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Home My WebLink About20222322.tiffMEMORANDUM TO: Chris Gathman, Planning Services FROM: Mike McRoberts, P.E., Development Review DATE: April 12, 2022 SUBJECT: USR22-0012 Knote The Weld County Development Review has reviewed this proposal. Staff comments made during this phase of the application process may not be all-inclusive, as other issues may arise during the remaining application process. COMMENTS GENERAL PROJECT INFORMATION/LOCATION Project description: A Site Specific Development Plan and Use by Special Review Permit for Oil and Gas Support including Outdoor Storage Yards for Oil and Gas Equipment in the A (Agricultural) Zone District. This project is south of CR 20 and is west of and adjacent to CR 23. Parcel number 131123000045. Access is from CR 23. ACCESS Development Review has reviewed the application materials and Weld County Property Portal and determined that the subject parcel has one (1) existing, permitted, residential access (AP19-00429) on CR 23. This access is located approximately 1,545 feet south of CR 20 and meets the 330 -foot minimum access spacing requirement for a Weld County collector road. No new access is proposed with this project. Per Sec. 8-14-30.G., of the Weld County Code, a new access permit is required when an existing access has a change of use. Because this access will now include commercial uses, the applicant shall obtain a new access permit through Development Review. The applicant shall reconfigure the existing access as necessary to meet the geometric requirements for a commercial access as prescribed in Table 8-3, of the Weld County Engineering and Construction Criteria manual. Table 8-3 and a schematic showing the required geometry for a commercial access on a collector road are provided below. Table 8-3 Access Geometry Type of Land Use Maximum Access Width Access Radii Single-family residential 24 feet wide 25 feet minimum Commercial/Industrial/Agricultural 40 feet wide 65 feet minimum I, 40.0' - j 14.0' COLLECTOR ROO CENTERLINE RURAL COLLECTOR COMMERCIAL (80' ROW) Please refer to Chapter 8 of the Weld County Code for more information regarding access. ROADS AND RIGHTS -OF -WAY County Road 23 is a paved road and is designated on the Weld County Functional Classification Map (Code Ordinance 2017-01) as a collector road, which requires 80 feet of right-of-way. The applicant shall delineate and label on the USR map the future and existing rights -of -way (along with the creating documents for the existing right-of-way) and the physical location of County Road 23. Pursuant to the definition of setback in the Weld County Code, Section 23-1-90, the required setback is measured from the future right-of-way line. Please be aware that existing County roadways may not be centered in the right-of-way. This road is maintained by Weld County. Per, Sections 8-13-30.B, a Weld County Right -of -Way Use Permit is required for any project that will be occupying, constructing or excavating facilities within, and/or encroaching upon, any County rights -of -way or easement. Right -of -Way Use Permit instructions and application can be found at: httgs://www.weldcaov.com/Government/Departments/Public-Works/Permits/Right-of-Way-Permits Weld County will not replace overlapping easements located within existing right-of-way or pay to relocate existing utilities within the County right-of-way. TRAFFIC Latest ADT on CR 23 counted 2,734 vpd with 33% trucks. The 85'" percentile speed is 61 mph. The traffic information submitted with the application materials indicates that there will be up to two (2) pickup and semitruck roundtrips per day with 100% of the traffic coming from the south on County Road 23. TRACKING CONTROL AND ROAD MAINTENANCE AGREEMENT Because of the limited amount of traffic generated by this project, no tracking control or Road Maintenance Agreement is required. DRAINAGE REQUIREMENTS This area IS within a Non -Urbanizing Drainage Area. Non -Urbanizing Drainage Areas typically require detention of stormwater runoff from the 1 -hour, 100 -year, storm falling on the developed site and release of the detained water at the historic runoff rate of the 1 -hour, 10 -year storm falling on the undeveloped site. Because this site was in violation for operating a commercial business without obtaining the proper Weld County land use permit, the applicant has submitted a drainage report that was reviewed and accepted by Development Review during the pre -application process. The cover sheet of the accepted report is titled, "Preliminary Drainage Report' and contains the pre -application case number, "PRE20-0194". For inclusion in the USR22-0012 land use case record, the applicant shall submit a stamped and signed drainage report with a revised cover sheet that includes the title, "Final Drainage Report" and the USR land use case number "USR22-0012". Historic Flows: The applicant will be required to maintain the historic drainage flows on the property and run-off amounts exiting the property. GRADING PERMIT The land disturbance associated with the proposed retention pond construction will exceed one (1) acre in size. Therefore, a Weld County Grading Permit is required. Below is the link to the Grading Permits section of the Weld County website. This section contains important grading permit information and downloadable documents needed to obtain a Weld County Grading Permit. https://www.weldgov.com/Government/Departments/Planning-and-Zoninq/Permits/Grading-Permits COLORADO STORMWATER PERMIT A Construction Stormwater Permit is required with the State of Colorado for disturbing more than one (1) acre of land. Please contact the Colorado Department of Public Health and Environment, Water Quality Control Division, at 303-692-3575, to obtain a stormwater discharge permit. CONDITIONS OF APPROVAL A. A Final Drainage Report and Certification of Compliance stamped and signed by a Professional Engineer registered in the State of Colorado is required. (Development Review) B. A Weld County Grading Permit is required. (Development Review) C. The USR map shall be amended to delineate the following: 1. County Road 23 is a paved road and is designated on the Weld County Functional Classification Map as a collector road which requires 80 feet of right-of-way at full buildout. The applicant shall delineate and label on the USR map the future and existing right-of-way (along with the creating documents for the existing right-of-way) and the physical location of the road. All setbacks shall be measured from the edge of the future right-of-way. This road is maintained by Weld County. (Development Review) 2. Show and label the approved access location, approved access width and the appropriate turning radii (65') on the map. (Development Review) 3. Show and label the entrance gate if applicable. An access approach that is gated shall be designed so that the longest vehicle (including trailers) using the access can completely clear the traveled way when the gate is closed. In no event, shall the distance from the gate to the edge of the traveled surface be less than 35 feet. (Development Review) 4. Show and label the accepted drainage features. The stormwater retention pond shall be labeled as "Stormwater Retention, No -Build or Storage Area" and shall include the calculated storage volume. (Development Review) 5. Show and label the drainage flow arrows. (Development Review) 6. Show and label the parking and traffic circulation flow arrows showing how the traffic moves around the property. (Development Review) DEVELOPMENT STANDARDS (NOTES TO INCLUDE ON THE USR MAP) 1. The property owner or operator shall be responsible for controlling noxious weeds on the site, pursuant to Chapter 15, Article I and II, of the Weld County Code. (Development Review) 2. The access to the site shall be maintained to mitigate any impacts to the public road, including damages and/or off -site tracking. (Development Review) 3. There shall be no parking or staging of vehicles on public roads. On -site parking shall be utilized. (Development Review) 4. Any work that may occupy and or encroach upon any County rights -of -way or easement shall acquire an approved Right -of -Way Use Permit prior to commencement. (Development Review) 5. The historical flow patterns and runoff amounts on the site will be maintained. (Development Review) 6. Weld County is not responsible for the maintenance of onsite drainage related features. (Development Review) cuNTY j/-:47/VV-14---i}‘\ Weld County Department of Public Health and Environment Memorandum To: Chris Gathman From: Lauren Light, Environmental Health Services Date: April 12, 2022 Re: USR22-0012 Applicant: Knote Cory A Environmental Health Services has reviewed this proposal for a Site -Specific Development Plan and Use by Special Review Permit for Oil and Gas Support including Outdoor Storage Yards for Oil and Gas Equipment in the A (Agricultural) Zone District. The existing residence is served by an individual well (58239 -F -R) and an on -site wastewater system permitted for 3 bedrooms (G19940179). Although the application states that no restrooms will be provided, employees retrieving and delivering equipment must have access to a restroom. Portable toilets are acceptable for employees or contractors that are on site for less than 2 consecutive hours a day in accordance with EH policy. Environmental Health Services recommends that the following requirements be incorporated into the permit as development standards: 1. All liquid and solid wastes (as defined in the Solid Wastes Disposal Sites and Facilities Act, 30-20-100.5, C.R.S.) shall be stored and removed for final disposal in a manner that protects against surface and groundwater contamination. 2. No permanent disposal of wastes shall be permitted at this site. This is not meant to include those wastes specifically excluded from the definition of a solid waste in the Solid Wastes Disposal Sites and Facilities Act, 30-20-100.5, C.R.S. 3. Waste materials shall be handled, stored, and disposed in a manner that controls fugitive dust, fugitive particulate emissions, blowing debris, and other potential nuisance conditions. The applicant shall operate in accordance with Chapter 14, Article 1 of the Weld County Code. 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6410 weldhealth.org Public Health cauN`rY =, Weld County Department of Public Health and Environment 4. Fugitive dust should attempt to be confined on the property. Uses on the property should comply with the Colorado Air Quality Commission's air quality regulations. 5. Adequate drinking, hand washing, and toilet facilities shall be provided for employees and patrons, at all times. For employees or contractors on site for less than 2 consecutive hours a day, and 2 or less full-time employees on site, portable toilets and bottled water are acceptable. Records of maintenance and proper disposal for portable toilets shall be retained on a quarterly basis and available for review by the Weld County Department of Public Health and Environment. Portable toilets shall be serviced by a cleaner licensed in Weld County, contain hand sanitizers and be screened from existing adjacent residential properties and public rights -of -way. 6. The operation shall comply with all applicable rules and regulations of State and Federal agencies and the Weld County Code. 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6410 weldhealth.org Public Health Submit by Email Weld County Referral April 4, 2022 The Weld County Department of Planning Services has received the following item for review: Applicant: KNOTE CORY A Case Number: USR22-0012 Please Reply By: May 2, 2022 Planner: Chris Gathman Project: A Site Specific Development Plan and Use by Special Review Permit for Oil and Gas Support including Outdoor Storage Yards for Oil and Gas Equipment in the A (Agricultural) Zone District. Parcel Number: 131123000045-R0142394 Legal: LOT B RE -1541, PT E2 SECTION 23, T2N, R67W of the 6th P.M., Weld County, Colorado. Location: East of and adjacent to County Road 23 and approximately 1/4 mile south of County Road 20. The application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Please reply by the above listed date so that we may give full consideration to your recommendation. Any response not received before or on this date may be deemed to be a positive response to the Department of Planning Services. If you have any further questions regarding the application, please call the Planner associated with the request. Please note that new information may be added to applications under review during the review process. If you desire to examine or obtain this additional information, please call the Department of Planning Services. r ❑ We have reviewed the request and find that it does / does not comply with our Comprehensive Plan because: We have reviewed the request and find no conflicts with our interests. See attached letter. Signature r 7'- U a Agency Oil & Gas Energy Department Date 4/21/2022 Weld County Planning Dept. 1555 N. 17th Ave, Greeley, CO 80631 (970)-440-6100 (970)-304-6498 fax Weld County Oil & Gas Energy Department Referral Comments Referring Agency: Weld County Department of Planning Services Reference Number: USR22-0012 Associated Parcel: 131123000045 OGED Reviewer: Kelly Holliday Review Date: April 21, 2022 The Staff of the Weld County Oil and Gas Energy Department (OGED) appreciates the opportunity to comment on the captioned planning case. Staff has completed review of the proposal and have no conflicts with the proposed activity. We have included additional comments below: 1. There are no active or proposed 1041 WOGLA Permits on the associated parcel. There are several oil and gas well sites in the area surrounding the parcel. 2. The parcel includes two (2) active oil and gas wells, listed in Table 1 below. OGED requests that the Applicant coordinate operations in proximity to existing wells and production facilities with the operator(s) of these wells. API Operator Well Title Well Status 05-123-08914 KP KAUFFMAN COMPANY INC 6 MORIE GERHARDT B PR 05-123-13221 KP KAUFFMAN COMPANY INC 9 MARIE GERHARDT B PR 3. The parcel includes one (1) plugged and abandoned (PA) well listed in Table 2 below. Additional information regarding these plugged and abandoned wells is available from the Colorado Oil and Gas Conservation Commission (COGCC). OGED recommends that the Applicant review this information and contact the responsible operator regarding well infrastructure that may have been abandoned in place prior to conducting operations in proximity to the wells. API Operator Well Title Well Status 05-123-07795 KERR MCGEE OIL & GAS ONSHORE LP 1 MARIE GERHARDT PA 4. The USR lands may include additional oil and gas related infrastructure, such as off -location flowlines or pipeline which are a use by right and not regulated by Weld County. OGED requests that the applicant reviews flowline data available from the COGCC map viewer and utilize Colorado 811 prior to any excavation activities. These comments and recommendations are based upon the review of the application materials submitted by the applicant and other relevant information available on the E -Permit site. go April 11, 2022 COLORADO Division of Water Resources Department of Natural Resources Chris Gathman, Planner Weld County Department of Planning Services Transmission via email: cgathman@weldgov.com Re: Knote and Diamond T. Services Site Development Plan a Use by Special Review Permit Case No. USR22-0012 Part of the S %2 NE 1/4 Sec. 23, Twp. 2 N, Rng. 67 W, 6th P.M. Water Division 1, Water District 2 Dear Chris Gathman: We have received the April 4, 2022 referral concerning the use of outdoor storage yards for oil and gas equipment by Diamond T. Services on the above -described 53.49 -acre Knote property, which is zoned agricultural. A 5 -acre portion of the property is used as an oilfield equipment laydown area by Diamond T. Services and the remaining portion of the property is used by the Knotes for their primary residence, stables, barn and associated out buildings. This referral does not appear to qualify as a "subdivision" as defined in section 30-28-101(10)(a), C.R.S. Therefore, pursuant to the State Engineer's March 4, 2005 and March 11, 2011 memorandums to county planning directors, this office will only perform a cursory review of the referral information and provide informal comments. The comments do not address the adequacy of the water supply plan for this project or the ability of the water supply plan to satisfy any County regulations or requirements. In addition, the comments provided herein cannot be used to guarantee a viable water supply plan or infrastructure, the issuance of a well permit, or physical availability of water. No water demand is associated with the Diamond T. Servies oil and gas activities, therefore our office has no comments on this proposal. However, a review of our records shows that we issued well permit no. 58239 -F -R to the Knotes on October 19, 2020 pursuant to section 37-90-137(4), C.R.S. and the findings of the State Engineer dated August 28, 2002, for the replacement of an existing well, permit no. 58239-F. A condition of this permit was that upon completion of this replacement well, the original well be plugged and abandoned and the abandonment report be filed with our office within 60 days of abandonment. The well owners must file a copy of the well abandonment report (GWS-09) for well no. 58239-F with our office to verify that the well has been plugged and abandoned in accordance with Rule 16 of the Water Well Construction Rules and the conditions of permit no. 58239 -F -R. The GWS-09 form is available for download at: https://dwr.state.co.us/eforms. Please contact Wenli Dickinson at 303-866-3581 x8206 or Wenli.Dickinson@state.co.us with questions. Sincerely, Joanna Williams, P.E. Water Resources Engineer Ec: Referral no. 29149 Well permit file nos. 58239-F and 58239 -F -R 1313 Sherman Street, Room 821, Denver, CO 80203 P 303.866.3581 www.colorado.gov/water Jared S. Polls, Governor Dan Gibbs, Executive Director I Kevin G. Rein, State Engineer/Director Form No. GWS-25 S-25 APPLICANT OFFICE.OF THE STATE ENGINEER COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 KEN ABELES 8711 WCR 23 FT LUPTON, CO 80621- (303) 523-4082 CHANGE/EXPANSION OF USE Northing: LIC WELL PERMIT NUMBER O51 e ;3 ' - - DIV. 1 WD 2 DES. BASIN MD Lot: B Block: Filing: Subdiv: 1311-23-1-RE1514 APPROVED WELL LOCATION WELD COUNTY SE 1/4 NE 1/4 Section 23 Township 2 N Range 67 W Sixth P.M. DISTANCES FROM SECTION LINES 1880 Ft. from North 800 Ft. from East UTM COORDINATES Section Line Section Line Easting: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT 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 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 37-90-137(4) and the findings of the State Engineer dated D1LQ 2 S. 2.:Do2• 4) Approved for the use of an existing well constructed under permit no. 174860. 5) The use of ground water from this well is limited to domestic and irrigation. 6) The maximum pumping rate of this well shall not exceed 45 GPM. 7) The average annual amount of ground water to be appropriated shall not exceed 14.1 acre-feet. 8) Production is limited to the Laramie -Fox Hills aquifer which is located 280 feet below land surface and extends to a depth of 585 feet. 9) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these markings. 10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request. 11) This well shall be located at least 600 feet from any existing well, completed in the same aquifer, that is not owned by the applicant. 12) This well shall be located not more than 200 feet from the location specified on this permit. 13) Pursuant to CRS 37-90-137(9)(b) and the Denver Basin Rules, no more than 98% of the nontributary ground water withdrawn annually shall be consumed and the well owner shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98% of the water withdrawn will be consumed. 14) This well is subject to administration by the Division Engineer in accordance with applicable decrees, statutes, rules, and regulations. 15) The issuance of this permit hereby cancels permit no. 174860. 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. C /01 a 84'a/o2. APPROVED GMB SEP 03 2002 BEXPIRATION DATE SEP 03 2j3 State Engineer ,Receipt No. 0495914 DATE ISSUED 40 COLORADO Division of Water Resources Department of Natural Resources WELL PERMIT NUMBER 58239 -F -R RECEIPT NUMBER 10006932 ORIGINAL PERMIT APPLICANT(S) CORY A KNOTE TRACI L KNOTE PERMIT TO REPLACE EXISTING WELL APPROVED WELL LOCATION Water Division: 1 Water District: 2 Designated Basin: N/A Management District: N/A County: WELD Parcel Name: 1311-23-1-RE1514 Lot: B Block: Filing: Physical Address: N/A SE 1/4 NE 1/4 Section 23 Township 2.0 N Range 67.0 W Sixth P.M. UTM COORDINATES (Meters, Zone:13, NAD83) Easting: 512644.0 Northing: 4441711.0 ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT 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 37-90-137(4) and the findings of the State Engineer dated August 28, 2002, for the replacement of an existing well, permit no. 58239-F. Upon completion of the new well, the old well must be plugged and abandoned in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment Report form must be submitted within sixty (60) days of abandonment of the old well. 4) The use of groundwater from this well is limited to domestic and irrigation. 5) Production is limited to the Laramie -Fox Hills aquifer which is located approximately 295 feet below ground surface and extends to a depth of approximately 575 feet. In accordance with Rule 10.4.8 of the Water Well Construction Rules, plain steel casing must be installed and grouted from the top of the permitted production zone up to at least ten feet above the base of the surface casing, or to the depth required by Rule 10.5.2.1, if no surface casing is installed. (NOTE: If coals and/or carbonaceous shales are encountered in the borehole, plain casing and grout should be installed through these intervals to exclude poor quality water from entering the well.) 6) The pumping rate of this well shall not exceed 45 GPM. 7) The average annual amount of groundwater to be withdrawn shall not exceed 14.1 acre-feet and the total volume of groundwater to be withdrawn shall not exceed 1,410 acre-feet. 8) The entire length of the hole shall be geophysically logged as required by Rule 9 of the Statewide Nontributary Ground Water Rules prior to installing casing. 9) The owner shall mark the well in a conspicuous location with well permit number(s), name of the aquifer, and court case number(s) as appropriate. The owner shall take necessary means and precautions to preserve these markings. 10) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner (recorded at least annually) and submitted to the Division Engineer upon request. 11) Pursuant to CRS 37-90-137(9)(b) and the Denver Basin Rules, no more than 98% of the nontributary groundwater withdrawn annually shall be consumed and the well owner shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98% of the water withdrawn will be consumed. 12) This replacement well shall not be constructed any closer to any other existing well than the well it is replacing, if such other well is within 600 feet of the replacement, is completed in the same aquifer, and is not owned by the applicant. 13) This well shall be constructed not more than 200 feet from the location specified on this permit. Printed 10-19-2020 For questions about this permit call 303.866.3581 or go to www.water.state.co.us Page 1 of 2 WELL PERMIT NUMBER 58239 -F -R RECEIPT NUMBER 10006932 14) This well is subject to administration by the Division Engineer in accordance with applicable decrees, statutes, rules, and regulations. 15) ADVANCE NOTICE REQUIRED - Pursuant to Construction Rule 6.2.2.1 (2 CCR 402-2), licensed or private drillers and pump installers must provide advance notification (by 11:59 pm the day before) to the State Engineer prior to each of the following for this well: the start of well construction, the initial installation of the first permanent pump, and the initial installation of a cistern connected to the water well supply system. Any change in the date of construction/installation must be re -noticed prior to the activity (by 11:59 pm the day before). Information regarding the notification process and a link to the electronic notification form can be found on the Division of Water Resources website at dwr.colorado.gov NOTE: This well is withdrawing water from a non-renewable aquifer. While the withdrawals from this aquifer are administered based on a 100 year aquifer life, water level declines may prevent this well from diverting the permitted amounts for that 100 years. NOTE: To ensure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above. NOTE: This permit wilt expire on the expiration date unless the well is constructed and a pump is installed by that date. A Well Construction and Yield Estimate Report (GWS-31) and Pump Installation and Production Equipment Test Report (GWS-32) must be submitted to the Division of Water Resources to verify the well has been constructed and the pump has been installed. A one-time extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension request form (GWS-64) available at: dwr.colorado.gov -7- '. Issued By AILIS THYNE Date Issued: 10/19/2020 Expiration Date: 10/19/2021 Printed 10-19-2020 For questions about this permit call 303.866.3581 or go to www.water.state.co.us Page 2 of 2 Form No GWS-09 0312017 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 dwr.colorado.gov and dwrpermitsonline@state.co.us For Office Use Only WELL ABANDONMENT REPORT Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or print in black or blue ink. Instructions and plugging standards are on reverse side 1. Well Permit Owners Well Number of plugged well or MH File Number MH- Designation- Receipt Number: 2. Individual/Company Name(s) Mailing Address City, St., Phone ( responsible for plugging and sealing the well: License # Zip ) Email 3. Well (Hole) Phone: ( Mailing Address, Owner: Name(s): ) Email: City, St., Zip: 4. Well Location 5. GPS Well UTM fl 6. Legal Distance Subdivision Address: Location: County Zone 12 or fl Zone 13 Easting Northing Location: 1/4 of the 1/4, Sec 1! E or W F , P.M. , Twp f N or S I, Range from Section Lines Ft. From I- N or S I- , Ft. From I- _l E or W I- Line. Name Lot , Block , Filing/Unit 7. 8. I/we report The well The well Other Aquifer (check the existing well/hole was plugged was plugged and sealed as required was not in use and was plugged and (please explain) and sealed on (date) for the following reason(s): . under Well Permit Number sealed. Type: r Type I (One Confining Layer) r Type I (Multiple Confining Layer) r Laramie -Fox Hills one) r Type II (Not Overlain by Type III) I© Type II (Overlain by Type III I© Type III (alluvial) 9. from from 10. Intervals of Casing Removed/Ripped: feet to feet, from feet to feet, from feet to feet, feet to feet, from feet to feet, from feet to feet, Amount and Type of Material Method of Placement Interval from feet to feet from feet to feet from feet to feet from feet to feet 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 contractor's name to be in compliance with Rule 17.4. 11. Signature(s) Please Print the Name, Title, a License No. Date It is the responsibility of the well owner to have the well/hole properly plugged and sealed. The Well Construction Contractor is responsible for notifying the owner of this requirement in writing. GWS-09 09/2016 Instructions This report must be computer -generated online, typed or printed in BLACK OR BLUE INK and may be reproduced by photocopy or computer generation. Photocopy reproductions must retain margins and print quality. Attach additional sheets if more space is required. Each additional sheet must be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground surface. If filing online please see the FORM SUBMITTAL, PAYMENT OPTIONS, Ft FEE SCHEDULE You may also save, print and email the completed form to: dwrpermitsonline@state.co.us These reports must be completed and submitted to the Division of Water Resources, usually within 60 days of plugging and sealing the well/hole. Please refer to Form GWS-09A for the Standards for Plugging, Sealing, and Abandoning Wells and Boreholes Item Instructions: (numbers correspond with those on the front of this form) 1. Complete the well permit and receipt number for the abandoned well. 2. Complete the name and contact information for the person performing the abandonment work. 3. Complete the well owner name and contact information. 4. Complete the address where the abandoned well is located. 5. Provide the GPS location and County where the abandoned well is located. Colorado contains two (2) UTM zones. Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 108th Meridian (longitude). West of the 108th Meridian is UTM Zone 12 and east of the 108th Meridian is UTM Zone 13. The 108th Meridian is approximately 57 miles east of the Colorado -Utah state line. On most GPS units, the UTM zone is given as part of the Easting measurement, e.g. 12T0123456. Check the appropriate box for the zone. 6. Complete the legal description location of the (abandoned) well. For wells located in subdivisions, the name, lot, block, and filing, must be provided. 7. Indicate the reason(s) for plugging and sealing the well/hole. 8. Indicate the aquifer in which the abandoned well was completed. 9. Indicate the intervals were casing was removed, perforated, or ripped. 10. Complete the amount, type, method of placement and interval placed of the sealing materials. 11. Complete the Name, Title, and License Number (if applicable) of the individual(s) who are responsible for the work performed. The report must be signed by the responsible party per Rule 17.4. If applicable, indicate if Professional Engineer or Professional Geologist in place of License Number. Rule 17.4 Certification - Work reports must be signed and certified as to accuracy and truthfulness of the information on the report by the well construction or pump installation contractors or authorized individuals responsible for the work performed by them or under their direction or supervision, or by the private driller or private pump installer if the work was performed by them. Such reports are deemed to be completed, signed and certified under oath. Submit completed report to: State of Colorado, Office of the State Engineer, 1313 Sherman St, Room 821, Denver, CO 80203. You may also save, print, scan and email the completed form to dwrpermitsonline@state.co.us GWS-09A 09/2016 Information and Standards Conditions of approval of a replacement well permit generally require that the old well be plugged and sealed according to the Water Well Construction Rules. A blank report form is provided to the well owner when a replacement permit is issued. This report is also used to affirm that other types of wells and holes have been plugged and sealed. RULE 16 STANDARDS FOR PLUGGING, SEALING, AND ABANDONING WELLS AND BOREHOLES 16.1 General - The plugging, sealing, and abandonment of all wells, monitoring and observation wells, monitoring and observation holes and test holes that are no longer intended for use, and the plugging, sealing, and abandonment of collapsed or unusable boreholes, and other incomplete wells or excavations is necessary to prevent contamination of groundwater and the migration of water through the borehole. It is the ultimate responsibility of the well owner to have an existing well properly plugged, sealed, and abandoned. The well construction contractor or authorized individual is responsible for notifying the well owner in writing of these plugging requirements. 16.1.1 In the event a borehole(s) is not completed for the intended purpose, the contractor will notify the well owner of the well owner's responsibility for the proper abandonment of the borehole(s) according to Rule 16.1. If the well owner does not agree to allow the contractor to abandon the borehole(s), the contractor must notify the Board of Examiners, in writing, of the existence of the borehole(s) and the contractor's effort to notify the well owner of the well owner's abandonment responsibilities under Rule 16.1 16.1.2 Persons Authorized to Plug, Seal, and Abandon Wells: 16.1.2.1 Licensed water well construction contractors are authorized to plug, seal, and abandon all types of wells or holes. 16.1.2.2 Licensed pump installation contractors may plug, seal and abandon only those wells that do not require the removal of casing that penetrates more than one aquifer or the ripping or perforating of casing opposite confining layers. 16.1.2.3 Authorized individuals may plug, seal, and abandon only those monitoring and observation wells and holes, dewatering wells, piezometer holes, and test holes that do not penetrate through a confining layer. 16.1.2.4 Well owners may plug, seal, and abandon only those wells they own that do not require the removal, ripping, or perforating of casing in accordance with this Rule 16. Well owners abandoning their own wells must consult with a licensed water well construction contractor or Board staff prior to abandoning their well. 16.1.3 Materials used for backfilling must be clean, inert, and free from contaminants. The well casing may be cut off below land surface so that it will not interfere with the anticipated use of the land. If the casing is cut off below land surface, the uppermost five (5) feet of the remaining casing must be filled with grout or a watertight cover must be permanently attached to the remaining casing and the excavation filled with materials that are not more permeable than the surrounding soils and adequately compacted to prevent settling. 16.2 Abandonment of Wells or Boreholes in Type I Aquifers (confined aquifers) Wells which were constructed through more than one aquifer must be plugged and sealed by placing a cement grout plug at the confining layer above each aquifer. If well construction records do not show that the casing opposite each confining layer was grouted when originally installed, the casing must be either completely removed from the hole, or perforated or ripped opposite such layer prior to placing the grout plug. Plugs must be no less than sixty (60) feet in length and must be designed to withstand the maximum potential hydrostatic pressure differential between the aquifers. The well casing, except for the grout plug intervals, must be completely filled to the land surface with clean native clays, cement, or high -solid bentonite grout. A watertight cover must be permanently welded or attached to the top of the casing. Code of Colorado Regulations 54 16.3 Abandonment of Wells or Boreholes in Type II (unconfined bedrock aquifers) and Type III Aquifers (unconsolidated aquifers) -Wells completed into unconfined bedrock aquifers and unconsolidated aquifers must be plugged, sealed, and abandoned by filling the well to the static water level with clean sand or clean gravel. Between the static water level and the ground surface, the borehole must be filled with clean native clays, cement, drill cuttings, or high solid bentonite grout to the ground surface. The uppermost five (5) feet of casing must be filled with grout or a permanent watertight cover must be installed at the top of the casing. If casing is removed, the hole must be filled as described above to within five (5) feet of the ground surface. The top five (5) feet of the hole must be filled with materials that are not more permeable than the surrounding soils that are adequately compacted to prevent settling. 16.4 Abandonment of Other Structures: 16.4.1 Abandonment of Dewatering Wells, Monitoring and Observation Holes, and Piezometer Holes-Dewatering wells, monitoring and observation holes, and piezometer holes must be plugged, sealed, and abandoned either (1) pursuant to Rules 16.2 or 16.3, as appropriate, or (2) by removing all casing that was installed and by filling the hole(s) with clean native clays, cement, or high solid bentonite grout to within five (5) feet of the ground surface. If the casing cannot be removed, the top five (5) feet of the hole must be filled with materials that are not more permeable than the surrounding soils that are adequately compacted to prevent settling. 16.4.2 Abandonment of Test Holes -Test holes must be plugged, sealed, and abandoned pursuant to the requirements of Rule 16.4.1 or by removing any casing or equipment from the hole and backfilling the hole with drill cuttings, clean native clays, cement, or high solid bentonite grout to the ground surface, and adequately compact the material to prevent settling. 16.5 A well for which a replacement well has been permitted and constructed must be plugged, sealed, and abandoned within sixty (60) days after the completion of the replacement well, unless otherwise re -permitted by the State Engineer. Hello