HomeMy WebLinkAbout20180589.tiffFORM No.
GWS-31
10/94
1.
WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO, OFFICE•OF THE STATE ENGINEER
1313 Sherman St. Rm 518. Denver, CO 00203
WELL PERMIT NUMBER 233845
1
1
2
3
Richard Robertson
2: OWNER NAME(S) P.O. Box 101
Mailing Address
City, St. Zip
Phone
rg. CO 80643
For Office Use only
o'y71-(o35-
RECEIVED
SEP 0 6 20D1
t;,ATER RESOURCES
STATE otNEER
3.
4.
WELL LOCATION AS DRILLEl7SW t r4NE 1/4. Sec. 19
DISTANCES FROM SEC. LINES:
2440 ft. from North Secline. and
(north or soutn)
SUBDIVISION:
STREET ADDRESS AT WELL LOCATION:
GROUND SURFACE ELEVATION
DATE COMPLETED 7/23/01
Twp.2N , Range 64W
1520 rt. from East Sec. line. OR
61f
least west)
LOT BLOCK FILING(UNIT)
h DRILLING METHOD
TOTAL DEPTH 803
5. GEOLOGIC LOG:
Depth Description of Material (Type, Size, Color, water Localroni
0-30 Yellow sandy shale
0-60 Gray shale & odd ss layers
U-90 C3rayish brown shale
3
4
4
4
5
5
5
6
6
6$0-720
7
Mailing Address box 416 Simla, CO 80835
NameiTitle (Please type or print)
Wayne Arde V.P.
ay & bfue shale & gtay silty shale & ss layers
0-390 Blue & yiay shale & lUts of (AM l layers
0-420 Blnu shale & lvta of hard ss layers
0-450 - I lard ss layers gray & blue shale
0-480 Blue & gray shale &-coal layer3
0 510 Layers of silty gray shale coal layers & blue gray shale
0 540 Gray & blue shalo w/ coal layers
gray s
gray shale & coal layers
U -b00 Silty gray shale tine sharp gray sand layers &Gray shale &
U-bUu coal tenses
0.660 Fine gray sharp sand & layers of silty gray shale & gray sttal
0-690 Silty gray as layers fine sharp gray sand & odd layers -of -btu:
ytay shale -
Brawn shale gray -shale & lots of fine gray sharp sand layers
AIR
coa
11
DISINFECTION: Type
HTH
FWD Rotary
It. DEPTH COMPLETED 803
6. HOLE DIAM. (in.) From (ft) To (ft)
9 0 41
6 1/2 10 803
7. PLAIN CASING
OD (in) Kind 0.188
Wall Size
7 4-.5— Steel-- 0.188
From(#t) To(h)
+1
10 625
4P RF. CAglap: Screen 4 Size:
8. fIILTER PACK:
Material -61—
Size
Interval
rt.
P/d aGec
G25 803
9. PACKER m4PLACE�,MENT ff
Type ('�)-f gT
Depth ,5%S
10. GROUTING RECORD:
Material Amount Density interval Placement
C4:611 3� rr v/ Tit/ r&Aee,
Cereal`342 //#fie., ; j� r 36G,r1,i x-575- / i1e
��
Amt. Used 8 oz.
12.
WELL TEST DATA:
TEST1NG METHOD
Static Level 145
Pumping level 600
•Remarks
❑ Check box i1 Test Data is suomltted on Form No. GWS 39 Supplemental Well Test
Airtiftod
ft. Date/Time measured __7_123/01
ft. Date/Time measured 7/23/01
, Production Rate
, Test length (hrs.)
15+ gPm.
4
13. :-have read the statements made herein and know the conrenIs tlicwol :72nd Thal they err nue to my knowledge, (Pursuant to Seclron Za-4-rue tt3jt;1
perlary III the second degree and is punishable cs a class misdemeanor.(
q41-2967 Llc. No.�149
C.R.S.. the making of false statements herein constitutes
CONTRACTOR Phon
Can -America Drilling, Inc. 7119
Signature
Date
7/23/01
Form No.
GWS.25
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
APPLICANT
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-3581
RICHARD ROBERTSON
PO BOX 191
KEENESBURG, CO 80643-
(303) 732-0132
PERMIT TO CONSTRUCT A WELL
1149
WELL PERMIT NUMBER 232845 -
DIV. 1 WD 1 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
SW 1/4 NE 1/4 Section 19
Township 2 N Range 64 W Sixth P.M.
DISTANCES FROM SECTION LINES
2440 Ft. from North Section Line
1520 Ft. from East Section Line
UTM COORDINATES
Northing: Easting:
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)(b)(lI)(A) as the only well on a tract of land of 40.00 acre(s) described as the
SW1/4 of the NE1/4, Section 19, Township 2 North, Range 64 West, 6th P.M., Weld County.
4) The use of ground water from this well is limited to fire protection, ordinary household purposes inside not more than
three (3) single family dwellings, the watering of poultry, domestic animals and livestock on a farm or ranch and the
irrigation of not more than one (1) 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 605 feet
and 890 feet below the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The depth to the top of the Laramie -Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from
zones immediately above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous
shale that overlies the Laramie sand portion of the aquifer.
7) The maximum pumping rate of this well shall not exceed 15 GPM.
8) 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.
9) 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.
./I/o 1
APPROVED
JMVV
,Receipt No. 0475635
,ed
4
State Engineer
DATE ISSUED JUN 0 5 2001 By
ION DAT
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