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Home My WebLink About20200853.tiff i FORM NO. / PUMP INSTALLATION AND TEST REPORT For Office Use only GWS-32 RECEIVED 10194 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1. WELL PERMIT NUMBER 21 A945 4 5 APR 1 7 2000 2. OWNER NAME(S) Mark Perlman `"r"" �ieJL.,i+1' S erman 5/aft C QrrleEA Mailing Address 24621 W.C.R. 53 City, St. Zip Kersey, CO 80644 Phone ( 970) 396-3254 3. WELL LOCATION AS DRILLED: SE 1/4 NE 1/4, Sec. 32 Twp. 5 N , Range 64 W DISTANCES FROM SEC. LINES: - 31 7 9 ft. from south Sec. line. and 70 ft. from east Sec. line. man)or tn) (east or west) SUBDIVISION: LOT BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: — 4. -PUMP DATA:Type - S»hmr,r c; hip - - - Installation Completed 4-12-2000 Pump Manufacturer Goulds Pump Model No. 13GS15412 1 5412 Design GPM 13 at RPM 3450 , HP 1 -5 , Volts 230 , Full Load Amps Pump Intake Depth 85 ' Feet, Drop/Column Pipe Size 1 " sch. Inches, Kind 80 P.V.C.w/brass 12-4 neo wire ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM: TURBINE DRIVER TYPE: ❑Electric ❑ Engine ❑Other Design Head feet, Number of Stages , Shaft size inches. 5. OTHER EQUIPMENT: Airline Installed❑Yes®No, Orifice Depth ft._ . Monitor Tube Installed ❑Yes❑No, Depth ft. Flow Meter Mfg. Meter Serial No. Meter Readout❑Gallons,❑Thousand Gallons,❑Acre feet, ❑ Beginning Reading 6. TEST DATA: ❑Check box if Test data is submitted on Supplemental Form. Date Total Well Depth 135 ' Time Static Level 12 ' Rate (GPM) 15 at 50 P.S.I . Date Measured 4-12-2000 Pumping LvI. 80 ' _ 7. DISINFECTION: Type H.T.H. Amt. Used 4 az s. 8. Water Quality analysis available. x❑Yes ❑ No 9. Remarks 10. 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)(a) C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] CONTRACTOR Lesh Drilling. Inc_ Phone ( 970) 834-2868 Lic. No. 21 -B Mailing Address p.0. Box 56 Ault, CO 80610 Name/Title (Please type or print) Date Edwin D. Lesh, Jr. Pres. —/i -. FORM NO. 7 WELL CONSTRUCTION AND TEST REPORT For Office Use only GWS 31 10/94 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 131;l Sherman St., Rm 818. Denver. CO 80203 R CEIVi=r 1. WELL PERMIT NUMBER 216945 APR 10 2000 2. OWNER NAME(S) ?lark rcrlman Mailing Address 21621 WCR 1153 WA]e;i iESUl11i tS City, St. Zip Ke r s c y, CO 8064-4 STATE ENGINEER Phone ( 970) 39K-3254 3. WELL LOCATION AS DRILLED: cW 1/4 qla 1/4, Sec. 17 Twp. 4 N , Range 64 DISTANCES FROM SEC. LINES: 3179 ft. from ( 6uth)Sec. line. and 70 ft. from cwt west)Sec. line. OR SUBDIVISION: LOT BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Standard Rotary • DATE COMPLETED 2-8-2000 . TOTAL DEPTH 1 35 ft. DEPTH COMPLETED 135 ft. 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft) Depth Description of Material (Type,Size,Color,Water Location) 1 1 D 90 R 20 135 0 .- 4 Topsoil 4 -- 20 Weathered shale 7. PLAIN CASING s _ �;d T ♦ horori sh i e OD (in) Kind Wall Size From(ft) To(ft) 46 - 66 Cray colored sandstone 6 . 5 steel . 250 1 above 20 66 - 90 Gray colored shale 4 _ pvc .250 5 70 An - tray r'olcreri sandstone with 4. 5 pvc . 250 115 135 thin sha1A streaks PERF. CASING: Screen Slot Size: _ 03 d 4 pvc ..250 70 11 8. FILTER PACK: 9. PACKER PLACEMENT: Material Gravel Type Size _ 5 Interval _3__ _t_n_4_3_5_1 3T' Depth 10. GROUTING RECORD: Material Amount Density interval Placement REMARKS: cement 6 cuft 6gal Q-35 pumped 11. DISINFECTION: Type H,T.H. Amt. Used 4 o z s. 12. WELL TEST DATA: ❑Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test. TESTING METHOD Submersible pump • Static Level 1 2 ft. Date/Time measured , Production Rate 1 7 gpm. Pumping level 60 ft. Date/Time measured , Test length (hrs.) 2 Hrs. t Remarks 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)(a) C.R.S.,the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] CONTRACTOR Lesh Drilling Inc_ Phone La2Dl R34-7568 Lic. No21 -R Mailing Address PQ Box 56 Ault, CCU 80610 ? • Name/Title (Please type or print) Date gi 44-9--.P41 Edwin D. Loot',, - rrc3 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 797 WELL PERMIT NUMBER 216945 - -_ APPLICANT DIV. 1 CNTY. 62 WD 1 DES. BASIN MD Lot: Block: Filing: Subdiv: APPROVED WELL LOCATION WELD COUNTY MARK PERLMAN SE 1/4 NE 1/4 Section 32 24621 WCR 53 Twp 5 N RANGE 64 W 6th P.M. KERSEY CO 80644- DISTANCES FROM SECTION LINES (970)396-3254 3179 Ft. from South Section Line 70 Ft. from East Section Line PERMIT TO CONSTRUCT A WELL CONDf1IONS 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 the 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)(b)(II)(A) as the only well on a tract of land of 37.5 acres described as part of the NE1/4 Section 32, Township 5 North, Range 64 West, Sixth Principal Meridian, more particularly described on the attached exhibit A. 4) The use of ground water from this well is limited to ordinary household purposes inside not more than three single family dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches, and the irrigation of not over one acre of home gardens and lawns. 5) Production from this well is restricted to the Laramie Fox-Hills aquifer which corresponds to the interval between 75 feet and 265 feet below ground surface. Plain casing shall be installed and grouted to prevent production from other zones. 6) The maximum pumping rate shall not exceed 15 GPM. 7) The return flow from the use of the 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. 8) This well shall be constructed not more than 200 feet from the location specified on this permit. Note: To insure 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: 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. „1 N 7,99 APPROVED n T14;iim% RAN I &/<1 �7 State Engineer By APR 1 6 2001Receipt No. 0443450 DATE ISSUED APR 16 1999 EXPIRATION DATE „C,OLCJRADO DIVISION OF WATER RESOURCES RECEIVEL DEPARTMENT OF NATURAL RESOURCES i�AR 199 1313,SHERMAN ST.,RM. 818, DENVER CO 80203 phor e - info: (303) 866-3587 main: (303) 866-3581 WATER RESOURCES RESIDENTIAL *(Note:You may also use this form to apply for livestock watering) Water Well Permit A iT}T NaFtion Review instructions prior to completing form Must be completed in black ink or typed 1. APPLICANT INFORMATION 6. USE OF WELL (check appropriate entry or entries) Name of applicant See instructions to determine use(s)for which you may qualify- 14-Pe K Pee, L M ici) ❑ A.Ordinary household use in one single-family dwelling 1 (NO outside use) Mailing Address B. Ordinary household use in 1 to 3 single-family CO 1 C- 5.3 dwellings: e�"�1i_ Number of dwellings: 2.- City State Zip code Home garden/lawn irrigation, not to exceed 1 acre: V-C% g--s e_Y GC_ 8bG4'k area irrigated t O sq. ft.)0 acre Telephone Number(include area code] Domestic animal watering --(non-commercial) 2. TYPE OF APPLICATION (check applicable box(es)) 181.C. Livestock watering (on farm/ranch/range/pasture) Constructnew°well - -— --O-Use existing-well -- -- -7:-WELL-DATA - --- -_ - -- -- • - - --- Maximum purrtping rata I Annual amount to be withdrawn _ - - _❑_Re?lace-exictina,well__ _ 17 Change /Increase Use.... _ /_ _ _ . T ❑ Change (source) aquifer 0 Reapplicationlexpired permit) � /0 gpm — ~ acre-feet ❑ Other: Totes depth Aquifer 3. REFER TO (if applicable): O`?Frov. ' -50b feet c y.,_\--)%\AS Water court case# Permit# 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM 74 Septic tank / absorption leach field Verbal# Monitoring hole acknowledgment# O Central system -VE- MH- District name: [Best Copy Available Well name or# O Vault Location sewage to be hauled to:• 4. LOCATION OF WELL 0 Other (attach copy of engineering design) County Quarter/quarter Quarter 9. PROPOSED WELL DRILLER (optional) LO ( J L, y Ai e % Name •G License number Section Township N or S Range E or W Principal Meridian f, 4 S , CO e1 I G PU. r J-v,c Ss 3 Z 5- ELEr ❑ (p 4-❑ or (_0 10. SIGNATURE of applicant(s) or authorized agent Distance of well from section lines The making of false statements herein constitutes perjury st -J fl C\ ft.from 0 N MS 7 0 ft.from OE❑ w in the second degree, which is punishable as a class 1 mis- Well location address,if different from applicant address(if applicable) demeanor pursuant to C.R.S. 24-4-104(13)(a). I have read the statements herein, know the contents thereof and state For replacement walla only-distance and direction from old well to new we . - that they are true to my knowledge. feet direction M�° '°'ai tura !� - "5:TRACT`ON`WHICH"WELL'WILL BE-LOCATED�y—` ;`�� - -- A. You must check one of the following-see instructions Title Date O Subdivision: Name C)W v"¢"%,„-- - Zg ^ 9 Lot no. Block no. Filing/Unit OPTIONAL INFORMATION O County exemption (attach copy.of county approval &survey) USGS map name DWR map no. 1 Surface elev. Name/no. Tract no. )_34-1 .1. ) 0 O Mining claim (attach copy of deed or survey) Office Use Only pvp Name/no. )--Ai`-' 7$" DIV r•.a+k 1 PLOther(attach legal description to application) c yc,li Ik if Ds‘c p)ir B. STATE PARCEL f -rat ID# (optional): WD C. #acne in tract D. Are you the owner of this property? CHECKS �n+ #�s; V33 ry 1J•�/v � 5. EYES 0 NO (if no- see detailed inst.) )iii OF 1=ERESOURCESBA )i E. Will this be the only well on this tract? AYES 0 NO (if other wells are on this tract-see detailed inst.) USE MD Form GWS-44(11/95) RECEIVED BAR 3 0 19991 WATER RESOURCES STATE ENGINEER CCLO. The SI/2 of the NE1/4 lying North and East of the Gilmore Canal except the North 60 feet thereof and the South 320 feet thereof, all in Section 32, Township 5 North, Range 64 West of the 6th P.M. , County of Weld, State of Colorado, EXCEPT a tract of land in the S1/2 of the NEI/4 of Section 32, Township 5 North, Range 64 West of the 6th P.M. , County of Weld, State of Colorado, being more particularly described as follows: Beginning at the Northeast Corner of said Section 32, Township 5 North, Range " 64 West of the 6th P.M. , and considering the East line of said Section 32 as • bearing South 00°20'05" East and with all other bearings contained herein relative thereto; thence South 00°20' 05" Eas 1540,44_£eet_along the East --- - - line of said Section 32; thence Sough 87 21' 55" West, 30.01 feet to the True Point of Beginning; thence South 00 20' 05" East; 430.00 feet; thence South 87°21'55" West, 125.00 feet; thence North 00°20' 05" West , 430.00 feet; thence North 87°21' 55" East, 125.00 feet to the True Point of Beginning, and EXCEPT a tract of land in the S1/2 of the NE1/4 of Section 32, Township 5 North, Range 64 West of the 6th P.M. , County of Weld, State of Colorado, being more particularly described as follows: Beginning at the Northeast Corner of said Section 32, Township 5 North, Range 64 West of the 6th P.M. , and considering the East line of said Section 32, as bearing South 00°20'05" East and with all other bearings contained herein relative thereto; thence South 0020'05" East, 1540.44 feet along the East line of said Section 32; 'thence South 87°21' 55" West, 30. 01 feet to the True Point of Beginning; thence South 87°21'55" West, 218 .52 feet; thence North 00°20'05" West, 218.52 feet; thence North 87°21' 55" East, 218.52 feet; thence South 00°20'05" East, 218:52 feet to the True Point of Beginning. 2�G�1' 7' M 6fhf3�0. 431s U EXHIBIT EXEMPT WELL DATA SHEET - DENVER BASIN, COLORAD APPLICANT: PERLMAN RECEIPT NO. 443450 LOCATION: SE1/4 OF NE1/4 OF SEC. 32 , T. 5N. , R. 64W. (2101 NSL, 70 ESL) PROPOSED AQUIFER: LARAMIE-FOX HILLS SURFACE ELEVATION: 4710 NUMBER OF ACRES IN TRACT: 37 . 5 IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S .B. 5 CONSENT MAPS? N IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS : ELEVATION DEPTH TO ANNUAL NET APPROP STAT AQUIFER BOT. TOP SAND BOT. TOP A-F UPPER DAWSON ---- ---- ---- ---- ---- ---- LOWER DAWSON ----- ---- ---- ---- ---- ---- --- DENVER ---- ---- ---- ---- ---- ---- UPPER ARAPAHOE ---- ---- ---- ---- ---- ---- LOWER ARAPAHOE ---- ---- ---- ---- ---- ---- --- *LARAMIE-FOX HILLS 4446 4634 122 264 76 6 . 863 NNT note : E indicates location is at aquifer boundary and values may be m * indicates the proposed aquifer. All values are interpolated from the S .B. 5 data base assembled in Move Hello