HomeMy WebLinkAbout20221429.tiffWELD COUNTY DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
1555 N. 17Th AVENUE
GREELEY, COLORADO 80631
PHONE: (970) 304-8415
FAX: (970) 304.6411
sE# l COCD, I
REPAIR #
LOAN #�
ISDS # _
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
THIS DOCUMENT IS IVOT A SEPTIC PERMIT
PARCEL# ti-Io`la`5n000
PROPERTY OWNER J�� D1^)
c -k kzis - 303 - aq 1- `Tsso
PHONE NO. ( tkQ -8c168
MAILING ADDRESS .Lq F"r kr� P1 F'T L.U�[C � _ �Q�a _
City_ State ,p
SITE/LOCATION ADDRES5ICAN, l�� A� C. C` i . L�Q 1 QC)C)4Q_,
i►3z NI.,3‘( City State Zip
LEGAL DESCRIPTION: PT SECTION �S TOWNSHIP \ RANGE (..cr)
SUBDIVISION LOT BLOCK_ FILING
LOT SIZE/ACRES V.a .(..oc.
COMMERCIAL: RESIDENTIAL: YES LNO
DESCRIPTION OF BUILDING AND YEAR BUILT (ex. house, mobile/modular home, shop, office):
NUMBER OF PERSONS NUMBER OF BEDROOMS BATHROOMS FULL 3/4 1/2 - a'�pc�2,0c�s T ALLs Cry ) (..1))WATER SUPPLY: PUBLIC YES / NO WATE ISTRICT NAME
PRIVATE YES / NO WELL l'ES NO CISTERN YES / NO Permit#
Circle which applies: TIER 1
SYSTEM SIZE AND CONSTRUCTION:
SEPTIC TANK: Septic tank material is constructed of CO and has ISO° _ gallons capacity.
FIELD: Trench square feet or Bed square feet YEAR INSTALLED
Provide a drawing indicating dimensions and location of the existing septic system, including distances from property
lines, easements, dwelling, other lot improvements, water line, water well, surface water features such as ponds,
irrigation ditches, etc.
TIER 2
TIER 3
The undersigned property owner hereby certifies that the above described septic system is in fact installed, as
described, and exists at this time on the parcel identified by the above legal description.
I further understand that any falsification or misrepresentation may result in invalid results in determining compliance
with current regulations based upon this information hereby submitted and in legal action for perjury as provided by
law.
ql acs \ ►q
DATE OWNER SIGNATURE
Subscribed and sworn to bfelore me this
Fay R � S'T IN) Ec .1— 1 V r T
Witness my hand and official seal.
OOA - 6- 7 -1 -
DATE
2.ta r day of
STATEMENT OF EXISTING ACCEPTED BY
,20V°1 ,
My commission expires: O �j - 1 ` "LLD 2_.�
NOTARY PLBIk
WENDY PARIS
Notary Public
STa- t# of Coiorado
M
Notary ID if 24034025388
______yz orest77 31-2Q23
OFFICE TECHNICIAN
DATE
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth,org
Septic Permit Application
Application Number: SE -1900021
App Type: HealthlCommerciallStatement of Existinglna
1931 LEONA AVE
FORT LUPTON, CO 80621
Owner Name: SHEPCO68, LLC
Parcel#: 146925000011-R6060386
Legal Desc: PT N2NW4 25-1-67 LOT B REC EXEMPT RE -373 (.38R) AND THAT PT OF VAC LEONA
AVE
Work Description:
Site Address: 1931 LEONA AVE
App Specific Info: FORT LUPTON, CO 80621
TERMS AND CONDITIONS
A permit fee, as set by separate ordinance of the Board of Weld County Commissioners, shall be required of applicants for onsite wastewater treatment systems,
payable at time of application Permit fees are non-refundable; permit applications are non -transferable If both a building permit and an OWTS are issued for tf
same property and construction is not commenced prior to the expiration date of the building permit, the OWES permit shall expire at the same time as the building
permit. If an OWTS permit is issued for a property that does not require a building permit, the OWES permit shall expire one year after its issuance if construction on
the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from
the Health Officer or his/her designated agent Expired permits can be renewed by payment of the permit fee only if:
A There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and
approved by a Division Representative
B The surrounding land, its use or zoning has not changed so -as -to cause the original application not lo be acceptable under these regulations
NOTICE
The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of
Public Health and Environment (WCDPHE) 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 title 25, CRS as amended The applicant certfies that the proposed system will not be located within 400 feet of a community
sewage system. The undersigned certifies that all statements made, information and reports submitted herewith are, or will be, represented to be true and correct to
the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein Applicant further
understands that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted, and in legal action or perjury as
provided by law
X
Owner/Applicant Date
Health Adminlalratlon
Vaal Records
TePx 97D-.Krt 6410
Fr,„,: 97D KM -6.,112.
Publlo Heallh &
Clinical Services
r6e; 970 3O.: 64Pa
rax', 97G -K4-6416,
Environmental Health
Services
Tele: 9.70- 0.1-6115
Fox: 97D aol-6.11
Communication,
Ed:raa#Can a Manning
Te le: 970,2O,1-GA70
Fox: ??0.301-6152
Emergency Preparedness
& Responio
f lr� 910-1a4-6410
Fox_ 970-204.6452
Public Health
DEPARTMENTS OF PLANNING
BUILDING AND ENVIRONMENTAL HEALTH
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
AUTHORIZATION FORM
1 (We) SHEPCO68 , give permission to Chnstana Elliiott
(Owner -- please print) (Authorized Agent — please print)
to apply for any Planning, Building or Septic permits on our behalf, for the property located at (address or parcel number) below:
1931 Leona Ave., Fort Lupton, CO
See AttachedLegal Description: of Section , Township N, Range W
Subdivision Name: Lot Block
Property Owners Information:
Address:
Phone:
1931 Leona Ave., Fort Lupton, CO
402-926-8968
Authorized Agent Contact Information:
E-mail:
Address: 2940 49th Street. Evans, CO 80620
AJ.Goldsmith@Cushwake.com
Phone: 303-249-7550 E -Mail: Christana3@comcast.net
Correspondence to be sent to: Owner
Additional info:
Authorized Agent Both X / by Mail Email
Owner Signature:L
Owner Signature:
Date: 09-20-2019
Date:
0
FRONT RANGE SEPTIC
26461 CR 64 • Greeley CO 80631
Phone: (970) 302-0467 • www,frantrangeseptic.00m
Customer Name Dan Shepard
Phone 303-249-7550
Job Address
1931 Leona Ave
Cell
Ft Lupton, Co 80621
County Weld
Date Pumped 09-26-2019
Mailing Address
Pumper Josh
E-mail chrWana3O,comcWnet
Contact Chris Elliot
L. Septic tank ❑ Grease trap
Tank size: ima
construction: ❑ Concrete
❑ Vault ❑ Other
Compartments: ❑ 1
❑ Plastic/Fiberglass
Liquid level in tank over inlet line? ❑ No
Leach field running back: ❑ No 5 Yes
1500
Tee Baffle
verify ❑
0
❑ Metal
D Yes ❑ Can't verify
Concrete Baffle Inlet: D No
❑ Can't verify
❑ Other
❑ Extra heavy n Can't verify
Gallons Pumped Tank
❑T9'8SBaffel Concrete Baffle Outlet: ❑ No ❑ Yes Can't
Lids within 8" of surface: Inlet: ❑ No ❑ Yes Outlet: ❑
No ❑ Yes Outlet Filter: ❑ No ❑ Yes If yes - Filter
should be cleaned every year
Pumper Comments: Mixed pumped and cleaned. the tank hed a thick sludge layer or B" I recommend pumping the tank every 8 months
Amount
Paid Check # 1112
MFQ I FC❑
First 1000 Gallons Pumped
375
00
Additional Gallons Pumped 500 @
.28
140.00
Septic Enzyme
Checklist
150
00
Digging Fee
Other
BALANCE DUE
665..00
S
signature
DAMAGE WAIVER; The oompany assumes no responsibility for damages inside of ourb of property line or
where damage may occur.
IMO
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Company Name: Front Range Septic
Customer Name:
Dan Shepard
Address of Pumping:
1931 Leona Ave Ft Lupton, Co 80621
Pumping Date:
09.28-2019
1. Tank Size: 1500
Gallons Pumped:
15013
Phone number: 970-302-0457
2. Lift Station: Yes_ No x
Pump Alarm: Yes_ No x
If yes, functioning: Yes
Yes No
No If yes, functioning:
3. Excessive water running back into tank from field? Yes_ Nox
If yes, estimate in gallons:
4. Liquid level in tank over inlet line? Yes_ No x
5. Tank Construction (check one)
Concrete x Metal Brick Plastic or Fiberglass
Cesspool or Seepage Pit Other
b. Tank Construction Observed: One Compartment _s Two Compartment
7. Inlet/outlet tees and/or baffles in good condition? Yes_ No_
$. Filter on outlet cleaned and inspected (if applicable)? Yes_ No N/A
9. Access to clean -out lids within $ inches of grade?
Inlet: Yes_ Nox Outlet: Yes x No
10.20 ml. plastic replaced and sealed over tank lid (flood plain only)? Yes_ No NIA
11. Tank structurally sound and water tight? Yes x No
12. Access lids structurally sound and water tight? Yes x No
13. Obvious cracks/leaks observed? Yes_ No x
If yes, explain area:
14. Other conditions noted which may affect proper functioning of system?
The inbound side of the tank is under ground with out a lid to the surface. with that i was not able to pump from
that side or see if there is a bailie.
15. Reason for Service:
Maintenance_ Real Estate Salex Emergency/Backup_ Other
September 26, 2019
Application Number:
App Type:
Owner Name:
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org
RECEIPT
SE -1900021
HealthlCommercial1Statement of ExistingIna
SHEPCO68, LLC
1931 LEONA AVE
FORT LUPTON, CO 80621
Site Address: 1931 LEONA AVE
FORT LUPTON, CO 80621
Rcpt # Pmt TVAe Pmt Method Ref # Pmt Date Amount
EHS-1900589 Paid Credit Car( 0172 09/26/2019 $10.00
Total Payments: $10.00
Cashier
JBEEBE
Comments
Haullh Adminforation
Vllal Records
Tete: 470-304-6410
Fax: 970.3174.6412
Public Health I
Cllnleal Services
f ele: 970-304- 6420
Fax: 970-304-6416
Emdtanmerilol Health
Servltes
Tale: 970-304-6415
Fax: 97- 4-6661
Cerrenunlealion,
Education 8 Planning
Tele: 970-306-6470
Fax; 970-304-4452
Emergency Proparadmess
R Rerpenmo
fele: 470-304-6474
Fast: 97O-304.6652
Public Health
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11323 Coal Mine Street
Firestone, CC) S0504
Phone: 720-324-3625
www.nec-engrs_com
January 31, 2022
Weld County Department of Health and Environment.
1555 N. 17`1' Ave.
Greeley, CO 80631
RE: 1931 Leona Ave. Ft. Lupton, CO 80621
To Whom It Nlay Concern:
It is my understanding that the property 1931 Lona Ave, Ft. Lupton CO want to go through a.
change of use. Weld County requires a letter regarding the use/design of the OWTS system of
the property from an Engineer is acceptable.
Weld County does not have record of the size of leach Held as it was installed prior to permits
being required and possible upgraded without the County's knowledge. Reviewing historical
images of the subject property we cannot find a green area that would give the approximate
size of the leach field. We sent a potholing crew to find the existing OWTS system. Frotn the
information that we have obtained, the OWTS system consists of a 1500 gallon septic tank and
a 102 foot long, single row of infiltrators (field determined 1129122). Groundwater was not
encounter during potholing, and the existing soils are considered a type 1 soil as most of the
soils are sand. The current owners of the property did not install any of the existing OWTS
system.
The property was previously used as a transportation depot that had 15 full time employees
and there are no known issues with. the septic system not functioning correctly. The existing
owner of the property' (International Farms, LLC, Jorge and Lillana Borrego) will only have
six full time employees. Per Table 30-6-2 of Weld County's OWTS Regulations an employee
produces on average 15 gpd with .06 BOD5 pounds per day. With a. total of 6 employees this
will equate to 90 gpd and 0.36 BOD5 pounds per day produced. This amount produced is less
than a two bedroom house per Table 30-6-1. With their proposed use, a septic tank of 1000
gallons would be required and assuming the soil is a type 1 soil (Sandy, Loamy Sand), a soil
treatment area for a trench system is 158 square feet. From the information that we have
received, we have an existing septic tank of 1500 gallons capacity, a leach field consisting of
a single row of infiltrators 102 foot long with a total area of 306 s.f. (102'/(4'
long/infiltrator)* 12sflinfiltrator— 306 s.f.). From my understanding the existing OWTS
system is in working order. The system as installed should be able to handle a total flow of
350 gpd (31 employees (15*23— 345 gpd)) assuming a trench system with infiltrators and an
area of 306 s.f. with type 1 soils. We attached a drawing showing the location of the existing
OWTS system. Please feel free to give me a call if you have any questions.
Sincerely,
Josh Cook, P.F.
President
NOCO Engineering Company.
Attachments
Page 2 of 2
D R
CO
COLORADO
Division of Water Resources
Department of Natural Resources
WELL PERMIT NUMBER 307777 -
RECEIPT NUMBER 3683452
ORIGINAL PERMIT APPLICANTi5)
DANIEL C SHEPHERD
PERMIT TO CHANGE OR INCREASE USE
APPROVED WELL LOCATIQN
Water Division: 1 Water District: 2
Designated Basin: N/A
Management District: N/A
County: WELD
Parcel Name: RECORDED EXEMPTION NO 1469-25-2-
RE373
Lot: B Block: Filing:
Physical Address: N/A
NE 1/4 NW 1/4 Section 25 Township 1.0 N Range 67.0 W Sixth P.M.
UTM COORDINATES (Meters, Zone:13, NAD93)
Easting: 513716.0 Northing: 4430928.0
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 37-92-602(3)(b)(I) and the policy of the State Engineer dated 4/23/86 under the following conditions,
for the change in use of an existing well constructed under permit no, 13320 -F -R. Well permit no. 13320 -F -R was canceled by
Order of the State Engineer upon issuance of this permit.
4) Approved as the only well on a tract of land of 16.7 acres described as lot B, Recorded Exemption No. 1469-25-2-RE373, Weld
County.
5) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-602(1)(c), for a
commercial business. Water from this well shall not be used for lawn/landscape/greenhouse irrigation, domestic
animal/livestock watering, or for any other purpose outside the business building structure(s).
6) Production from this well is restricted to the alluvium.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed 0.33 acre-foot (108,600 gallons).
9) 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.
10) The return flow from the use of this 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. The maximum consumptive use of ground
water shall not exceed 10 percent.
11) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTICE: This permit has been approved subject to the following changes: The UTM coordinate values were calculated from the
distances from section lines provided with the permit application, the annual amount of ground water to be withdrawn shalt not
exceed 0.33 acre-foot pursuant to CRS 37-92-602(3)(b)(I) and the policy of the State Engineer dated 4/23/86. You are hereby
notified that you have the right to appeal the issuance of this permit, by filing a written request with this office within sixty
(60) days of the date of issuance, pursuant to the State Administrative Procedures Act. (See Section 24-4.104 through 106,
C.R.S.)
Printed 12-05-2017
For questions about this permit call 303,866.3581 or go to www.water,state.co.us
Page 1 of 2
WELL PERMIT NUMBER 307777- RECEIPT NUMBER 3683452
Issued By AILI5 THYNE
Date Issued: 12/5/2017
Expiration Date: N/A
Printed 12.05.2017
For questions about this permit call 303,866.3581 or go to www.water.state.co.us Page 2 of 2
State of Colorado Water Resources - View Well Details: Receipt 3683452 Page 1 of 2
Colorado Department of Natural Resources
Do\yi ., 6.1
Colorado's Well Permit Search
THIS PAGE IS NOT THE ACTUAL PERMIT
The information contained on this page is a summary of the permit file and may not reflect all details of the well permit. (Full Disclaimer)
Well Constructed
Receipt: 3683452 Division: 1
Permit #: 307777- - Water District: 2
Well Name / #: County: WELD
Designated Basin: Management District:
Case Number:
WDID:
[-] Imaged Documents - Permit File
Document Name Date Imaged Annotated
Well Permit 12/05/2017 No
[-] Applicant/Contact
Applicant/Contact Name
SHEPHERD, DANIEL C.
Mailing Address
1931 LEDNA AVE
City/State/Zip
FORT LUPTON, CO 60621
L[-] Location Information
Approved Well Location:
Q40 Q160 Section Township Range PM Footage from Section Lines
NE NW 25 1N
67W Sixth 325 N 2575 W
Northing (UTM y): 4430928.0 Easting (UTM x): 513716.0
Location Accuracy: Spotted from section Ilnes
Subdivision Name
RECORDED EXEMPTION NO 1469-25-2 RE373
Filing Block Lot
B
Parcel ID:
Acres in Tract:
1 I-] Permit Details
Date Issued: 12/05/2017 Date Expires:
Uses(See ifneNeCi0acurrre11Nfor more rnfomafron)
General Use(s): Commercial
Special Use:
Area which may be Irrigated:
Annual volume of appropriation: 1
Statute:
Cross Reference Permit(s): Permit Number Receipt
1332O -F -R 0108774
Comments:
[ [-] Construction/Usage Details
Aquifer(s): ALL UNNAMED AQUIFERS
Help I Last Refresh:
well Construction Date: O7/12/1979 Pump Installation Date: 07/17/1979
Well Plugged: 1st Beneficial Use:
Elevation Depth Perforated Casing (Top) Perforated Casing (Bottom) Static Water Level Pump Rate
55
Driller
Pump Installer
Lic # Name Address
513 RANK, SAMUEL C 1106 50TH AVE GREELEY, CO 60534
513 RANK, SAMUEL C 1106 50TH AVE GREELEY, CO 66634
Phone Number
3633526130
3033526130
[-] Application/Permit History
Permit Issued
Application Received
Pump Installed
Well Constructed
12/05/2017
11/13/2017
07/17/1979
07/12/1979
L Disclaimer
Colorado goy I Contact Us
http://www.dwr.state.co.us/WellPermitSearch/View.aspx?receipt=3683452 12/6/2017
State of Colorado Water Resources - View Well Details: Receipt 3683452 Page 2 of 2
"The Infermatlon cobtalrred to thlLraacie is a summary of the petTnit file and may not reflect all
Oetalls Of the well permit. THIS PAGE 15 HOT THE ACTUAL PERMIT.
This papa should not be used as basis for any legal Cgnsitteration, to determine the alit! wed uses of
the inch TA determine construction information or to determine me terms and connittdn5 wirier
which the well can operate. The complete well permit file should be viewed to obtain details on the allowed
uses and other relevant Information. A complete copy or this file is available in the "Imaged Documents" section of
this page, and can be viewed by opening all of the documents listed under that section (documents will open as
pdf files).
Note that all of the terms and conditions under which a well can operate, particularly for non-exempt wells, may
not be specified on the well permit. Wells may also be subject to relevant statutes, rules and decrees. To learn
more about well permitting in Colorado, please visit iyw is well einu9rug raiv. If you have any questions about
this well permit file, please contact the OWN. Ground Water Information Desk.
Copyright ® 2015 colored° Division of Water Resources All rights reserved.
Home I Contact Us I Help I Water Links I Colorado.gov I DNR I Privacy Policy I Transparency Online Project (TOP)
http://www.dwr.state.co.us/WellPermitSearch/View.aspx?receipt=3583452 12/6/2017
Form No. GWS-07 EXEMPT
07/2016
STATE OF COLORADO
DIVISION OF WATER RESOURCES
OFFICE OF THE STATE ENGINEER
1313 Sherman St., Ste 821, Denver, Colorado 80203
(303) 866-3581
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-92-602
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully read the conditions of approval on your well permit. The conditions and the information on
this information sheet must be complied with in order for the permit to remain valid.
The well permit number is located in the upper right hand corner of the permit, and the expiration date is located
in the lower right hand corner.
THE WELL PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. Evidence of well
construction must be received on appropriate form PRIOR TO THE EXPIRATION DATE OF THE PERMIT.
The required form is the Well Construction and Test Report (Form No. GWS-31).
The expiration date of the permit may be extended one year at a time for good cause shown, at the discretion
of the State Engineer. If an extension of time is necessary to construct the well, the owner must file a written
request for the extension. The request must be received by the State Engineer prior to the expiration date. The
request must state why the well has not been constructed, and must include an estimate of time required to
construct the well.
Water well construction and pump installation contractors are licensed in Colorado to perform these
specialized tasks. It is illegal for individuals who do not hold these licenses to construct wells and
install pumping equipment in or on wells. The well must be constructed and pumping equipment
installed by contractors with current license(s) issued by the State of Colorado unless exempted as
described on the reverse side. Please ask to see their license(s). Backhoe Operators and Licensed Plumbers
may or may not hold the respective Well Construction and/or Pump installation licenses. Please be aware of this
when you contract to construct the well and install pumping equipment. The well construction report including a
test of the well yield must be submitted to the office of the State Engineer within sixty (60) days of completion of
the work or within seven days after expiration of the permit, whichever is earlier. The pump installation report
including a pumping system test must be submitted within sixty (60) days of completion of the work. The
contractor(s) must provide you with a copy of the work report(s) filed with the State Engineer. Additional
information regarding well construction, pump installation, required testing and well plugging and sealing
regulations are found on the reverse side of this sheet.
Keep a copy of this permit for your records. The official digital image of the permit is on file in the Denver office
Records Section. You may view or print the entire permit file using our online well permit search tool:
http:/hvww.dwr,state.co.us/ ellPermitSearch/ Hard copies of permit documents may be obtained from our
Records Section for a fee of 50 cents per page. Statutes require that any change of mailing address or
ownership be reported to the State Engineer. Form number GWS-11 is used both by new owners to report
ownership changes and current owners to report address changes.
If you have questions, contact the Ground Water Information Desk at (303) 866-3587, or the Division Office in the
area where your well is located.
Division 1
810 9"' St., Ste. 200
Greeley, CO 80631
(970) 352-8712
Fax: (970) 392-1816
Division 2
310 E. Abriendo Ave Ste B
Pueblo, CO 81004
(719) 542-3368
Fax: (719) 544-0800
Division 3
301 Murphy Drive
Alamosa, CO 81101
(719) 589-6683249-6622
Fax: (719) 589-6685
Division 4
MCommercial Way (physical)
ont 81401
Montrose,
P.O. Box 45566 Zip 81402 (mailing)
(970)
Fax: (9970)70) 249-8728
Division 5
Division 6
202 Center Drive (physical)
505 Anglers Dr. Suite 101 (physical)
Division 7
Denver Office
Glenwood Spgs., CO 81601
Steamboat Spgs, CO 80487
160 Rockpoint Dr Ste E
1313 Sherman St., Ste 821
P.O. Box 396 Zip 81602
P.O. Box 773450 Zip 80477
Durango, CO 81301
Denver, CO 80203
(mailing)
(mailing)
(970) 247-1845
(303) 866-3581
(970) 945-5665
(970) 879-0272
Fax: (970) 259-0944
No Fax
Fax: (970) 945-8741 Call First
Fax: (970) 879-1070
WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER
You may construct the well and/or install pumping equipment yourself if the well is for your own use, is on
Nr1.1pe 41 y you c .,n, and is constructed or pumping equipment is installed with equipment owned and
operated by you, it is your responsibility to complete and submit the Well Construction and Test Report
(Form No. GWS-31) and/or the Pump Installation and Test Report (Form No. GWS-32). These forms are
available from our website at the following link:
hitp:l/water,state,co.us/DWRDoes/Forms/PagesiWellPermittinoFormsByNumber,aspx, or from any
Division of Water Resources office. The well must be constructed and the pumping equipment installed in
accordance with the well construction standards of the Board.
The WATER WELL CONSTRUCTION RULES and BOARD OF EXAMINERS RULES can be obtained
from our website at the following link: http://water.state.co.us/groundwater/ROF/Pages/ROFRules.aspx, or
purchased from any Division of Water Resources office for a small fee. These Rules cover the minimum
requirements for well construction, pump installation, disinfection, plugging and sealing and contractor
licensing regulations. If you are constructing your own well or installing pumping equipment, it is
recommended that you obtain a copy of these Rules for reference.
The well construction and primp installation reports including testing of well yields and pumping systems
must be submitted to the office of the State Engineer by the respective contractors within sixty (60) days of
completion of the work or prior to the expiration date of the permit, whichever is earlier. Your contractor(s)
must provide you with a copy of the work report(s) filed with the State Engineer.
RULE 12 WELL TESTING
12.1 General - The provisions of this rule establish minimum standards for the testing of water wells.
Every well constructed for the purpose of producing ground water shall be tested to determine:
a. a stabilized yield for the well; and
b. the production rate of the equipment installed when the well is placed into service.
12.2 Well Yield Test - The yield of a well shall be determined as a stabilized production rate where the
withdrawal rate and the drawdown do not change by more than 10 % during the last hour of the test. The
test shall demonstrate that either:
a. the well is capable of producing the permitted pumping rate for the well; or
b. that the maximum yield of the well is less than the permitted production rate.
12.3 Responsibility for Well Yield Test - Well construction contractors are responsible for
performing the well yield tea and submitting the test data to the State Engineer. . If the construction
contractor also installs the production equipment, the well yield test may be combined with the production
equipment test, provided that the test meets the requirements of Rule 12.2. The construction contractor
may forgo the well yield test if he can show that a licensed pump installer will perform the well yield test
with the permanent production equipment within thirty (30) days of completion of construction of the well. If
the pump installation contractor performs the well yield test, he/she shall submit the test information on the
Pump Installation and Test Report.
12.4 Production Equipment Test - The production equipment installed in wells shall be tested to
ensure it is functioning as designed. The test shall demonstrate the production capacity of the equipment
as actually installed in the well. It is the responsibility of the person installing the pumping system to ensure
that the production from the well complies with the conditions of the permit.
12.3 Responsibility for Production Equipment Test - Pump installation contractors are responsible
for testing the production equipment installed in a well upon completion of their work. If the well
construction contractor determined the well yield and submitted a report, the pump installer need not
perform another well yield test If the pump installer does not perform a well yield test with the permanent
production equipment, he shall perform a production equipment test and report the data (results) to the
State Engineer on the Pump Installation and Test Report.
Wells to be plugged and sealed must be plugged in accordance with of the Water Well
Construction Rules. A Well Abandonment Report, Form No. GWS-9 must be submitted to confirm
plugging and sealing of the well. This form is avaiiabie from our website at the following iink:
http://water.state.co.uslDWRDocs/FormsiPages/WeIIPermittind FormsByNumber.aspx, or from any
Division of Water Resources office. The specific rules for plugging and sealing wells are found on the
reverse side of the Well Abandonment Report form, or under Rule 16 of the Water Well Construction
Rules.
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