HomeMy WebLinkAbout20202769.tiff Form No. OFFICE OF THE STATE ENGINEER
.GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203
(303)866-3581 LR
WELL PERMIT NUMBER 226S78 -
APPLICANT DIV. 1 WD 3 DES. BASIN MD
APPROVED WELL LOCATION
• WELD COUNTY
ELDON L& PATRICIA J HARRELL NW 1/4 NW 1/4 Section 4
4123 CENTRAL Township 5 N Range 65 W Sixth P.M.
EVANS, CO 80620-
DISTANCES FROM SECTION LINES
1310 Ft. from North Section Line
(970) 338-3953 1115 Ft. from West Section Line
REGISTRATION OF EXISTING WELL _
,
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) This well is recorded and permit approved in accordance with CRS 37-92-602(5)for historic use as indicated herein and
described in CRS 37-92-602(1)(e), being a well producing 20 GPM and used for ordinary household purposes inside two
(2)single family dwellings,fire protection,the watering of domestic animals and poultry, and the irrigation of not more than
10,000 square feet of home gardens and lawns.
4) The date of first beneficial use, as claimed by the applicant, is April 1, 1910.
I,.li •
• c
APPROVED
MAS •
State Engineer "`N 2 7 Z00a By /
„Receipt No.0460313A DATE ISSUED JILL EXPIRA N DAVE / A- . ,
VORM No. STATE OF COLORADO R EC E 3 V offuc use onlr
OWS-12cvs, ,. :OFFICE OF THE STATE ENGINi ER p �1�I'f'
1:,7.— !, 818 Centenn1al Bldg., 13]3 Sherman Sc.,Denver,Colorado W
, 80203 MAY 0 8 g NUMBER
.'(303)$66-3581
FOR INSTRUCTIONSREVERSE SIDE wSTA E EENAINEEA
COL
.REGISTRATION OF MISTING WELL
L WELL OWE '------) —
1 am
w
NAMES) L 1 ,14 \ C' ) ,:,-. Ck`C LI *4 41.
41.
5 il.'
Mailing Address _1413 3 C. 0..4-rc .
City, St.Zip )C1 .\ c ReNDQO i t
Phone '1.C ) 039— 32_,53 : I
Receipt No.
2. WELL LOCATION: s,� l� �• k ' WELL DESIGNATION /'
(Address) f (City) (State) (Zip)
)1.9 ..1/4 of the 'D1) 1/4, Sec. 7`" Twp. ,arN. or O S., Range %...5--
El E. or Ow. 4 P.M.
0
Distances from Section /3/') Ft. from VI N. or O S. Line, /2/5- Ft. from O E. orgl W. Line.
3. The well hart historically been used for the following purpose(s): On rne.S4- 1Q, /{C.upv,. q_ r(L.,-
-- - ---..---- J _ . .... .—
4. Water.kom the well was first used beneficially by the original owner for the above described purpose(s) -
on—14'T ti ]� — 19 I) .
5. The total depth of this well ism- feet.
6. The pumping rate is c O gallons per minute. .�
7. The average annual amount of water diverted is / acre feet. Y
. 8. The land area of home lawn and garden irrigated from this well is: JO O61O O Acre or 0Sq, `e feet,
J (Number) I ' ° Ith
described as: 1.. --. --\-- -$-.. c, )0 L)0 u. I/ W l 4, \ lV !�2 c l . �1 :
1pt
or as . Subdivision Lot(s) Block Filing/Unit
I (we) have read the statements made herein, know the contents thereof, and state that they are true to my (our)
knowledge. want to Section 21. 1-104 (13)(a) C.R.S., the making of false statements herein.constitutes perjury
in the second degree and is punishable as a Class 1 misdemeanor.]
9: Name/Title Wk s=type or print) fSignatur � y rate
. . �; _t'
u FOR.OFFICE USE ONLY
.,I_, r iterestr
t`a - e38 1oi 4. -t-,*. CC,_,
fir, • it- i /Wryer, IoFso.C5,Lt,
State Engineer -. By Date ,.
Court Case No. Div.' V Co. WD 3 Basin MD Use
RECEIVED
r r MAY 082000
" COLORADO DMSION OF WATER RESOURCES FIELD INSPECTION REPORT
WA1ER OiEscukcEs
STATE F►GiNEE'll
Please complete this foram in INK ccc o
DI a f WO O3 3 appL receipt no(s). ' tp03 k„
❑LATE OF INSPECTION, 3-,5 2D elo
APPLICANT: LPo R ELI-- person contacted arnot applicant 13 !hnJ Ho R EG
AOORESS: ! 2.3 47.A A L - W.C.name&phone#LO 140 Fr
0ACo s cL.a.o 9 -to aeX - 3303
phone* 47o — 3 ? - ?53
EaSTING.WELL LOCATION:
N 14‘./ 1/4, Ci 114, Sec. 1 • rwp. 5A) T, Rag- k) P.ArI.,
DrST._L /0 . ei S recline, I//S from Mine;County U. E-p
(if repl,,give dist&dlr to new well site- /0 r+l d RTt- )
circle type of a ds ng well: DRILLED, €1TD-I----.1.....5)SPRING WELL. CALL1 'WELL, GRAVEL PIT, OTHER
hole/many otherwells are located on this parcel? °Ai E use? /R Iv'1( #4 r rO
are they registered? permit/case #(s)? loq d669 001 I W- 0 _7
EST_DATE WELL CONSTRUCTED 1.°1 10 _ DATE OF FIRST USE ? � d O EST.PUMPING RATE 20 gpm
TOTAL. #OF ACRES IN THIS TRACT/PARCEL 0 ACRES
additional sum/per 4-01- 4 fv r t) NO L.6 7- I .3"4...)A< VI R63-0
roe. L J :o ,U C-O4-0
USE OF WELL:
household use In (indicate how many) single family dwellings)
V Ong of poultry /or domestic animals(-domestic animals would include a few cows, horses, etc)
watering of livestock on a farm or ranch—approx.how Mary head?
is this a feed lot? ;how many head?
VOtis Important to specify estimated historic lawn/garden irr.) in. /o,ee) feet acre of lawn and/or garden
_ fire protection —
cormmercial—drinking&san_ only/?(write details in'comments'section)
other(write details in'comments'seCOon)
I no WERE THE USES CHECKED ABOVE INITIATED PRIOR TO MAY 8, 1972?
NOTE: IF ANY CHANGE IN THE HISTORIC U$E OF THIS WELL. HAS OCCURRED SINCE Mar 8, 1971 please
indicate the date(s) the use changed,and discuss this changefand/or capaflsion of the curie or proposed use
in he'comments section of this form
(if completing inspection for NONMPT USES, use comments section below(include case #, #acres irr. if applicable, etc.))
signed_ \\4_ dated 6 ! l 0 0
additional comments and/or information:: Ulm
more room for comments on the back
FORM �'- ---_,E
0919-31WELLCONSTRUCTION AND TEST REPORT For Office Use only
x4 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
, - I,
Ma . —
1. WELL PERMIT NUMBER w
2 OWNER NAME(S) EL-DON , ti h Picrre 1(14 IAA RE L-L L AUG 1 1 2000
Mailing Address_-- •-l;l C-I r i R A L _
City, St. Zip _Il I 1 N C 0 6 r .ST TE-clUtilNFER'
Phane.(OR O) 9 . 9 5 col.° -
a CATION AS DRILLED: NW 1/4 N V ,114, Sec. 4 Twp. 5 Ki , Range tq 5 Vi_
DISTANCES FROM SEC, LINES:
1310 ft. from H Sec. line. and I 1 15 ft. from i Sec, line. OR
(wigwam-
SUBDIVISION: _ LOT BLOCK FILING(U NTI)
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft. DRILLING METHOD P Drrn R y
DATE COMPLETED cR-1-f-QQ ._-I_ I.p ft. DEPTH COMPLETED 1t
-_. -. B. -GEOL IC-LOG:.. - - - -- 6.F4c LE DIAM: (in,)..-Rohl
( - To ti)-- .
Depth Description of Material (Type.Size,Color,Water Location) _
y —I--_-T0 P O I I-- - - �—
1- -
D Rri- Jfi- _ T
18-.9-g A N t-i 6-R i -V.E L i NJ is -Ccz Rock( T. PLAIN CASING
8Q(5wr Cl ay OD (in) Kind Wall Size From(ft) To(ft)
-- - O MI+ VA-,.,b u T o i1E L •)S . !- .ci
14.3-50 44 Ltr $ ' .PVC- 1 I77 .2O so
_ PERI .CASING: Screen Slot Size:
5 4 plE RC ' 7 - "B _ bO
_ 1 =
8. FILTER PACK: 9. PACKER PLACEMENT:
„_ Material p Eft G-e4vEL Type _
- T Size 3 -
-- ._ Interval `oZO- so Depth
10. GROUTING RECORD:
r. • __ Material Amount Density Interval Placement
REMARKS: C' HENT ,)ccx 1'8G 0 -,„ac, POukiZN
----_... — - - - -_ -
11. DISINFECTION: Type H- Amt. Used l Cu P
12 WELD TEST DATA: O Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test
TESTING METHOD _SA, I LE _
Static Level 1 b . ft. Date me measured - 16- 1 -o O , Production Rate 1 5 gpm.
Pumping level i B _ ft. Date/Time measured S- 1-^coo , Test length (hrs.) 1,c-
Remarks
.._•o . . - - - -
13. I have read the statements made herein and know the contents thereof,and that they are true to my knowledge, [Pursuant to Section 24-4-104(13)(e)
CRS..the making of false statements herein constitutes perjury in the second degree and is punishable as a class I misdemeanor.]
CONTRACTOR Q i Q u,-i i.L d CAL)i.-tP Phone (q f ) 3 53- -61t.5 Lic. No. S57- -
Mailina Address Q ,_0 _ 7 I-Y c _
Name/Trtle (Please type or print) Signature _ m Date
Form No. OFFICE OF THE STATE ENGINEER
GWS-26 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203
(303)866-3581 857
WELL PERMIT NUMBER 4g2a02 4 Z 71 - -
APPLICANT DIV. 1 WD 3 DES. BASIN MD .
APPROVED WELL LOCATION
WELD COUNTY
ELDON L& PATRICIA J HARRELL NW 1/4 NW 1/4 Section 4
4123 CENTRAL Township 5 N Range 65 W Sixth P.M.
EVANS, CO 80620-
DISTANCES FROM SECTION LINES
1310 Ft. from North Section Line
(970)339-3053 1115 Ft. from West Section Line
PERMIT TO CONSTRUCT A WELL _-
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 37-92-602(3)(c)for the relocation of an existing well, permit no. +2 87
The old well must be plugged in accordance with Rule 16 of the Water Well Construction Rules within ninety(90)days of
completion of the new well. The enclosed Well Abandonment Report form must be completed and submitted to affirm that
the old well was plugged.
4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than two
(2)single family dwellings,the irrigation of not more than 10,000 square feet of home gardens and lawns, and the
watering of domestic animals. This well Is to be located at 288 1st Ave., Greeley,Weld County,CO.
5) The maximum pumping rate of this well shall not exceed 20 GPM.
6) This well shall be constructed not more than 200 feet from the location specified on this permit
APPROVED . his"
MAS
State Englnsar By JUN2 8 2002
%Receipt No.04603138 DATE ISSUED JUN 2 8 2000 EXPIRA ION DATE
RECEIVED
COLORADO DIVISION OF WATER RESOURCES •
DEPARTMENT OF NATURAL RESOURCES MAY 0 8 2000
, I3I3 SHERMAN ST., RM.818, DENVER CO 80203 WATER RESOURCES
phone info: (303) 866-3587 main; (3031 866-3581 STATE ENGINEER
RESIDENTIAL *INote!You may also use this form to apply for livestock watering} Water Well Permit Ap ation
Review instructions prior to completing loran) Mrfst be com.pleted_in black ink or typed
1. APPLICANT INFORMATION 6. USE OF WELL (check appropriate entry or entries)
Nitre of applicant -
�. See inotrUctions to determine usels)for which you may qualify —
❑ A. Ordinary household use in one single-family dwelling
ElAti i �, , 01�'C (NQ outsidt3 use)
'dilating Addraee B. Ordinary household use in 1 to 3 single-family
JI dwellings: +�
_ .. f ,r�:02 \-111.\ Number of dwellings: rr
City - —. Stets Zip code 4, Home garden/lawn irrigation, not to exceed 1 Ore:
Q CV Q �d1c . area irrigated_ / ❑ sq. ft. acre
-
Teiekone Plumber.linclucte r coolel ® Domestic animal watering -- (non-commercial)
2. TYPE OF APPLICATION (check applicable box(es)) '►' C. Livestock watering (an farm/ranchlrangelpasturc) -_
}❑ Construct new well
0 Use existing well WELL DATA _..
y4(,Replace existing well CIChange /Increase Use Meai,Yiwn punplr1p rate Annul amountto b.,.dehdr.wn
lrL�J Change (source) aquifer 0 Reapplication(expted penult) _. gpn'i / acs -feet
q Other: Total depth Addles
3. REFER TO (if applicable): - feet 41U01 0/ "`-i
Water court ease# Permit i7 8 TYPE OF RESIDENTIAL SEWAGE SYSTEM .
Septic tank / absorption leach field
Verbal# Monitoring hole acknowledgment p Central system
-VE_ Nil-I- District rlarne: .
Well slams or if— - -- 0 Vault
Location sewage to be hauled to: - _ --
4. LOCATION OF WELL _ ❑ Other (attach copy of engineering design)
County Quarter/quarter Quarter 9, PROPOSED WELL DRILLER (optional) _
` LL, 14 igf) ) % Name License nahnhar
Section Township N or$ Range4+
E or W Prirwipal Meridian a 1 1.;,R. \,--v\-%9
_ pi 0 0 04 -4 e 10, SIGNATURE of applicant(s) or authorized agent
Metal-ice of welt from section linca The making of false statements herein constitutes perjury
Zp3 LC) ///...5'
rt, from �N ❑s . ft. lam 0 E �, W in the second degree, which is punishable as a class 1 mis-
Well location a idrsa,if e1 t tiers applicant eddreea Of applicable(. demeanor pursuant to C.R.S. 24-4-104(131(a). I have read
RQ (`g ,_ , — C Y the statements herein, know the contents thereof and state
For replacement/wale only-diu*n s and direction from old
j&cell to new weir that they are true to lily knowled .
I..� feet '"-' direction Mwr l>a eridra�signet-.
�
5. TRACT ON WHICH WELL WILL BE LOCATED 1 -^}�k i l ..
A. You must check one of 111.following-tee instructions Title bete
0 Subdivision: Name - - - . I Dr 7
Lot no. Block no. Filing/Unit OPTIONAL INFORMATION -
__
CAWap no. Surface also,
0 County exemption (attach copy of county approval & survey) 1.1 map name
O
Name/no. Tract no. __ _ Y
O Mining claim (attach copy of deed or survey) Office Uue Duly
•
N e/na. -.._ • .DIV _
ether (attach(seal description to application)
CO
a. STATE;PARCEL
ID## logtiana)); 13W d
mi
C. I sere* In tract A. a you the owner of this property? IiWQiC3
siBistie 1$4� �,
AYES 0 NO lit no- tee detailed inst.) . cas11 eT I}�7 �1BA
f" bra
E. Will this a the o y well on this tract?
OYES NO (If_ather wells are on this tract-see detailed instl _ t1Tchase- *tom
- Form GWS-44(11195)
1. •• •' •J
I
i RECEIVED ''
r
• MAY 0 8 2000
,-
M AP 3 R 65W STATE ENGINEER
JOINS MAG 20 S7AYE Q NEEii
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;*, �" LORENZ �m #�e LM iwA N.
K1 FARMS INC .. liar aVM1NrT4l 6
.�. ply....
t�1 7' sc�uer
+`r'r 1� �. a+ Mkt., 1 SUSAN I•, -'»• 9hia5 T .
k.'::', / /liG!// rE ' M1 s. r ALLEN �-
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HELEN M d
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3 *$ 1 0. +role liLi
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• a- I5.SINertisT(i
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� , ..id AR"r ui y 4 Y K. I RANDALL Q JAMES a I meaL6 a PHYL4f5_-..-- '•_... T
Fir /., '� ❑4RIF.4>A $ MIgHELE JOHNSON
.. ' r "ET n u FLGA R. a 4121.1N a ' I MARION VETTING 1 h�rte~ •
'' 't e,� .I Meg 44" MARJORIEa LOPRAIFE ALL$$ -
_{➢ Q it /� i. LEAMIttr3 ALLE5Y 1 .., . r .. d',,rt..
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1 Ma9!! err -I SAUER 4 I"" N''.�' ' RESERvgp co. LOUIS
37 lEl " LI re SCNM�T F
4I R3 JOINS MAP 29 x181 4 i�J .
SCHEDULE A
Order Number: 9261 Commitment Number: CG 30059
1. Effectrvedate: October 11 , .1972 at 7:45 A.M.
2. Policy or Policies to be rued: Amount of Insurance
CIKXLVitcliIUDWItitta
Standard Owner's(marketability) $24,250.00
Proposed Insured:
ELDON L. HARRELL AND PATRICIA J. HARRELL RECE v r)
lbr SA rd Polo't ;! S • MAY 0 8 2000
Frp ,tot!0.4
WATER RE5QLwick;;
STATE ENGINEER
(c) Leamhold
! CO1 tD
Proposed Insured:
r .• ,., � > .. .. :..: .,. ,,..s ... , ..: , A FEE SIMPLE.
4. Title to Uw fee Simple 4s1•JCe uF Ia Ai„Jl i i..11eit,rc date FIEILVt vSn11.a1 III
MELVIN F. BAIN AND GRACE E. BAIN
5. The land referred to in this Commitment is described as follows -
Lot One (1 ) of the Southwest Quarter (SW1/4) of the Northwest Quarter (NW1/4)
and Lot Four (4) of the Northwest Quarter (NW1/4) of the Northwest Quarter
(NW1/4) all in Section Four (4) , Township Five (5), North, Range 65 West of the 6th
P.M. , according to the subdivision of lands made by the Union Colony of Colorado.
4
tkk
1'• REGULAR RATE
• Owner's $143.80
•
Tax Cft. 3.00
TOTAL ' $146.88
•
•
•
•
Page 2 "TE ART TITL +
OUAtR4NTT COMPANY
Form No. OFFICE OF THE STATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203
(303)866-3581 LR
WELL PERMIT NUMBER 287278 -
APPLICANT DIV. 1 WD 3 DES. BASIN MD
Lot: 1 Block: Filing: Subdiv: UNION COLONY LANDS
APPROVED WELL LOCATION
WELD COUNTY
SW 1/4 NW 1/4 Section 4
BRIAN K HARRELL Township 5 N Range 65 W Sixth P.M.
288 1ST AVENUE DISTANCES FROM SECTION LINES
GREELEY, CO 80631- 1687 Ft. from North Section Line
1288 Ft. from West Section Line
(970) 405-6175 UTM COORDINATES (Meters,Zone:13,NAD83)
REGISTRATION OF EXISTING WELL Easting: Northing:
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) Construction details for this existing well have not been provided to this office;therefore, it is not known if the construction
of this well is in compliance with the Water Well Construction Rules, 2 CCR 402-2. The issuance of this permit does not
relieve the well owner of responsibility or liability in the event contamination of the groundwater source results from the
construction or use of this well, nor does the State Engineer assume any responsibility or liability should contamination
occur.
3) This well is recorded and permit approved in accordance with CRS 37-92-602(5)for historical use as indicated herein
and described in CRS 37-92-602(1)(e), being a well producing 50 GPM and used for fire protection,the watering of
domestic animals, poultry and livestock on a farm or ranch.
4) The date of first beneficial use, as claimed by the applicant, is December 31, 1970.
5) The well owner shall remove any pumping equipment that is rated for a discharge greater than 50 gpm and replace it with
pumping equipment with a discharge that will not exceed 50 gpm. The applicant shall submit a Pump Installation and Test
Report(Form GWS-32)to the Division Engineer within 60 days of the issuance of this permit, affirming the pumping
equipment has been replaced. If the applicant wishes to utilize the existing pumping equipment installed in the well, the
Applicant shall submit a letter to the Division Engineer within 60 days of the issuance of this permit specifying the type of
pump installed and confirming that the pump is rated for a discharge not to exceed 50 gpm. At a minimum, confirmation
should include the pump horsepower and pump discharge diameter.
6) If not already in place,the well owner shall fit the well with a cap or sanitary seal to prevent surface water, pollutants, or
contaminants from entering the well. The Applicant shall submit a letter to the Division Engineer within 60 days of the
issuance of this permit confirming the well has an existing cap/sanitary seal, or a new cap/sanitary seal has been installed
on the well
NOTE:This well was decreed in case no.W-2620 as Well No. 1-Unregistered for irrigation of 20 acres with a pumping
rate of 202 GPM (0.45 cfs) absolute. On November 3,2011,the applicant submitted a request to register the well for
watering of domestic animals/poultry and livestock, and an affidavit of abandonment of the nonexempt use. }}
- LA1 12120 1(
APPROVED
JMW
State Engineer By
Receipt No.3652884 DATE ISSUED 12-20-2011 PIRA 1ON DATE
7 �
Form STATE OF COLORADO ` For Office Use Oalw
No. OFFICE OF THE STATE ENGINEER
GWS-12 1313 Sherman St., Room 818, Denver, CO 80203
7/2009 Phone(303) 866-3581 SEP 2 3 2011
Fax(303)86&3589 htty:/lwater.state.co.us
REGISTRATION OF EXISTING WELL
Review form instructions prior to completing form
NAME & CONTACT INFORMATION OF WELL OWNER:
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NAME(S) CD C:s
l ink.- 451,tat
k NOV 03 2_U1`. �'r+
MAILING ADDRESS
Zc 1st WAlEti ;., o
STATE , "
CITY: STATE: ZIP CODE: , • . Jit F
fir: a 5a,G j
TELEPHONE NUMBER E-MAIL (OPTIONAL) " ,
f rc)i*
WELL LOCATION County u,d1 Owner's Well Designation(optional)
(Address) (City) (State) (Zip)
Li) 1/4 of the VI.) 1/4, Sec. 9 ,Twp. 3— ,E N. or❑ S., Range ,S ❑ E. orZ W., 4 P.M.
Distance from Section Lines dg-39 Ft. M N. or❑ S. Line, /ZgS'' Ft ❑ E. orjE W. Line.
ATTACH A COPY OF A CURRENT DEED FOR THE SUBJECT PARCEL
Subdivision Name 1.,/4# /241•14y ZA-0/S , Lot , Block , Filing/Unit
Optional: GPS well location information in UTM format. The following GPS settings are required: Fasting )-
Format must be UTM. Units must be in meters. Datum must be NAD83. Unit must be set to true
north. ❑Zone 12 orgZone 13
Was GPS unit checked for above items? ,YES D NO Northing7.75-46.1/
The well has historically been used for the following purpose(s): star
Water from the well was first used beneficially by the original owner for the above described purposes on /0-J/-._
The total depth of this well is 3Q feet.
The pumping rate of this well is 5t2 gallons per minute.
The average annual amount of water diverted is acre-feet
The lawn and garden irrigated(watered)by water from this well is O 0 Acre or❑ Square feet.
Number
The making of false statements herein constitutes perjury in the second degree,which is punishable as a class 1 misdemeanor pursuant to
C.R.S. 23-3-104(13)(a). I have read the statements herein, know the contents thereof, and state that they are true to my knowledge.
Signature(s)of the Well Owner(s) Print Name and Tide of Well Owner(s) Date
For Office Use Only
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CWCB r
AQUA *c
My.JAIT Div I - WD 3 Basin MD
Form COLORADO DIVISION OF WATER RESOURCES For Office Use Only
No. DEPARTMENT OF NATURAL RESOURCES RECEIVED
GWS- 1313 SHERMAN ST., RM 818, DENVER, CO 80203
12-A Phone--info: (303) 866-3587 main: (303) 866-3581
7/2009 Fax: (303) 866-3589 http://www.water.state.co.us SEP 23 2011
STATEMENT OF HISTORICAL USE NOV 03 ?_43. %Node-
Review form instructions prior to completing form l Ar k •
This form is to be submitted with the Registration form,GWS-12 STATE �y: t' -GltEri! •_-.
do state as follows: I am the owner of a well located in the
(print name of well owner) /
1/4 of the Al 0/ 1/4, Sec. `,7 , Township _5— N. or❑S., Range '- E E.or W, J' P.M.
Water Court case no. w 06 Zd (if applicable), Owner's well designation (well name) hl� 'e we.// -_Z
Location of well (street address-if applicable): 7g-e- "sic �.
Location of well (subdivision name/lot/block/filing—if applicable): /c/ - „ ,�� ea/d-sue.
Is historical use on same parcel as where well is located? L'C Yes/ No. If no, provide location where well is used
(address/subdivision name/lot/block/fiiing):
Size of parcel where well is located 70 acres. Will this be the only well on the parcel? Yes/ No. If no, list permit number(s)
or water court decree case number(s)for other well(s)
Will future use be on same parcel as historical?. �Yes/ No. If no, provide new location (address/subdivision name Mot/block/filing)
Existing well location and visual conditions: If stating no, must include an explanation of the circums)anes.
Type of existing well(circle one): drilled; hand dug;spring well;gallery well; gravel pit; other .... "--441:3,‘
Distance to nearest septic tank/sewer line (approximate) 'Zi?"O feet. Distance to nearest leach field (approx.) 2 feet
Is the well in a clean and sanitary location?
Is the ground at the surface surrounding the well firm and stable and sloped away from the well for proper drainage? yts
Is the well situated in a well house or vault? hc, If so, is the well house or vault in good repair and condition?
Existing well construction and materials: If stating no, must include an explanation of the circumstances.
Is the well equipped with a sanitary well seal/cap? ,vo
Is the well constructed with steel casing that extends at least one(1)foot above the ground surface? ,r'a
Casing size(diameter) /≥ __inches.
Who constructed well? Who installed pump?
Historical use initiated prior to May 8,1972
The well identified above has been used since prior to May 8, 1972 as the water supply for the following exempt uses listed in§37-92-602,
C.R.S. (or§37-90-105, C.R.S., in a Designated Ground Water Basin):
a) Ordinary household use inside 0 _single-family dwelling(s) (maximum of 3 single family dwellings);
b) The irrigation of a acre/square feet(circle one)of home gardens and lawns(maximum of one acre-one
acre is equivalent to 43,560 square feet);
c) The watering of domestic animals/poultry yes/ no; livestock on a farm or ranch .jr yes/ no
OR(above uses cannot be combined with commercial uses]
d) Drinking and sanitary facilities inside an individual commercial business yes/ no (If commercial use claimed, Form
GWS-57, Commercial drinking and sanitary well worksheet,must also be completed and submitted.)
(Note: Commercial wells in a Designated Ground Water Basin may also include outside uses.)
Have the above claimed uses been in continuous use since May 8, 1972? Yes/ No. If no, for each claimed use, list dates when
this well supplied the above claimed uses: 174..—v Orr ,✓�rr,G �C?cZs
I understand that uses that were not initiated prior to May 8, 1972 are not eligible for registration and any expansion of use that occurred
after May 8, 1972 is not eligible for registration. Additionally, I understand that if the well has not been operational or has not existed for a
period of at least ten (10)years,the well is not eligible for registration.The making of false statements herein constitutes perjury in the second degree,which is punishable as a class 1 misdemeanor pursuant
to §23-3-104(13)(a), C.R.S. I have read the statements herein, know the contents thereof,and state they are true to my knowledge.
Print Name &Title (Well Owner(s)) Signature of Well Owner(s) Date
/a- e e ,, ,r. I 9-O_1--//
c°4O DEPARTMENT OF NATURAL RESOURCES
t"7" a\ DIVISION OF WATER RESOURCES
• •, john W.Iiickeniooper
1876 Governor
• Mike Kin
September 26, 2011 Nov 1t 2101;Executive-Director
• Dick Wolfe,P.E.
t,Jk:}:I ctor/StateEngineer
BRIAN K HARRELL • NEFr'bavid L.Nettles,P.B.
288 161.AVENUE Division Engineer
GREELEY, CO 80631
RE: DOWNGRADE EXISTING WELL TO EXEMPT STATUS
To: Brian Harrell
To the best of our knowledge you are the owner of the following well:
Water Court
WDID Case No: Permit No. Section Township Range
0106851 W-2620 ---- 4 5 N 65 W
The purpose of this letter is to follow up on your September 23, 2011 visit to the Division One
office in Greeley during which you filled in the paperwork to re-permit this well for the historic
exempt uses of the watering of domestic animals and livestock watering.
During a site visit.by our office in August 2011, we noted the twelve inch casing Size and that
there is a large capacity pump and motor at the well. In order to ensure the well cannot be
used for irrigation in the future, one of the conditions of the exempt permit will be that the
twelve-inch casing be modified so that a pump of a size appropriate for exempt-type uses can
be used.
An acceptable casing modification includes installing a liner casing, no larger than six inches in
diameter, inside the exiting casing of the well. The liner casing shall be steel casing in the
interval required by the Water Well Construction Rules, may be PVC casing below the steel
cased interval, shall be grouted in the intervals specified for new wells in the Water Well
Construction Rules, and shall be fitted with a standard sanitary well seal. You may also submit
a proposed plan for modifying the existing well casing to the address below—a diagram and
brief explanation of the intended modification may be acceptable. We will review your
proposed plan of modification and forward the request to the permit office in Denver for their
approval.
Additionally, a copy of the deed of the parcel is required as part of the permit application—refer
to the requirements for Form GWS-12.
If you have any questions about the `downgrade' process, please call me at the telephone
. number listed below.
Sincerely,
0
Jean Lever
Ground Water Commissioner
Water Division 1 s Greeley
• 810 9'h Street,Suite 200•Greeley,CO 80631 •Phone:970-352-8712•Fax:970-392-1816
http://water.state.co.us
RECEIVED
AFFIDAVIT TO PERMANENTLY ABANDON USES,REDUCE DECREED C +( \ 1
AND REQUEST TO CANCEL WELL PERMIT
waTER SOURCES
DIVISION I
I, £i.,z. /4 #4.4-.0"/ (print name)do swear and depose as follows: CREEtEY.col OMDO
1. I am the owner of a well located in the 'A of the ,d 'A of Sec. ¢/ C r�r► it
Township 5,✓. S(circle one),Range 65 E! circle one),
well permit no. viA ,WDID no.(only if decreed) O,04&.,1
2. I have been using the well identified above as the water supply for the following exempt uses N0V II'f 2O1
listed in Section 37-92-602(1)(b)or(1)e,C.R.S.: •1v,4-r
?q7 :-
"GINEFc
a. ordinary household uses in O (no.)single-family dwellings;
b. the irrigation of O (area,< 1 acre)of home gardens and lawns;
c. the watering of domestic animals , yeti/ no;
d. the water of livestock on farms and ranches, rtC CE) no;
e. fire protection es/ no.
I understand that if I limit the use of this well to only these uses,the well would qualify as an
exempt well and no plan of augmentation or substitute water supply plan would be required.
3. I have permanently abandoned the use of said well for all but the aforementioned"exempt"
uses.
4. I have been using the well for the above listed uses before(check one):
a. ,k May 22, 1971 (well production is limited to 50 gallons per minute);
b. May 8, 1972(well production is limited to 15 gallons per minute).
5. I understand the Division Engineer will seek to abandon all but the exempt water rights,and
will limit the decreed capacity to id/A gpm/cfs,associated with this well in the next
decennial abandonment list pursuant to Section 37-92-401(2)(b)and I hereby attest that it is my
unequivocal intention to abandon said water rights and,further,that I hereby bind any and all
successors-in-interest to comply with and be subject to my stated intention to abandon the
associated water rights.
6. This is a formal request to cancel the non-exempt well permit no. N/A
7. I hereby apply for late registration of an exempt well with the State Engineer's Office pursuant
to Section 37-92-602(5)C.R.S. Enclosed is an original application for late registration of a well
for the above exempt historical uses in accordance with 37-92-602(5)along with my$100.00
filing fee and the field inspection by Water Division 1 evidencing historical use of the well.
Print Name Affiant(Signature)
e-e
Address
City,State,Zip
ubiscribe and sworn to before me in the unty of 1 J Je l C\ , State of
p this 23 day of � ,201 1 .
My commission expires:
NOTARY PUBLIC 2.012
Mail to: Division Engineer
Attn: Ground Water Commissioner
810 9th Street,Suite 200
Greeley,CO 80631 (revised 08/03/10)
NOV (}3 20r
November 1, 2011 VArLFc
STATE ENTo: Joanna Williams, Arlene Boone
The enclosed forms were submitted to the Greeley office by Brian Harrell to downgrade the following
well to an exempt status:
WDID 0106851, W2620, no permit
■ Mr. Harrell has requested to fully abandon the irrigation water right, and obtain an exempt
permit for domestic animals and livestock. A field inspection of the location does show
domestic animals present on the property; however the well team is unable to confirm
stockwater use at this time.
• This well does require a casing modification. Mr. Harrell was informed of this via a letter and I
give him the opportunity to provide our office with a description of how he intends to modify
the casing. I've including a copy of that letter. He has not responded as of October 31, 2011.
Please add the standard casing modification language to the permit.
Thanks,
•
Jean Lever
Groundwater Commissioner
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