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Apparently the prior property owner ran a _
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from the lot to the north - said water out
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February 10, 2016. Water service will A ,'" ..
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Form
No. GWS-7 EXEMPT PERMIT INFORMATION SHEET
12/2015 STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
1313 Sherman St. , Ste 821 , Denver, Colorado 80203
(303) 866-3581 Fax (303) 866-3589
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-92-602
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully read the conditions of approval on your well permit. The conditions and the information on this
information sheet must be complied with in order for the permit to remain valid.
THE PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. The well must be constructed and
evidence of it's construction must be received by this office in the form of a Well Construction and Test report from
the well construction contractor confirming that the well was constructed prior to expiration of the well permit. The
well permit number is located in the upper right hand corner of the permit, and the expiration date is located in the
lower right hand corner. The expiration date of the permit may be extended one year at a time at the discretion of
the State Engineer for good cause shown . If an extension of time is necessary to construct the well, a written
request for the extension of time must be received by this office prior to the expiration date of the well
permit. In the request, you must provide the well permit number, your name and mailing address and the
reasons why the well has not been constructed and approximately when it will be constructed.
Water well construction and pump installation contractors are specifically licensed in Colorado to perform these
specialized tasks. It is illegal for contractors who do not hold these licenses to construct wells and/or install pumping
equipment in or on wells. The well must be constructed and the pump installed by contractors with current
license(s) issued by the State of Colorado unless exempted as described on the reverse side. Please ask to see
their license(s). Backhoe Operators and Licensed Plumbers may or may not hold the respective Well Construction
and/or Pump Installation licenses. Please be aware of this when you contract to construct the well and install
pumping equipment. The well construction report including a test of the well yield must be submitted to the office of
the State Engineer within sixty (60) days of completion of the work or within seven days after expiration of the
permit, whichever is earlier. The pump installation report including a pumping system test must be submitted within
sixty (60) days of completion of the work. The contractor(s) must provide you with a copy of the work report(s) filed
with the State Engineer. The Well Construction and Test Report, Form Number GWS-31 and the Pump Installation
and Test Report, Form Number GWS-32 are available from the Division of Water Resources offices. Additional
information regarding well construction , pump installation, required testing and well plugging and sealing regulations
are found on the reverse side of this sheet.
Keep a copy of this permit for your records. The official digital image of the permit is on file in the Denver office
Records Section . You may view or print the entire permit file using our online well permit search tool:
http://www.dwr.state.co. us/WellPermitSearch/ Hard copies of permit documents may be obtained from our Records
Section for a fee of 50 cents per page. Statutes require that any change of mailing address or ownership be
reported to the State Engineer. Form number GWS-11 is used both by new owners to report ownership changes
and current owners to report address changes.
If you have questions, contact the Ground Water Information Desk at (303) 866-3587, or the Division Office in the
area where your well is located .
Division 1 Division 2 Division 3 Division 4
810 9th St. 2nd Floor 310 E. Abriendo Ave Ste B 301 Murphy Drive 2730 Commercial Way
Greeley, CO 80631 Pueblo, CO 81004 Alamosa, CO 81101 Montrose, CO 81401
(970) 352-8712 (719) 542-3368 (719) 589-6683 (970) 249-6622
Fax (970) 392-1816 Fax (719; 544-0800 Fax 719) 589-6685 Fax (970) 249-8728
Division 5 Division 6 Division 7 Denver Office
Direct mail to Box 396 Direct mail to Box 773450 160 Rock Point Dr. , Ste. E 1313 Sherman St. , Ste 821
Glenwood Spgs CO 81602 505 Anglers Dr. Suite 101 Durango, CO 81301 Denver, CO 80203
202 Center Drive Steamboat Spgs, CO (970) 247-1845 (303) 866-3581
Glenwood Spgs. , CO 81601 80477 Fax (970) 259-0944 Fax (303) 866-3589
(970) 945-5665 (970) 879-0272
Fax (970) 945-8741 Call first Fax (970) 879-1070
WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER
You may construct the well and/or install the pump yourself if the well is for your own use, is on property you own ,
and is constructed or pumping equipment is installed with equipment owned and operated by you . It is your
responsibility to complete and submit the Well Construction and Test Report, Form Number GWS-31 and/or the
Pump Installation and Test Report, Form Number GWS-32. These forms are available from our offices. The
well must be constructed and the pump installed in accordance with the well construction standards of the State
Board of Examiners of Water Well Construction and Pump Installation Contractors.
The Water Well Construction Rules are available from Division of Water Resources offices for a fee of $5.00 or
online at: http://water.state.co.us/groundwater/BOE/Pages/BOERules.aspx. The Rules cover the minimum
requirements for well construction , pump installation, disinfection, plugging and sealing and include contractor
licensing regulations. If you are constructing your own well or installing pumping equipment, it is recommended
that you obtain a copy of these Rules for reference.
RULE 12 WELL TESTING
12. 1 General - The provisions of this rule establish minimum standards for the testing of water wells. Every
well constructed for the purpose of producing ground water shall be tested to determine:
a. a stabilized yield for the well; and
b. the production rate of the equipment installed when the well is placed into service.
12.2 Well Yield Test - The yield of a well shall be determined as a stabilized production rate where the
withdrawal rate and the drawdown do not change by more than 10 % during the last hour of the test. The test
shall demonstrate that either:
a. the well is capable of producing the permitted pumping rate for the well; or
b. that the maximum yield of the well is less than the permitted production rate.
12.3 Responsibility for Well Yield Test - Well construction contractors are responsible for performing the
well yield test and submitting the test data to the State Engineer. If the construction contractor also installs the
production equipment, the well yield test may be combined with the production equipment test, provided that the
test meets the requirements of Rule 12.2. The construction contractor may forgo the well yield test if he can
show that a licensed pump installer will perform the well yield test with the permanent production equipment
within thirty (30) days of completion of construction of the well. If the pump installation contractor performs the
well yield test, he/she shall submit the test information on the Pump Installation and Test Report.
12.4 Production Equipment Test - The production equipment installed in wells shall be tested to ensure it
is functioning as designed. The test shall demonstrate the production capacity of the equipment as actually
installed in the well . It is the responsibility of the person installing the pumping system to ensure that the
production from the well complies with the conditions of the permit.
12.5 Responsibility for Production Equipment Test - Pump installation contractors are responsible for
testing the production equipment installed in a well upon completion of their work. If the well construction
contractor determined the well yield and submitted a report, the pump installer need not perform another well
yield test. If the pump installer does not perform a well yield test with the permanent production equipment, he
shall perform a production equipment test and report the data (results) to the State Engineer on the Pump
Installation and Test Report.
Wells to be plugged and sealed must be plugged in accordance with of the Water Well Construction
Rules. A Well Abandonment Report, form number GWS-9 must be submitted to confirm plugging and sealing of
the well . This form is available from our offices. The general Rule for plugging and sealing wells is printed below.
The specific rules are found on the reverse side of the Well Abandonment Report form.
RULE 16 STANDARDS FOR PLUGGING AND SEALING WELLS AND WELL EXCAVATIONS
16. 1 General - The plugging , sealing and abandonment of all wells, monitoring and observation wells,
monitoring and observation holes and test holes that are no longer intended for use, and the plugging , sealing ,
and abandonment of dry holes, collapsed or unusable boreholes, and other incomplete wells or excavations is
necessary to prevent contamination of ground water and the migration of water through the borehole. It is the
ultimate responsibility of the well owner to have an existing well properly plugged , sealed and abandoned . The
well construction contractor or authorized individual is responsible for notifying the well owner in writing of these
plugging requirements.
WATER SUPPLY INFORNW 'IO I SUMMARY
Section 30.28.133,(d). C.R.S. requires that the applicant submit to the County/Adequate evidence that a water supply -that
is sufficient in terms of quantity, quality and dependability will be available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
RED OILFIELD SERVICES
2. LAND USE ACTION
3. NAME OF EXISTING PARCEL AS RECORDED 147128000059
SUBDIVISION FILING BLOCK LOT A
4. TOTAL ACREAGE 32.79 5. NUMBER OF LOTS PROPOSED PLAT MAP ENCLOSE 1 DES
6. PARCEL HISTORY - Please attach copies of deeds, plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1, 1972? ® YES ❑ :NO I
8. Has the parcel ever been part of a division of land action since June 1, 1972? gr YES ❑ NO
If yes, describe the previous action Recorded Ex a vwpt ion No. P43178-) - R E 3 U ' S
7. LOCATION OF PARCEL • Include a map deliniating the project area and tie to a section corner.
E 114 OF NE 1/4 SECTION 28 TOWNSHIP 1 ON ❑S RANGE 66 ❑ E 0 W
PRINCIPAL MERIDIAN: 12 6TH 0 KM. 0 UTE ❑ COSTILLA
8. PLAT - Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat 0 Yes ❑ No If not, scaled hand drawn sketch ❑ Yes ❑ No
9.. ESTIMATED WATER REQUIREMENTS • Gallons per Day or Acre Feet par Year 10, WATER SUPPLY SOURCE
..................
O EXISTING O DEVELOPED
jes NEW WELLS
WELLS SPRING
PROPOSED AOUFERS - (CHECK ONE)
HOUSEHOLD USE of units GPO AF WELL PERMIT NUMBERS o ALLUVIAL a UPPER ARAPAHOE
UPPER OAWSON O LOWER ARAPAHOE
COMMERCIAL USE of S.F. GPO AF o LOWER DAWSON ' LARAMIE FOX HILLS
❑ DENVER 0 DAKOTA
IRRIGATION II I of acres GPO AF
Zqq 840 O OTHER
STOCK WATERING # of head GPO AF O MUNICIPAL
0 ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER - GPO AF . ❑ COMPANY
❑ DISTRICT
TOTAL GPO - AF ' NAME
LETTER OF COMMITMENT FOR
SERVICE ❑ YES ❑ NO
11. ENGINEER'S WATER SUPPLY REPORT 1 YES 0 NO IF YES, PLEASE FORWARD WITH THIS FORM. (This may be required before our review is completed.)
12. TYPE OF SEWAGE DISPOSAL SYSTEM
SEPTIC TANKILEACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME
❑ LAGOON O VAULT - LOCATION SEWAGE HAULED TO
ENGINEERED SYSTEM (Mach a copy of engineering design) $ OTHER S v .; 00 f l 6wT lU (o ,Q,t,° �,� Say-
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