO CONSTRUCT A WELL d �j ! : p + iA �' '
APPLICATION FOR: C7 REPLACEMENT FOR NO. 64 0-410 C4La
C7 A PERMIT TO INSTALL A PUMP I�
L 7 OTHER r.,
PRINT OR TYPE LOCATION 0 WELL
APPLICANT Edward and Ruth F. Dill COUNTY Welid .
Street Address Route 'I NE . , NE �, sec. 9
City & State Platteville, Colorado 80651 T. . 3N , R. 66W 6 P.M.
Street or
Use of ground water Domestic Lot & Block
Owner of land on which well City or
is located Subdivision
Number of acres
to be irrigated Ground Water Basin
Legal description of ---- Water Management
irrigated land District
Other water rights on
this land LOCATE WELL ON THE BACK OF THIS SHEET
Owner of irrigated
land Driller Cummins Well Works No. 73
Aquifer(s) groundwater is to be obtained Driller's
from Gravel and Sandstone Address 121-13th St. Greeley, Colo. 80631
Storage capacity , AF
Signature of Applicant
THE FOLLOWING TWO FIGURES ARE MAXIMUMS AND
CANNOT BE EXCEEDED IN FINAL USE. CONDITIONS OF APPROVAL
MAXIMUM PUMPING RATE 20 GPM
AVERAGE ANNUAL AMOUNT OF GROUND WATER TO
BE APPROPRIATED Acre-Feet
ESTIMATED WELL DATA
Anticipated start of. drilling December 19 68
Anticipated start of use December 19 68
Hole Diameter: APPLICATION APPROVED:
8 in. from O ft. to -ohft. VALID FOR ONE (1) YEAR AFTER DATE ISSUED
L 7/8 in. from ?11 ft. to 350 ft, UNLESS EXTENDED FOR GOOD CAUSE SHOWN TO
THE ISSUING AGENCY
Casing: PERMIT NO. 36151 CONDITIONAL / /
Plain 5n in. from 0 ft. to 194 ft. 1
in. from ft. to ft. DATE ISSUED DEC 20968
None ;�'�'��,c �/'
Perf, in, from ft. to ft.
in. from ft. to ft. STA EN lN. R or CHAIRMAN GROUND
WATER COMMISSION
ESTIMATED PUMP DATA
Outlet By IRe,dat,
Type Submers HP 1 Size 11
APPLICATION MUST BE COMPLETED SATISFACTORILY BEFORE ACCEPTANCE
(OVER)
THE LOCATION OF THE PROPOSED WELL SHALL BE SHOWN ON THE DIAGRAM BELOW WITH
REFERENCE TO SECTION LINES OR GOVERNMENT SURVEY CORNERS OR MONUMENTS.
feet from (North or South) section line
feet from (East or West) section line
IF WELL IS FOR IRRIGATION, THE AREA TO BE IRRIGATED MUST BE SHADED OR CROSS-HATCHED.
This diagram represents nine (9) sections. Use the CENTER SQUARE (one section)
to indicate the location of the well .
T r 7 T I
- .+ _ + _ + _.f- +. +
I I I _ -I f - I
. - + — . + — + — + + +
. J.
- + - + -, + - + -
N
I I , I I d
2
- + - + 1 - + --- + -
- + - + - _l_. _ + + _ + _
I I + I I 1
- + - + - + + + i- + -,
I II I l i I ,
THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE-MILE
PUMP INSTALLATION AND PRODUCTION EQUIPMENT TEST REPORT For Office Use Only
Form No. State of Colorado, Office of the State Engineer
GWS-32 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581
10/2016 _.water.state.co us and dwrpermitsontineCstate.co.us
1. Well Permit Number: 36151- Receipt Number:9063824
2. Owner's Well Designation:
3. Well Owner Name:ROBERT ANDERSON
4. Well Location Street Address:14900 CR 36, PLATTEVILLE, CO 80651
5.GPS Well Location: *Zone 12 OZone 13 Easting:519117 Northing:4455142 County:WELD
6. Legal Well Location: NE 1/4, NE 1/4, Sec. 9 Twp. 3 f N or S n, Range 66 f E or W
Distances from Section Lines: ft. from Q N or S II sec. line, and ft. from II E or W II sec. line
Subdivision: , Lot , Block , Filing (Unit)
7. Check Installation Type: El Initial Pump Installation ®Replacement Pump OChange in Depth Only El Repair
8. Pump Data: Type: SUBMERSIBLE Date Installed(mm/dd/yyyy):02/06/2023
Pump Manufacturer: FRANKLIN ELECTRIC Pump Model No. 10FA1S4
Design GPM: 10 at RPM 3650 HP 1 Volts 230 Full Load Amps 9.8
Pump Intake Depth: 263 Feet, Drop/Column Pipe Size Inches, 1.25 Kind of Drop Pipe PVC
Additional Information for Pumps Greater Than 50 GPM: Turbine Driver Type:❑Electric Q Engine ❑Other
Design Head: feet Number of Stages: Shaft size: inches
9. Other Equipment:
Airline Installed:DYes a No, Orifice Depth ft. Monitor Tube Installed:IN es ONo, Depth ft.
Flow Meter Mfg. Meter Serial No,
Meter Readout:OGallons, DThousand Gallons, DAcre feet Beginning Reading
10. Cistern Information: Material: Capacity: gallons Date Installed:
11. Production Equipment Test Data: [1 check box if data is submitted on Form Number GWS-39 Well Yield Test Report.
Date: 2/6/23
Total Well Depth: 350 ft. Time: 13:00
Static Level: 29 ft. Rate (gpm): 10
Date Measured: 02/06/2023 Pumping Level (ft): 210
12. Disinfection: Type: STERILENE Amt. Used: 23 OZ
13. Notification: Was Advanced Notification Required Prior to Installation?EJYes QNo, Date Notification Given:
14. Water Quality analysis available: DYes U No If yes, please submit with this report.
15. Remarks:
16. I have read the statements made herein and know the contents thereof, and they are true to my knowledge. This
document is signed (or name entered if filing online) and certified in accordance with Rule 17.4 of the Water Well Construction
Rules, 2 CCR 402-2. The filing of a document that contains false statements is a violation of section 37-91-108(1)(e), C.R.S.,
and is punishable by fines up to $1,000 and/or revocation of the contracting license. If filing online, the State Engineer
considers the entry of the licensed contractors name to be compliance with Rule 17.4.
Company Name: Email: Phone w/area code: License Number:
QUALITY WELL AND PUMP kristie®qualitywellandpump.com (970) 353-3118 1461
Mailing Address: 39525 US HWY 85, AULT, CO 80610
Sign(or enter name i in online) Print Name and Title Date:
CHRIS JONES, OWNER 02/23/2023
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