HomeMy WebLinkAbout20150769.tiff COLORADO DIVISION OF WATER RESOURCES Form GWS-57(10/2011)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST.,STE 821, DENVER,CO 80203 Application Receipt No.
main: (303)866-3581 http://water state co us
fax:(303)866-3589 Online Requests:AskDWR NGL WATER SOLUTIONS
Applicant's Name:
COMMERCIAL DRINKING AND SANITARY WELL WORKSHEET
Review instructions on reverse side prior to completing form.The form must be completed in black or blue ink or typed.
1. Name and Type of Business: EXPEDITION WATER SOLUTIONS
2. Is this application for a new well?
El Yes
❑ No If no, is this application for a change of use for an existing well?
❑Yes Permit Number of well (if applicable)
❑ No For wells used for drinking and sanitary purposes prior to May 8, 1972, a field inspection of the well to
verify historical uses may be required. See form GWS-12 Registration of Existing Well and
form GWS-12A Statement of Historical Use for further information.
3. Is the parcel the well is located on(or will be located on)within the boundaries of a water service area(water district,
municipality,water company, etc.) or is water available from another source(such as a well)?
❑Yes If yes, indicate what this other source is
Q No (name of water district/supplier,or well permit number)
4. Proposed type of disposal system to be used:
El Septic tank/absorption leach field
❑ Central System (district name:)
❑ Vault(location sewage hauled to:)
❑ Other(attach copy of engineering design)
5. Water Demand Calculations(for average factors for water demand see below)
Employees
Number of X Number of Gallons X Number of Days Employee = Gallons per Year
Employees per Employee per Day Works per Year
10 X 15 IX I 365 I= I 54750 A
Customers
Number of X Number of Gallons X Number of Days Business = Gallons per Year
Customers per Day per Customer is Open per Year
10 X 5 X 365 = 18250 B
Other Uses(Note: No uses outside of the building would be permitted for this type of well.)
Type of Use X Gallons per Use per Day X Days per Year = Gallons per Year
X X = C
Total amount of water required:
= Gallons per Year
(A+ B +C)
73000
For wells used for commercial drinking and sanitary purposes on or after May 8, 1972, the total water demand cannot exceed
108,600 gallons(1/3 of an acre-foot) per year.
For wells used for commercial drinking and sanitary purposes prior to May 8, 1972,the total water demand cannot exceed 325,900
gallons(1 acre-foot)per year.
General Guidelines for Water Demand in Gallons per Day
Day Workers at Offices— 15 gallons/person/day
Food Service Establishments(with toilet and kitchen wastes)— 10 gallons/patron/day
Churches(does not include food service)—5 gallons/seat/day
Overnight Lodging—50 gallons/customer/day
On-Site Proprietor of Overnight Lodging (i.e. on-site owner of a Bed & Breakfast)—80 gallons/person/day
Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject.
COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(07/2013)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 821, DENVER, CO 80203
Main: (303)866-3581 Fax: (303)866-2223 dwrpermitsonlinenstate.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be computer generated,typed or in black or blue ink.
1. Applicant Information 6. Use Of Well (check applicable boxes)
Name of applicant
Attach a detailed description of uses applied for.
NGL Water Solutions
❑ Industrial ❑ Dewatering System
Mailing address Municipal❑ P ❑ Geothermal(production or reinjection
3733 Cherry Creek North Drive
Irrigation
City Stale Zip code ❑
Denver CO 80209
Commercial ❑ Other(describe):
Telephone#(area code&number) E-mail(online filing required) 7. Well Data (proposed)
303 868 1286 info@highsierraenergy.com Maximumpumpingrate Annualamounttobewithdrawn
2. Type Of Application (check applicable boxes) 10 gpm 16 acre-feet
Construct new well ❑ Use existing well Total depth Aquifer
❑ Replace existing well ❑ Change or increase use feet Fox Hills
❑ Change source(aquifer) ❑ Reapplication (expired permit) 8. Land On Which Ground Water Will Be Used
❑ COGCC Well ❑ Other:
Legal Description of Land(may be provided as an attachment):
3. Refer To (if applicable)
Weil permBII Water Court case# S 1/2 OF THE SE 1/4 OF SECTION 30-3N-65W
Designated Basin Determination k Well name ork OF THE 6TH PRINCIPAL MERIDIAN, WELD, CO
4. Location Of Proposed Well Construction &operationof a salt water disposal facility
County (If used for crop irrigation,attach a scaled map that shows irrigated area.)
Weld SE 1/4 of the SE 1/4 A. #Acres B. Owner
Section Township Nor S Range E or W Principal Meridian 81.39 NGL Water Solutions
30 3 EC ® 65 ® IM 6th C. List any other wells or water rights used on this land:
Distance of well from section lines(section lines are typically not property lines) NA
Ft.fromON OS Ft.fromf E�W
For replacement wells only-distance and direction from old well to new well 9. Proposed Well Driller License #(optional):
feet direction 10. Sign or Entered Name Of Applicant(s)Or Authorized Agent
Well location address(Include city,State,Zip) check if well address is same as in item 1 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.
NA 24-4-104(13)(a). I have read the statements herein, know the contents
thereof and state that they are true to my knowledge.
Optional: GPS well location information in UTM format You must check GPS unit for Sign or enter name(s)of person(s)submitting application Date(mm/ddlyyyy)
required settings as follows:
Format must be UTM
If signing print name and title
Ell Zone 12 orJ Zone 13 Easting 525607
Units must be Meters
Datum must be NAD83 Northing 4449012 Office Use Only
Unit must be set to true north
DYES USGS map name DWR map no. Surface elev.
Was GPS unit checked for above?
❑ Remember to set Datum to NAD83
5. Parcel On Which Well Will Be Located
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) Receipt area only
A. Legal Description(may be provided as an attachment):
S 1/2 OF THE SE 1/4 OF SECTION 30-3N-65W
OF THE 6TH PRINCIPAL MERIDIAN, WELD, CO
B. #of acres in parcel C. Owner AOUAMAP
WE
81.39 NGL Water Solutions
WR
D. Will this be the only well on this parcel? E YES®NO(if no list other wells) CWCB
TOPO
E. State Parcel ID#(optional): MYLAR
SB5 DIV _ WD___ BA _ MD
121330400017
WATER SUPPLY INFORMATION SUMMARY
Section 30.28-133,Id). 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
2. LAND USE ACTION •_..E°_�_
3. NAME OF EXISTING PARCEL AS RECORDED
SUBDIVISION FILING BLOCK LOT
4. TOTAL ACREAGE 5. NUMBER OF LOTS PROPOSED r PLAT MAP ENCLOSED YES
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? 0 YES 0 NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? ►- YES 0 NO
If yes, describe the previous action
7. LOCATION OF PARCEL - Include a map deliniating the project area and tie to a section corner.
• 1/4 OF .. r, 114 SECTION TOWNSHIP ON OS RANGE • ❑ E CI W
PRINCIPAL MERIDIAN: 0 6TH 0 lt.M. 0 UTE 0 COSTILLA
8. PLAT - Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat € Yes 0 No If not, scaled hand drawn sketch 0 Yes 0 No
9. ESTIMATED WATER REQUIREMENTS - Gallons per Gay or Acre Feet per Year 10. WATER SUPPLY SOURCE
IE EXISTING 0 DEVELOPED J NEW WELLS -
WELLS SPRING PROPOSED WAFERS-ICHECK lien
HOUSEHOLD USE # of units GPO AF WELL PERMIT NUMBERS O ALLUVIAL O UPPER ARAPAHOE
y r, 0 UPPER DAWSOH 0 LOWER ARAPAHOE
COMMERCIAL USE # ` '' of S.F. GPD AF fl LOWER MAWSOH tARAMIE FOX HHLS
7 DELVER ❑DAKOTA
0 OTHER
IRRIGATION# of acres GPO AF
•
STOCK WATERING # of head GPO AF O MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER GPO AF 0 COMPANY
❑ DISTRICT
TOTAL GPD AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES D.NO IF YES, PLEASE FORWARD WITH THIS FORM. {This rosy he required before our review a completed)
12. TYPE OF SEWAGE DISPOSAL SYSTEM
.5:SEPTIC TANK/LEACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME
❑ LAGOON 0 VAULT - LOCATION SEWAGE HAULED TO
❑ ENGINEERED SYSTEM Mulch a copy or enpinssrinp design) 0 OTHER
Form No. OFFICE OF THE STATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 180203
(303)866-3581
1397
WELL PERMIT NUMBER 272956 - -
APPLICANT DIV. 1 WD2 DES. BASIN MD
APPROVED WELL LOCATION
• WELD COUNTY
SE 114 SE 114 Section 30
CONQUEST DISPOSAL SERVICE Township 3 N Range 65 W Sixth P.M.
8203 W 20TH STREET STE A DISTANCES FROM SECTION LINES
GREELEY,CO 80634- 1174 Ft. from South Section Line
4541142„,Ft. from East Section Line
(970) 356-5560 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO CONSTRUCT A 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) 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)(I)and the policy of the State Engineer dated 4/23/86 under the following conditions.
4) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-602(1)(c).for a commercial
business. Water from this well shall not be used for lawn or landscape inigation or for any other purpose outside the business building structure.
5) Production from this well is restricted to the Laramie Fox Hills aquifer.Which corresponds to the interval between294feet and-04,Lfeel below
the ground surface. Plain casing shall be installed and grouted to prevent production from other zones. 280 605
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 andtor carbonaceous shale that overlies the Laramie sand
portion of the aquifer
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed Of33 acre-feet(108,600 gallons),as applied for.
9) Approved as the only welt on a tract of land of 80.00 acre(s)described as the S 1/2 of the SE 114,Sec.30,Twp.3 North,Range 65 West,6th
P.M.,Weld County,reference attached exhibit"A". .
10) The return flow from the use of this well must be through an individual waste water disposal system of the type so that not less than 2%of the
total amount of water withdrawn is returned to the same stream system;in which the well is located.
11) A totalizing flow meter must be installed on this well and maintained in good working order- Permanent records of all diversions must be
maintained by the well owner(recorded at least annually)and submitted to the Division Engineer upon request.
12) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE:To ensure a maximum productive life of this well,perforated casing should be set through the entire produci erval of the
approved zone or aquifer indicated above.
(7iref7
* Well location and aquifer interval amended based on information from the applicant B
•
•
ri
r
APPROVED IJ -vAix, dz ' 4i;
State Engineer By
Receipt No,3612977 DATE ISSUED 03-12-2007 EXPIRATbN DATE 03-12-2009
Form No. OFFICE OF THE STATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Shen an St.,Denver,Goloradol80203
(303)866-3581
1397
WELL PERMIT NUMBER 272956 - -
APPLICANT DIV. 1 WD2 DES. BASIN MD
•
•
•
APPROVED WELL LOCATION
WELD COUNTY
SE 1/4 SE 1/4 Section 30
CONQUEST DISPOSAL SERVICE Township 3 N Range 65 W Sixth P.M.
8203 W 20TH STREET STE A DISTANCES FROM SECTION LINES
GREELEY,CO 80634- • 1174'%% Ft. from South Section Line
4541•}42.Ft. from East Section Line
(970)356-5560 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO CONSTRUCT A 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 avner 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 Wee Conslnsctlon and Pump Installation Contractors In accordance with Rule 18.
3) Approved pursuant lo CRS 37-92-602(3)(b)(p and the polity of the State Engineer dated 4/23/86 under the following conditions.
4) The use of ground water from this well is limited to drinking and sanitary facilities as described In CRS 37.92-602(1)(c),for a commercial
business. Water from this well shall not be used for lawn or landscape;irrigation or for any other purpose outside the business building structure.
5) Production from this well is restricted to the Laramie Fox Hills aquifer.Which corresponds to the interval between29Qfeet and'845.1eet below
she ground surface. Plain casing shall be installed and grouted to prevent production from other zones. 280 605
6) The depth to the top of the Laramie-Fox Hills aquifer is approximate. To ensure the exclusion of poor quality wafer 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 pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed Oi33 acre-feet(108,600 gallons),as applied for.
9) Approved as the only well on a tract of land of 80.00 acre(s)described as the S 1/2 of the SE 1/4,Sec.30,Twp.3 North,Range 65 West,6th
P.M.,Weld County,reference attached exhibit'A^.
10) The return flow from the use of this well must be through an individual waste water disposal system of the type so that not less than 2%of the
total amount of water withdrawn is returned to the same stream system!in which the well is located.
11) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be
maintained by the well owner(recorded at least annually)and submitted to the Division Engineer upon request.
12) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE:To ensure a maximum productive life of this well,perforated casing should be set through the entire produce erval of the
approved zone or aquifer indicated above. �3(7d7
•
* Well location and aquifer interval amendied based on information from the applicant. B
i r
APPROVED /� '
JLViLL' • ' ~
State Engineer I By
,Receipt No,3612977 DATE ISSUED 03-12-2007 dXPIR)DN DATE 0 -12-2009
WATER SUPPLY INFORMATION SUMMARY
Section 30-28.133,IdL 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
C6 Solids Processing Facility
2. LAND USE ACTION USA
3. NAME OF EXISTING PARCEL AS RECORDED 1 21 33040001 5
SUBDIVISION FILING BLOCK LOT A
4. TOTAL ACREAGE 5. NUMBER OF LOTS PROPOSED PLAT MAP ENCLOSED ❑ YES
8. PARCEL HISTORY - Please attach copies of deeds. plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1, 1972? 0 YES ❑ NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? 0 YES ❑ NO
If yes, describe the previous action
7. LOCATION OF PARCEL • Include a map deliniating the project area and tie to a section corner.
SE 1/4 OF SE 114 SECTION 30 TOWNSHIP 3 0 N 0 S RANGE 65 0 E 0 W
PRINCIPAL MERIDIAN: 0 6TH 0 h,M. 0 UTE 0 COSTILLA
8. PLAT - Location of all wells on property must be plotted and permit numbers provided.
Surveyors plat ❑ Yes ❑ No If not, scaled hand drawn sketch ❑ Yes ❑ No
9. ESTIMATED WATER REQUIREMENTS - Gallons par Day or Acre Feet per Year 10, WATER SUPPLY SOURCE
O EXISTING ❑ DEVELOPED 0 NEW WELLS -
WELLS SPRING PROPOSED AQUIFER (CHECK Rae
HOUSEHOLD USE A' of units GPO AF WELL PERMIT NUMBERS 0 ALLe'ML a UPPER ARAPAHOE
o UPPER OAWSON ❑LOWER ARAPAHOE
272956
0 Le
COMMERCIAL USE # of S.F. GPD AF DENVER in wwsae 0 n xAKorAr FOX RILLS*
❑ o
o OTHOI
IRRIGATION A' of acres GPD AF
STOCK WATERING # of head GPD AF ❑ MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER Oil & Gas - 21,600 GPO AF ❑ COMPANY
❑ DISTRICT
TOTAL GPO AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT ❑ YES 0 NO IF YES, PLEASE FORWARD WITH THIS FORM. (This may be required before our review a completed.)
12. TYPE OF SEWAGE DISPOSAL SYSTEM
❑ SEPTIC TANK/LEACH FIELD ❑ CENTRAL SYSTEM - DISTRICT NAME
❑ LAGOON ❑ VAULT - LOCATION SEWAGE HAULED TO
a ENGINEERED SYSTEM (Attach a copy of enpinearinp design) 0 OTHER
Weld County Env` nnmental Health Services Department
J4 1555 N. 17th Avenue
Greeley, CO 80631
Wi`De Septic Permit - Final Phone; (970) 304-6410
Fax: (970) 304-6411
COLORADO
NMNJ.CO.weId.CO.US
application Number: SP-0700035 Status: Ready to Final
App Type: Health\Commercial\Ne\MSeptic Applied: 02/28/2007
Applicant Name: JIM GODDARD Issued: A3/27/21107
CONQUEST OIL COMPANY Finaled: i q or/
8203 W 20TH ST#A
GREELEY, CO 80634
Owner Name: MARCUM MIDSTREAM 1995-2 BUSINESS TRUST
Parcel#: 121330400014-R6806796
Legal Desc: S2 SE4 30 3 65 (1R) SITUS: WELD 0
Site Address: TBD
Apo Specific Info:
1/2 Bathrooms 2
3/4 Bathrooms 1
Application Date 02/28/2007
Associated Building Permit
Associated Building Permit Number
Basement Plumbing No
Full Bathrooms 0
Location Description TBD WCR 39 AND WCR 28 N ON WCR 39
Number of Bedrooms 0 •
Number of Persons 17
Other Water Supply Utility
Parcel Acres 35
Private Water Supply Well
Private Water Supply Permit Reference PENDING
Number
Public Water Supply No
Public Water Supply Utility
Repair Reason Type
Septic Permit Expiration Date 02/28/2008
Waive Fees No
Waive Fees Comment
Year Installed
E S erc Test Site :
Engineer Design Required Yes
Engineer Evaluation Received Yes
Engineer Job Number 06-1196
Engineer Letter Received No
Ground Slope 2
In 100 Year Flood Plain No
Limiting Zone Feet 8
Limiting Zone Inches 0
Limiting Zone Qualifier
Percolation Rate Qualifier Equal To
Percolation Rate Value 35
Slope Direction SE
Soil Description
Soil Type Suitable Yes
Variance Required No
A//,� Weld County,Er '-onmental Health Services Department
Pt le
1555 N. 17th Avenue
Greeley, CO 80631
WEwe Phone: (970)304-6410
Septic Permit - Final Fax: (970) 304-6411
www.co.weld.co.us
Minimurnl stallation:
Absorption Bed • 1154
Absorption Trench 0
Additional Terms and Conditions Y
Bed Option 1
Bed Option 2 75
Bed Option 3
Chamber Option 1
Chamber Option2 Infiltrator Quick4
Chamber Option 3
Septic Tank Size 1000
Trench Option 1
Trench Option 2
Trench Option 3
Actual Installation: Chambers
Septic Tank: la7 gallons Absorption Trench: / sq ft
CA- Absorption Bed : p`61-1 sq ft
Design Type: (' - Chamber Modet~t_
NOTICE
The issuance of this permIt does not imply compliance with other state, county,or local regulatory or building requirements,nor shall it act to
certify that the subject system will operate in compliance with applicable state,county and local regulations adopted persuant to Article 10,
Title 25, CRS as amended,except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit
persuant to CRS 1973 25-10-111(2).
This permit Is non-transferable and non-refundable.The Weld County Department of Public Health and Evnironment reserves the
right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent
upon t final inspection of the completed system by the Weld County Department of Public Health and Environment.
Environmental Health Specialist Date
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