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Home My WebLink About20220614.tiffWeld County Environmental Health ervices Depar1rnint 1555 N 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 Web: weldhealth.org Septic Permit ^ Final Application Number: SP -1200212 Owner Name: STOLL HENRY Site Address: 15509 CR 4 BRIGHTON, CO 80603 App Type: Health\Residential\New\Septic DON BUXMAN BUXMAN EXCAVATING LLC 1900 68TH AVE #702 GREELEY, CO 80634 Parcel #: 147127000022-R6270186 Legal Desc: 15967-C S2SW4NW4SE4 & W2SW4SE4 27 1 66 (.5R) App Specific Info: Finaled Application Status: Final Pending Applied Date: 10/01/2012 Issued Date: 10/03/2012 Finaled Date: Location Description 15509 CR 4 BRIGHTON CO Application Date 10/0112012 Septic Permit Expiration Date 10(01/2013 Waive Fees No Number of Bedrooms 3 Basement Plumbing No Full Bathrooms 2 314 Bathrooms 0 1/2 Bathrooms 0 Public Water Supply No Private Water Supply Well Private Water Supply Permit Reference Number 288990 Parcel Acres 24 Actual Installation: Septic Tank: gallons Absorption Trench: sgft Chambers Absorption Bed sq ft t Design Type: _ Chamber Model _ 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 ocal occupancy permit persuant to CRS 1073 25-10-111 {2). TMs r n n•transferabl an eon. refu_able The Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required tom our regulsti ns on a continuing basis, Final permit approval was contingent upon the final inspection of the earrtptet tem by the Weld County ❑ rtrCr of Prr he l4eallh and Environment Envl nmental Health Special! Date Report ID: EHS00033v006 Page 1 of 2 Print Date Time: 10f31f20123:32:02PM Application Number: SP -1200212 Owner Name: STOLL HENRY Site Address, 15509 CR 4 BRIGHTON, CO 80603 EN L] 10 71 c?_ 1{I s i' J Report ID: EHS00033vOO6 Page 2 of 2 Print Date Time: 10131120123:32:02PM Scanning Cover Sheet for Septic Permits Permit # 19721103 Permit Type: Health / EHS History / EHS Conversion History Situs Street Address 15509 CR 4 Situs City, State, Zip SeclTownlRange: 27-01 N -66W Application Status: Finaled Application Date: 03/11/1996 Parcel # (12 digits) Owner Full Name: Owner Address: Contact Name: Contact Address: 147127000022-R6270186 STOLL HENRY B 5660 E. AMMHERST , 80200 Owner Phone #: 303 7569255 Contact Phone# Information above has been Verified in Accela by employee noted below Processed by: April 08, 2009 Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 4/8/2009 3:14:30PM A /, 7O 5a rorrnSTATE OF COLORADO Ll (�tev. ) DIVISION OF WATER RESOURCES MAR 161962 OFFICE OF THE STATE, ENGINEER HIND WAT IWD✓ GROUND WATER SECTION COLORS Jas f✓ STATE trg,sl.r#d , I&YJ LOG AND HIS TO ELL fj ;ardi Typed ....._... PERMIT # , : i Lie, Drilled by Mosher Drilling Co No . _4 WELL LOCATION&, 10wner Harry Greet, Wei County Address Brighton, Colorado Tenant 'Used for Domestic on or by (description of site or land) Date Started Jan. 5 , 19 62 `Date Completed Jan. 12 a 1962 Date Tested Jan. 12 1962 • Yield 5 .,�9PM cfs Pump type Not furnished Outlet Size Driven by HP@RPM. � Depth to Water 1,0 Ft. Draw down - 25OFt. Depth to Inlet ______Ft..; Bowl. - Ft. S Size and Kind of Casing: If the above is not applicable fill in: From 0 to 20 Type Steel Wt. From 20 to 290 Type Steel Wt. 7, 7 Town or Subdivision From to Type Wt. Street Address or Lot & Block Perforations: Size and Type From 250 to 294 Type SteelSize Ground elevation � (if known) From 290 to 35Q,_TypeOpen Size Hole How Drilled: From to Type Size Rotary _4 of _$.-. t of Sect. _____ Twp , I N , Rge. 66 ipm LOCATE WELL ACCURATELY IN THE SMALL SQUARES REP - PRESENTING 40 ACRES W I I I M � I I I I ! I Well description: Total Depth Ft. (from 0 to 20 B in. Hole (from 20 to 290„ , 6 in. Diam. (from 290 to 350 , 4 in, REMARKS Cementing, Packing, Type of Shut-off, Depth to Shut-off, etc. PUT LOG OF WELL ON RE- VERSE SIDE TO BE MADE OUT IN QUADRUPLICATE ; Qri ia.al Blue ant# l o cats Green to State Engineer's Office, White copy to Owner, and Yellow copy to Driller ..�s.+: *,�r+r,;R++,'.�'.. re„ .y;• . S.�r^+.ztsJIR9R'.sk`RS..e' rlG'.., +r •,., ,✓w� •4,��t`�i,'dVaL"? F7 LOG OF WELL (ADD SPACES AS NEEDED) From O ft to1 ft. Surface' 15 ft. tom s `ft. Derwer formation •2 t. to 3a� O ft. Arapahoe sands _________ft. toft. ft. to ft. Packer at 2O ft. Formation shut off to 250 ft. . Forok, C(Rev. ) 7-55/5M _' . STATE OF COLORADO APPLICATION FOR USE OF GROUND WATER JAN 2 19S2 Use Indelible Pencil or T ewriter D Applicant r r►. P.O. Address rr—j—ay Quantity applied far pm or AF Storage Used for Jcfi I Purposes on/at (legal description of land si e Total acreage Irrigated an other rts. ESTIMATED DATA OF WELL Hole size: in. tam ft. • iet], to . ft in Casing Plaxa. from ft. r 'n. fxon tq ft, Perf In ' in. from -te ft. P€1M1 7"' ,F f h'n Outlet DATA: Type . HP. Size Use initiation date 1--•9 (Use Supplenn ntal pages for additional data) W ThITjf TCATION OFWF (7LQounty a r� ! E FJY I tfL1secti7 T' Rge P. m. OR Street A.ddresa or Lot & Block No. awnor Subdivision N r � 7+ r �+ l i t' r Locate well. in 40 acre (a a11) . ware aneatr as poaetble, $25.40 fee required for Industrial, Co uercial or Irrigation uses. NO. x 040 Applicant rr DATE.JA 2Ate�nt o • •1g Ilrille cr ear* C N•.�„ Address NOTE —SATISFACTORY COMPLETION REQUIRJD FOR APPROVAL OF APPLICATION. •r�.- .;! .,,.., '':end:: :A:: ;�� `' - .'; :..aw rt3;ra",; ++r•?: —,q • r -? Form STATE E Itv. e OF COLORAD O •( 1 A UG 3 9-57 DIVISION OF WATER RESOURCES R�jI40 WA OFFICE OF THE STATE ENGINEER cOLO p GROUND WATER SECTION LOG AND HISTORY OF WELL PERMIT NO. 10k98 Lie. Drilled by Noaher Dril.Ung Cod, No. _354 WELL LOCATION Owner Herr,y Green _, Weld County Address __i hton Colorado n j of SE u of Seat. 27 Tenant Twp . �N , Rge. b�W , jF1VI Used for LOCATE WELL ACCURATELY IN THE SHALL SQUARES REP -- on or by .011 zits PRESENTING 40 ACRES (de6cripticnn of site or land)��' N Date Started Janus. - .r , 19 Date Completed .7enuam 1.5 19 Date Tested januAt _r I A 19L2 Yield_ 2 gpm cfs Pump typeNot Outlet Size Driven by HP a RPM Depth to Water�9a_Ft. Draw down.Ft. Depth to Inlet Ft,; Bowl Ft, Size and Kind of Casing: From._cL to 2q0 Type l Wt. From to Type Wt. Fromto Type Wt. Perforations; Size and Type Open Hole From 350 Type ize From to Type. Size From to Type Size Well description: Total Depth Ft. (from 0 to 290 6 in. Hole ( (from 294 to 350 4 in, (from to in. Il I I I I I � _ I S If the above is not applicable fill In: Town or ubdivision Street Address or Lot & Block Ground elevation (f known) How Drilled: Rotar' REMARKS E Cementing, Packing, Type of Shut-off, Depth to Shut-off, etc, PUT LOG OF. WELL ON RE- VERSE SIDE .LLJ Ji 1Yi21i1C VEJ"1 J1V UdtU UYLiUA 1 Ui' J'itle and Duplicate to Htat ;E e]'x',Ofice, copy to s'(w �.,_ Y. copy t] ( f more spree it required is •addil1nnel sheet) WELL DRILLER'S STATEMENT This well was drilled under my supervision and the above information is true and correct to the best of my knowledge and belief. Signed.. By aeted—. —, 14� Form No, OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (30,%% nap 3581 APPLICANT HENRY B & HAZEL M STOLL PO BOX 673 BRIGHTON, CO 80601 - EXST WELL PERMIT NUMBER 288990 DIV. 1 WD2 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY NW 1/4 SE 114 Section 27 Township 1 N Range 66 W Sixth P.M. DISTANCES FROM SECTION LiNES 1350 Ft. from South Section Line 220 Ft. from East Section Line (303) 659-6011 UTM COORDINATES Meters Zone:1 NAD83 GHANGEIEXPANSION OF USE OF AN EXISTING WELL Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RiGHT CONDITIQ,{,L QE 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 for the change/expansion of use of an existing well constructed under permit no. 57284, 4) Approved pursuant to CRS 37-92-602(3)(b)(I) and policy of the State Engineer under the following conditions for a 24.9 acre lot known as S1 /2 of the SW 1/4 of the NW 1/4 of the SE 1/4 and the W1 /2 of the SW 114 of the SE 1/4 of Sec 27, Twp. 1 North, Rng. 66 West, 8th P.M., Weld County. 5) The use of ground water from this well is limited to ordinary household purposes inside two (2) single family dwellings, the watering of the user's own non-commercial domestic animals, and the Irrigation of not more than I acre of home gardens and lawns. 6) Production from this well is restricted to the Laramie Fox Hills aquifer. 7) The pumping rate of this well shall not exceed 15 GPM. 8) The annual withdrawal of ground water from this well shall not exceed 3 acre-feet. 9) The Issuance of this permit hereby cancels permit no. 57284. 10) The return flow from the use of this wall must be through an individual waste water disposal system of the type so that not less than 2% of the total amount of water withdrawn is returned to the same stream system In which the well Is located. 11) This well shall be constructed not more than 200 feet from the location specified on this permit. 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 declin s. f �� APPROVED JLV State Ecgi� e ' *r P DATE ISSUED 08-01-2012 DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST., Ste 821, DENVER, CO 80203 RESIDENTIAL Notac aeo use this ram to apply for liveatook watering Water Well Permit Application Revlewfanrl instructions prior to cornpinungitorm. Hand completed forms must be complahad In black or blue ink or typed. 1_ Annilcant Information Henry B. Stoll and Hazel M. Stoll IPO y slate Zip code Brighton CO 80801 303-659-6011 2. Type Of Application (cheek applicable boxes) ❑ Construct new well Q Change source (aquifer) ❑ Replace existing wall O Reapplication (expired permit) ■ Use existing wall ❑ Rooftop pip. collection • Change or Increase use O Other 3. Refer To (If applicable) See Weld NW 1f4ortis SE ti+4 Secdon Township N or S Range Ear W Rindpal Meridian 27 1 0 El 66 C] 6 Dlslanc Cr woC from sedlon llr+ee (sad lon lint are typilr not pfuwty rinro) 1350 Ft. from❑ N ®s 220 FL from ®E ❑ W feet Direction Well looatlon adr$ae (Include City, State, O Check well address is seine as in llent 1. 15509 Weld County Road #4 Brighton Colorado 80602 opeonar: OPS well locator k*rmauon In LTM foment. OPS unit aettlnge are as follows: Foment must be tr1M 0Zara f2 orQ Zone 13 Eeellmg; unite swot be Maters Datum must Ire NADW Northing: unit must be sst a true north Was OPS unit &mcmd forabove? ❑ YES Ramemberto set Datum to NAD83 5. Parcel On Which Well Will Be Located (You must attach a current dead for the subject parcel) A. You must check and complete one of the following: ❑ Subdivision: Name Lot Block Filing/Unit ❑ County exemption (attach copy of county approval & survey) Namely Lot 0 II Parcel less then 35 acres, not in a subdMvlslon attach a deed with metes & bounds description recorded prior to June 1, 1972, and current deed ❑ Mining claim (attach copy of deed or survey) Namely: ❑ Square 40 acre parcel as described In Item 4 ❑ Parcel of 35 or more acres (attach metes & bounds description or survey) ❑ Other (attach metes & bounds description or survey) 13. it of sore N parasr C. Are you the owner of ups parcel? 24.9 IlDNO D. will tide be the ordy wall on thin parrs!? IYES ® NO pf no — list other wells) Office Use Only TI Fns (1112011) JUL 022012 6. Use Of Wei] (checkpphcable boxes) See Instructions to determine use(s) for which you may qualify ❑ A. Ordinary household d d use 1n one singleamiiy dwelling (no outside use) ■ B. Ordinary household use In Ito 3 single-family dwellings: Nui3ber of dwellings: 2 ® Dme garden/lawn Irrfgalion, not to exceed one acre: area Irrigated 250 l) sq. ft, ❑ acre Domestic animal watering —(non-commardal) ❑ C.Uvostookwatering (on farmlranchlrange/pasture) to � 7. Well Data (proposed) 15 gpm acre-feet 11000 , feet ! Laramie Fox Hills I Is this parcel within boundaries of a water service area? ClYes W NO If yes, provide name of suppiloc 9. Type Of Sewage System __ ■ Septic tank ! absorption leach field ❑ Central system: District name: ❑ Vault: Location sewage to be hauled to. ❑ Other (explain) 10. Proposed Well Driller License # o Clonal 11. Sign or Enter Name of Applicant(s) or Authorized Agent degree, which Is punishable as a class I misdemeanor pursuant to C.R.S. 24-4-104(1 3)(a). 1 have read the statements herein, know the contents sign or sneer namesor personsj aurmsmng appuceson rote tmmmly r1 Henry B. Stoll 06130/2012 K el®Nna Stint nen a and line t � ltecslpr area arty qy AFAIrnI L_ - 3L Aqun Iran set fan tk 31 1 Dabs, 712/2012 4:34:40 PRA Transsctlan Total: $100.00 wra CREDIT CARD $1Q0.00 Gv: ji TO MY ass oiv_J__ WD -L SA MD Report Date: 8/1/2012 Bedrock Aquifer Evaluation Determination Tool Denver Basin Aquifer - Specific Location Determination Tool Applicant: STOLL Receipt No; 3855995 Evaluated By: JLV Location: NE 114 of SE 1/4 of Sac, 27, TIN, R.66W. (1350 SSL. 220 ESL) Basin Designation: Location Is within the UNKNOWN Designated Ground Water Basin. Ground Surface Elevation: 5180 Feet Number of Acres: 24.9 Warning! The depth intervals estimated in this area may vary from actual conditions due to lack of data and/or structural complexity. AQUIFER ELEVATION (ft) NET SAND DEPTH TO (ft) ANNUAL STATUS Bot Top Bot. Top APPROP. Upper Dawson -- - - -. -- Lower Dawson — — — -. - Denver -- — -- — — — Upper Arapahoe 4838 4886 22.5 342 294 0.95 NT Lower Arapahoe 4496 4783 100.8 884 417 4.27 NNT Laramie -Fox Hills 3858 4168 186.6 1322 1014 6.97 NT NOTE: 'E indicates a location Is at an aquifer boundary and the values may be more approximate. Elevation of the bottom and the depth to the bottom of the Upper Arapahoe aquifer are approximate and should be checked against the DENVER BASIN ATLAS NO. 3. SC'Cvl'.7��i9YCT3 ma,�yy- • � 1 � '�. rl LY �+\ pl� }� IMVV L L Iqh�' K�. �In ._� SPO....�RecorEer. This`• •~ fa mad-tme tbootand nine tfuaarod,=and. Sy --eight F ECCIV Q y f" JUL 032011 .' a L � WATER RESOURCES Conn utd Sr�tia`fif STATE ENGINEER i p3 cif toi i3]rvek Sr to .3. and Many El'1erl; Stoll ads= afCity' .Ind at Denver edd State of Calua+lo, of tba secaad rare: WITNS�+SETS', that the Wl Der of the first vary for and b, dn'etlan of the atno of part fnhnn4 vaatd by the said patina of the uccond pert, the receipt whereof 6 bY oifteeet! dad-rao9oaowfe l , ha a n ted. barite std and coercyod, and b7 these pre eats do ea 6ar$alursall'.coae9 And a:anflrm.wutp'tktitam vomits of the a+saend part, their hairs cud earlgau farasar, not In tq¢anr$-in ncien r but In Jalat tenantg, 41 0--Mlo'e'lr deic 4•1ottr parcel ci Was; dtgat4_lYing and •sc ng In Lire C=%Y of Weld• aand State of Colorado. 4o atitr s tide SW?x Of th oaf the' SEA mend rte- W of the of te sa zf Set1 7,4o4ip 1• :&o. tb4 Range 66 West of the 6th 0G131 R with ell and singular tbe" herediarmerita end appttr[enenaet therenntp betonsing, ar i� anrwlaa a anti the raeerslan and ranr raionaf r.ni fader en remalnderr, rnu bsuoe sad profits thereof# end alb the rG: thetw or e4ti[tp,' rnir +ti+4d': ' cJr iim4+ reuri s�' ' sl alfr ra l acnMs oil adtsta4eueueei. �'O;I V fail D _x0 I3 L1) she sold' premises above barvaia'ed stud det Tibed, with ihrAppart'ansaeae, into the said• it . paYtle6 Cd ihp+aietoud very clash It lra and esiI ns forever. goal the said pvt y of thi Aral vary far 1.ilxrf f•fJ ll-ia htrlie, enecuta5re,-end admkaietratmj,doAS • wv4aany Smog bnrQeln Rod are to zed-wfth,the syid-p6flu of #ec ntt..thr4', heirs sod rya, that.at-the tins of thi'auaeeiiog and dctivarr of tbeee presents he well'sched r the pa'ataaleiA a above anovaytdars'of good, sue,-yarfec , ibeddrrta and iadefeaaible estate of itrberimnce, in bar:"In ipa iple, end ha: a goad right♦ ft a iad lawfoT•ectherib to rani begiJnsell and con ory the stoma tat aMntiliax dil:tb; i,'itorgsaid, antd that tha.same.era' free end clew' fraau elf for end other $rentsbatgafaa, sale, Itemi, • - •ae0.aeeasatilataie ioa Inc nabraaem of whale er i Ind or nature saxvtr, en#ept the 1966 taxes k{ ofd 'eaie>ent'.s, rights of way and reservations of record. end tie above ¢aargninod, prtmlace In the.quet aad.yeac.e hie pioas -0 the agda! p mica of the seeo4d Vert,. tbck bens 'i eo4 ouf�a, 4g`ejnshadi and:eve17I Obran ax pcY•xons iawfal1Y � or tgc•.elaiin the whole r any pout Fhtrmf, the Mid p ` u1)l.Ereepery; a hall wed T¢ 1 b7' . PD 7$1 :DEFEND ;.'w ol *betmrae I B hareonfosot itiwhsod,. and ., 'a d F $ t'erritL(pa' �. �� • ' . - ., J Vin- _ '� "y!s-•'-s.sF�1..3��'t...bTf',�J{T�e�•,i5;,",'�Pb'R �,'A ."�.. .aLt,4Ai& OF COLORADO, County Denver J E f etrament-was a loaatwlaodged bafnre me this 16 ' da of September • i > 7ro rel1 Bali , , air . ., rf t t w • 14baud and official PGx, $8L Ti ,t}m —xa 7otne .—t#aa kCaLfaeaa prhsttaa Ommlianr, tAY4ie atcat saeaa Maori ci mde �u a trran or Varato 'nara 59mt p>.mla`or . S tt Deccan m eaentgtt ar - aFtt-pa'a99i' �ihaA .a6�a.vi Rmrtran. r>�o0: phdr aermi�a1� ar�JF��4rfl }.` �} 8oato i>�INt#S,OO a! , plda�4t ax a#bw tHtloata at carob f t+� .ate. �'-' ✓' f,{' •J }~,' _,.1� z•'141i'..- Lr - iG r r 'Pr[•r 'z'',-_ ti �'_rFy'}4 �,rr.+r`��ck-f' '1�r4i� ,,�{'r ii I. E- gin r TO Y +. " Y r S rh F r ti - 4ter. {" of ++ F�'�.i� �y t \] 5 1�" `_ 5 £fZ i yi.. 1, •vim l 4 r - '4V .�+YY R •,--.Y� Y M. '' ti��'�~ • •_1 - 4,+ '�r�, .J�r[ `,' Y yj M e �Gy,�ls i•�Iu�� t YQi4t� tiled11ajaiF r ky r —n r_ s . � 1f♦ ry}�OF `} _ �..� {�� Y. -. r � h .^ + fin'. L x+ i `� r /."j •+ - ' -Y�r W+4..r��....� �S}L �r�-F�Y'Qj"Q.�i rZY �, � � .. y F N- � �� i C �~ lr,� � y�� [L,1P�. rF� •� - +' a� �--•� r� -� � y *� •. 'k'J�`-yam' =� �'� Y = t 9r `.4� i r � �-�' } _ ar - q Y:� Y•+- YI N�� •+,.Y- i ', � -L G ��_ � 5 � x ��t, f p - - ti- I �, r� , tom+� J rP•�7�t�vY•��"f0��Gt� �- -_ " . +�- ✓�'•' -d 'i - :: - F't'} si'A S- y." £T4 �s- 'yam, `�• it a • ,_ �F —• IF�f.�`s f, 3r•� '�'� ` rrry �,^+yyr.�-+} - r •y �{ „.{ r e s _''; {-iTl'' f"� -st 7 _�� f1 p. fla...�C,� �^� ' ` v _#�- • 'E`� �i3r iS �x � {- - {x. rF- kY+� �1?�'' � _ � �;4T s '�� .. {� � i. o- .� �� . . v.� a .¢ WRJ-29-72 J. COLORADO DIVISION OF WATER RESOURCES THIS FORM MUST HE.SUSMITTED 101 Calumne Bldg., 1 46 Sherman St, NrJTHIN SO DAYS OF COMPLETION Denver, Co E0203 OF THE WORK.OESCRIBE1 HERE. ON. TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTA1 'I RT INK. PERMIT NUMBER`�� WELL OWNER . HI Y B. STQL_L I W 1, Uf the ADDRESS 5660 E. AMH€IST AVE1 DENVER 0010, T. N , R. 66 W 6 P.M. DATE COMPLETED JUNE 27 ,19 2. HOLE DIAMETER WELL LOG 278- in, from a to 50 , ft. From To Type and Color of Material Water Loc. C) 34 clay sanct 34 37 hard rook 37 78 sand 78 121 sand clay 121 13% sand streaker yellow 137 146 Clay 146 152 shale 152 177 sand clay 177 201 sand yellow iron etain'% 201 205 shale 205 209 sand hard 209 227 shale 227 240 sand black coal 240 255 shale sandy 255 324 sand shale 324 325 hard rook 325 341 sand 341 362 shale 362 372 sand streaker 372 825 shale hard rock streakes' 625 830 coal 830 915 shale coal streakes 915 939 shale 939 943 hard rock 943 1005 coal shale 100 1009 saM 100 1920 shale 102 1103 sand good TOTAL DEPTH 1,3 Use additional pages necessary to complete log. —_ in. from . 50 'to ft. .. 8 In, front,_..385.. to __[lot. CASING RECORD: Plain Caring Size 658 & kind ate®'I®t from 0 to 5.. ft. Size. )4 & kind —st _... from ,"L, toe ft. Size & kind from to _______ft. Perforated Casing Size & kind A+ eel from 1,019 to 1403- ft. Size __r___ & kind from to ft. Size . & kind from to ft. GROUTING RECORD Material Intervals CQt$tant Placement Method Did GRAVEL PACK: Size Interval TEST DATA Date Tested JUNE 2 , 19 Static Water Level Prior to Test ... -- ft. Type of Test Pump . Length of Test ._.._ - Sustained _ 21a Sustained Yield (Metered) 45 Final Pumping Water Level -_520' PUMP INSTALLATION REPORT Pump Make U IR1BY Type SUB. Powered�by ELF4O. HP 2 Pump Serial No. Motor Serial No. Date Installed . _ _ Pump Intake Depth Y`' Remarks .. , I. a' WELL TEST DATA WITH PERMANENT PUMP Date Tested _' _—_ AUr., 7 _ ,"____ Static Water Level Prior to Test - _' _ T Length of Test .. S4 hr . .,Hours Sustained yield (Metered) GPM Pumping Water Level 5, -- Remarks iii WATER t CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation described hereon; that he has read the statement made hereon; knows the content al. thereof, and that the same'is true' of his n owled e. Signaturb. i' License No. 93__ '&tate of Colorado, Cbunty of S5 Subscribed end•suutirn to before me this day of 19 My PAtniuiswslvn cxpites May 21 y My Commisshon expires: Y9 Notary PisbfiC FORM TO 9E MAP I* OUT IN QUADRUPLICATE, WHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be tlled with the State Engineer. PINK COPY is far the Owner and YELLOW COPY is for the Driller. Hello