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Home My WebLink About20203357.tiff Scanning Cover Sheet for Septic Permits Permit # SP-9700365 Permit Type: Health / Residential/ New Situs Street Address 16955 CR 33 Situs City, State, Zip _ Sec/Town/Range: 10-03N-66W Application Status: Fina/ed Application Date: 07/0712008 Parcel # (12 digits) 121110100021-83646105 Owner Full Name: PHELAN MICHAEL Owner Address: 10314 CR 23 FORT LUPTON,CO 80621 Owner Phone #: (303)857-21413 Contact Name: PHELAN MICHAEL E Contact Address: 10314 WCR 23 FORT LUPTON,CO,80621 Contact Phone# (303)857-2141 Information above has been Verified in_ 4ccela b emplo yee nofed below July 07, 2008 Processed by: Date Report ID: EHS00024v003 Page 1 of 1 Print Date -Time: 7/7/2008 1:51:35PM FORM PUMP INSTALLATION AND TEST REPORT For Office Ilse Only GWS32 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 04/2012 1313 Sherman St, Room 821,Denver, CO 80203 Main(303)866-3581 Fax(303)868-3589, COL/E. dwreerm itso rf ilnetO state.o0.us D U 1. WELL PERMIT NUMBER:227143-A re 1 20/8 2, WELL OWNER INFORMATION r1j % NAME OF OWNER Cpl �c .. DOUG AND LEANE TSCHUDY MAIUNG ADDRESS 16955 CR 33 CITY STATE ZIP CODE PLATTEVILLE I CO 80651 TELEPHONE S (area code) 303-994-1250 3. WELL LOCATION AS DRILLED:NE 1/4, NE 114 Sec. 1.0 Twp.3 'r N or r S, Range 66W r E or r W DISTANCES FROM SEC.LINES: ft from r—N or Es section line and — ft.from r E or 7W section line. SUBDIVISION: LOT , BLOCK , FILING(UNIT) Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Easting:520888 must be meters, Datum must be NAD83, Unit must be set to true N, r Zone 12 or ir Zone 13 Northing 4455023 STREET ADDRESS AT WELL LOCATION: 4. PUMP DATA: Type:SUBMERSIBLE _ Date Installed(mm/ddtyyyy):05/04/2016 Pump Manufacturer:FRANKLIN Pump Model No, 15FA05 Design GPM: 15 at RPM 3450 HP 1/2 Volts 115 Full Load Amps 12 Pump Intake Depth: 225 Feet, Drop/Column Pipe Size Inches, 1_25 Kind of Drop Pipe PVC ADDITIONAL INFORMATION FOR PUMPS GREATER THAN 50 GPM:Turbine DriverTypeDElectric InEngine©Other Design Head feet Number of Stages Shaft size inches 6. OTHER EQUIPMENT: Airline Installed Yes No, Orifice Depth ft, Monitor Tube Installed Yes No, Depth ft. -- _ Flow Meter Mfg. - Meter Serial No. Meter Readout'OGallons,DFhousand Gallons.CIAcre feet Beginning Reading _ 6. TEST DATA: check box if Test Data is submitted on Supplemental Form. Date: 05/04/2016 Total Well Depth:250 ft. Time: _ Static Level:40 ft Rate(gpm): 15 Date Measured: 05/04/2016 Pum in Level R: 64 7. DISINFECTION: Type STERILENE _ Amt. Used9 OZ 8. Water Quality analysis availabler3YesriNo If yes,please submit with this report, _ _ 9. Remarks: _ _ — 10, I have read the statements made herein and know the contents thereof,and they are true to my knowledge. By signing or entering my name I am certifying 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$5000 and/or revocation of the contracting license. Company Name: Phone w/area code: License Number_ QUALITY WELL AND PUMP 970-353-311$ 1461 Mailing Address: 39525 US HWY 65,AU 0 80610 Sign or Enter Name a i Date(nvn/dd/yyyy) CHRIS JONES OWNER 06/09/2018 l 'n FORM NO. WELL CONSTRUCTION AND TEST REPORT For Otrceuse Only GWS-31 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER 4/2012 1313 Sherman St„Ste 821,Denver,CO 80203 Main(303)866-3581 Fax(303)866-3589,r w.waler.staks& 1.WELL PERMIT NUMBER: 727143 . �l O 2.WELL OWNER INFORMATION rV r B NAME OF WELL OWNER:DOUG AND LEANNE TSCHUDY _ Q1& MAILING ADDRESS: 16955 CR 33 Alleoe CITY: PLATTEVILLE STATE: CO ZIP CODE:80651 *$ TELEPHONE NUMBER wlarea coda:303-994-1250 :3. L LOCATION AS DRILLED: NE 114, ilf-1/4, Sec., 10 Twp 3 III Nor S, TI Range. ❑ E or W DISTANCES FROM SEC. LINES: ft.from 1 N or r S section line and ft.from O E or❑W section line. • SUBDIVISION: -, LOT , BLOCK . FILING(UNIT) Optional GPS Location:GPS Unit must use the following settings: Format must be UTM, Unite Owner's Well Designation: must be meters,Datum must be NAD83.Unit must be set to true N, TI Zone 12 or Pi Zone 13 Eastrng:520.B88 T STREET ADDRESS AT WELL LOCATION: Northing:4455023 4. GROUND SURFACE ELEVATION feet DRILLING METHOD ROTARY DATE COMPLETED 04/18/2016 TOTAL DEPTH 250 feet DEPTii COMPLETED 250 feet 5. GEOLOGIC LOG: 6. HOLE DIAM(in.) From (ft) To Depth Type Grain Size Color Water Loc. _9 0 105 0-2 TOPSOIL 61/8 105 250 240 CLAY 30-35 COAL 7. PLAIN CASING: 35-76 SANDSTONE BROWN OD(in) Kind Wall Size(in) From(ft) To(ft) 75-132 SHALE 65/8 STEEL 1 RR +1 105 132.201 _- _ SANDSTONE GRAY xxx 4 1/2 PVC .250 10 130 201-250 SHALE 4 112 PVC .250 230 250 PERFORATED CASING: Screen Slot Size(in): .030 _ 4 1/2 PVC .250 130 250 1 _8. FILTER PACK: 9, PACKER PLACEMENT: I Material Type --- —, -,-. Size _ Interval Depth 10. GROUTING RECORD Material Amount Density Interval Placement Remarks: CEJ1ENN 2 YRD _ 1.86 0-105 P0S DISP 11. DISINFECTION: Type STERILENE Amt. Used 9 OZ 12. WELL TEST DATA-, ❑Ctreck box if Test Date is submitted on Form Number GWS 39 Supplemental Well Test TESTING METHOD AIR LIFTEI it OVERPUMPED _ Static Level 40 ft. Date/Time measured: 4/25/2016 , Production Rate 15 gpm. Pumping Level 64 ft. Date/Time measured 4/25/2016 , Test Length(hrs)4 Remarks: • 13. I have road the statements made herein and know the contents thereof,and they are true to my knowledge. This document le signed(or name entered If filing online)and cerdfled In accordance with Rule 17,4 of the Writer Well Construction Rules,2 CCR 402-2. The filing or a dowument that contains false etatomsnta fee violation of;action 37.9tw1b8(1)(*),rf,R,B„end Is punishable by fires up to$5000 endfor revocation of the conbeciing license, if flaing online the State Engines!cenakiers ent.erirg of licensed contractor name to be a comjiilance with Rule 17.4 Company Name: Phone w/area code: License Number. QUALITY WELL AN PUMP LLC 970-353-3118 1461 Mailing.Addres .55 5 US HWY 85tLA SALLE, CO 80645 Sign(or ent ameif ling online) Print Name and Title Date CHRIS JONES OWNER 06/09/2016 Hello