HomeMy WebLinkAbout20151066.tiff 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 dwrpermitsonline(a�state.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 ❑ Geothermal(production or reinjection
3733 Cherry Creek North Drive
City ❑ Irrigation ❑ Other(describe):
Denver CO '80209 0 Commercial
Telephone a(area code&number) E-mail(online Siting required) 7. Well Data (proposed)
303 868 1286 info@highsierraenergy.com Maximum pumping rate Annum amouttobowohdrawm
2.Type Of Application (check applicable boxes) 15 gpm
.333 acre-feet
III Construct new well ❑ Use existing well Total depth Aquifer
❑ Replace existing well ❑ Change or increase use 350 feet I FOXHILL
❑ Change source(aquifer) ❑ Reapplication(expired permit) 8.Land On Which Ground Water Will Be Used
❑ COGCC Well ❑ Other:
3.Refer To(if applicable) Legal Description of Land(may be provided as an attachment):
won permit 0 Water Court case N Please see attached Lease
Designated Basin Determination ft 7 Well name or 0 Land used for construction &operation
4.Lo_c_atio n Of Proposed Well of a salt water disposal facility
County (If used for crop irrigation,attach a scaled map that shows irrigated area.)
Weld SW 114 of ma SE 114 A. aAces B. Owner
Section ` ToragNp N or S ` Range E or W I Pnnapet Menden 26.1 J NGL Water Solutions
35 7 r I I 66 In In 6th C. net any other webs or water rights used on Ills tend
Distance of well from section lines(section lines are typically not property lines) NA
Ft.hornyN(—S Ft rrorrfE❑W
For replacement wails only—distance and 6nrt cn from dd wei to newwell 9. Proposed Well Driller License#(optional):
feet direction 10.Sign or Entered Name Of Applicant(s)Or Authorized Agent
War'moon address(include city.stets,Zap) O Check if wren address is earns es in item i. 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 locabon information in UTM format You must check GPS unit for Sign or enter name(s)of person(s)submitting application J Date(mrtvddfyyyy)
required settings as follows
Format mrnt to UTM If signing print name and tine
nlzone 12 orrej Zone 13 Easting 531533
Units must be Meters
Datum must be NADB3 Northing 4486067 Office Use Only
Unit must be sot to true north
DINR map no. Surface dev.
Was GPS unit checked for above-,❑YES Remember to sot Datum to NAD83 ISGS mop none
5. Parcel On Which Well Will Be Located Reeeiptar�lordy
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A. Legal Description(may be provided as en attachment):
Please see attached Lease
B. k of acres in parcel C. Owner
AOUAMAP
WE
26.1 NGL Water Solutions
WR
D. we this be the only well on this parcel? al YES9 NO(if no list other wells)
CWCB
TOPO
E. State Parcel IDN(optional): MYLAR
SB5 DIV WD BA MD
COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST(07/2013)
DEPARTMENT OF NATURAL RESOURCES
GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS
Applications must be computer generated on-line, typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the
application must be completed. Incomplete applications may be returned to the applicant for more information.
Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form
may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the
original form. If filing online see online filing instructions! You may also save, print, scan and email the completed form to:
dwrpermitsonlineRstate.co.us For further information please visit www.water.state.co.us
FEES: This application must be submitted with a $100 filing fee. Acceptable forms of payment are check or money
order, payable to the Colorado Division of Water Resources. Visa, MasterCard or Discover are accepted by phone through
our Records Section at 303.866.3581. Fees are nonrefundable.
USES: This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot,
geothermal (see Geothermal Rules for fee requirements), recovery wells, and other uses not otherwise noted in the
following list:
RESIDENTIAL use wells—Use of form GWS-44 is required
LIVESTOCK watering on a farm, ranch, range or pasture (not feedlots)— Use form GWS-44
MONITORING/OBSERVATION wells—Use form GWS-46
GRAVEL PITS—Use form GWS-27
REGISTRATION of an existing well— Use form GWS-12 (must have been in use prior to May 8, 1972)
GEOEXCHANGE SYSTEM LOOP FIELDS—Use form GWS-72
REPLACEMENTS OF WELLS FOR THE ABOVE USES
ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form)
1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be
sent.
2. Check all boxes that apply.
3. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of water right, the
case number or determination number must be indicated. If applying to replace or change the use of an existing well,the permit number of the existing
well must be indicated.
4. The county, '/4 of the Y,section designation,section#,township,range,principal meridian,and distances from section lines for the proposed well must
be provided. (An option to providing distances from section lines and the%of the Y.section designation is to provide an accurate GPS location in UTM
format. The required GPS unit settings must be as indicated on this form.) Colorado contains two(2)UTM zones. Zone 13 covers most of Colorado.
The boundary between Zone 12 and Zone 13 is the 108Th Meridian (longitude). West of the 108°Meridian is UTM Zone 12 and east of the 10811
Meridian is UTM Zone 13. The 108th Meridian is approximately 57 miles east of the Colorado-Utah state line. On most GPS units, the UTM zone is
given as part of the Easting measurement,e.g. 12T0123456. Check the appropriate box for the zone. Provide the property address of the well location
if one exists. If it is the same as the mailing address,check the box next to the well location address.
5. Please attach a current deed for the subject parcel. Complete all boxes and provide a complete legal description of the parcel of land on which the
well will be located. If filing online please see onlino filing instructions for how to submit deed and or legal description attachments.
6. Check all boxes that apply and attach a detailed description of the uses applied for.
7. Complete all boxes.
8. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation
is a proposed use,provide a map of the land area with proposed irrigated areas accurately drawn,including section numbers and section lines.A list of
all other wells or water rights used on the described land must be provided.
9. The well must be constructed by a Colorado licensed well driller,an authorized individual in accordance with the Water Well Construction Rules,2 CCR
402-2, or under the "private driller" provision as defined in CRS 37-91-102(12). A listing of licensed well drillers/pump installers is available at:
http://water.state.co.uskiroundwater/BOE/Paqes/LicensedContractors.aspx
10. The individual signing the application or entering their name and title must be the applicant or an officer of the corporation/company/agency identified as the
applicant or their attorney. An authorized agent may also sign the application, if a letter signed by the applicant or their attorney is submitted with the
application authorizing that agent to sign or enter their name on the applicant's behalf. If you filled the form out on-line you may save or print,sign,scan and
email the form to the Division of Water Resources. Payment must be received via phone,fax or mail prior to processing the application.
IF YOU HAVE ANY QUESTIONS regarding any item on the application form,please call the Division of Water Resources Ground Water Information Desk(303-
866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683),
Montrose (970-249-6622), Glenwood Springs (970-945-5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to our web site at
http://www.water.state.co.us for general information,additional forms,and access to state rules or statutes.
COLORADO DIVISION OF WATER RESOURCES Form GWS-57(1012011)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST.,STE 821, DENVER,CO 80203 Application Receipt No.
main:(303)866-3561 http://water.stale.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?
■❑Yes
LI 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
0 No (name of water districtrsupplier,or well permit number)
4. Proposed type of disposal system to be used:
❑■ Septic tank/absorption leach field
❑ Central System(district name:)
❑ Vault(location sewage hauled to:)
LI 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 X 365 = 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.
.86.t COMMERCIAL ON-SITE WASTEWATER
� Er.-TTTREATMENT SYSTEM (OWTS) INSTALLATION
�l� J PERMIT (New or Repair)
v � I_ J
NEW OR REPAIR COMMERCIAL OWTS PERMIT FEE: $850.00
• All payments are due at the time of application submittal; by cash,check or credit card
• Incomplete applications will not be accepted(Site and soils evaluation,engineer design document,along with site plan
must be included)
PARCEL NO.: 070935000012 (12 DIGIT NUMBER)
LEGAL DESCRIPTION: SECTION 35 TOWNSHIP 7N RANGE 65W ACRES 259.41
SUBDIVISION NA LOT NA BLOCK NA FILING NA
INFORMATION CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT(970)353-3845 EXT 3650,OR ON THE
COUNTY WEBSITE UNDER PROPERTY INFORMATION.Link to property information:
http://www.co.weld.co.us/Departments/Assessor/PropertylnformationPortal/index.html
SITE ADDRESS WCR 74&WCR 47 Galeton Weld County Colorado
DETAILED DIRECTIONS TO SITE(ATTACH MAP) Take WCR 47 North to WCR 74&turn Right Access is on the North side of
WCR 74 after-1486 ft
PROPERTY OWNER: Booth Land&Livestock,LLC
MAILING ADDRESS: 33071 US Highway 85 CITY Luceren ST CO ZIP 80646
HOME PHONE:( ) WORK PHONE(970 ) 353 7055 FAX U
EMAIL ADDRESS: boothland@yahoo.com
APPLICANT NAME: NGL Water Solutions DJ,LLC
MAILING ADDRESS: 3773 Cherry Creek North Drive#1000 CITY Denver ST CO ZIP 80209
HOME PHONE:( ) WORK PHONE( 303) 8151010 FAX( )
EMAIL ADDRESS: info@highsierraenergy.com
PROPOSED USE(Refer to Table 30-6-2 of the Weld County OWTS Regulations for Average Wastewater Flow):
O MULTI-FAMILY/BOARDING HOMES/MOBILE HOME PARKS
TYPE OF USE(Ex.mobile home park,boarding home,triplex):
NUMBER OF BEDROOMS or SPACES(i.e.mobile home parks):
NUMBER OF PERSONS(i.e.boarding homes):
'OJ COMMERCIAL/INDUSTRIAL
TYPE OF USE(Ex.repair shop,office,dog kennel,restaurant): Salt Water Disposal Facility
NUMBER OF EMPLOYEES: -10
FLOOR DRAINS EXISTING OR PROPOSED: YES NO
O RECREATIONAL/INSTITUTIONAL
TYPE OF USE(RV Park,day camp,church,school,public pool):
EPA CLASS V INJECTION WELL INVENTORY REQUEST FORM COMPLETED: YES NO
WATER SOURCE:
O PUBLIC WATER SUPPLY(NAME OF SUPPLY)
Vir INDIVIDUAL WELL(PERMIT#) Application in progress
O CISTERN(PERMIT#)
PLEASE DRAW A MAP TO YOUR PROPERTY.
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ENGINEERING October 28, 2014
Subject: Soil Percolation Testing, C-10
Deep Injection Well, Eaton,
Colorado
Job No. 14-0028
Mr. Christopher Lattimer
M3 Construction
2861 West 120th Avenue
Westminster, Colorado 80234
Dear Mr. Lattimer
On October 24th, 2014 Ground Engineering Consultants, Inc. (GROUND) completed
construction of four percolation test holes to provide septic design information to M3
Construction, per Weld County Department of Public Health and Environment On-Site
Wastewater Treatment System Regulations at the proposed C-10 Deep Injection Well
west of the intersection of Weld County Road 74 and Weld County Road 47. Three test
holes for geotechnical design information were also excavated on the site and utilized to
determine bedrock and groundwater depths. The approximate locations of the
percolation holes and the geotechnical design holes are shown in Figure 1. Logs of the
holes are presented in Figure 2. Explanatory notes and a legend are provided in Figure
3.
The proposed septic field is located east of the proposed C-10 Deep Injection Well. The
site is relatively flat with slopes on the order of 1 percent to the East.
Percolation holes and geotechnical design holes were drilled with a truck-mounted,
continuous flight power auger rig. Four percolation holes were advanced for the septic
field to depths of approximately 30 to 32 inches below existing grades for percolation
testing.
Based on test holes excavated for the geotechnical design portion of this project,
groundwater was encountered locally at a depth of 19 feet below existing grades and
bedrock was located as shallow as 11 feet below grade.
The average percolation rate at the site was found to be approximately 32 minutes per
inch. The percolation test data is shown in Appendix A.
LOVELAND OFFICE 2468 East 9th Street I Loveland, CO 80537 I (970) 622-0800 I www.groundeng.com
ENGLEWOOD I COMMERCE CITY I LOVELAND I GRANBY I GYPSUM I CASPER
C-10 Deep Injection Well
Percolation Testing
Please contact this office if additional information is needed.
Sincerely,
GROUND Engineering Consultants, Inc.
Kelsey Van Bemmel, P.E. Reviewed by Joseph Zorack, P.E.
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GROUND
ENGINEERING CONSULTANTS
LOGS OF TEST HOLES
JOB NO.:14-0028 FIGURE:2
CADFILE NAME:0028LOG1.DWG
LEGEND:
Topsoil
.- Sand and Clay: Materials ranged from sand and clay to clay were, fine to medium grained, medium to
!•r
highly plastic, medium stiff to very stiff/medium dense, moist, and light brown to brown
in color.
IN Weathered Claystone: Fine grained, medium to highly plastic, weathered, gray with iron staining and local
sand lenses.
Sandstone/Claystone Bedrock:Materials were interbeded, fine to medium grained, low to high plasticity,
medium hard to hard, moist to wet, and grey to white to brown in color
with iron staining.
Drive sample, 2-inch I.D. California liner sample
23/12 Drive sample blow count, indicates 23 blows of a 140-pound hammer falling 30 inches were
required to drive the sampler 12 inches.
0
Depth to water level and number of days after drilling that measurement was taken.
NOTES:
1) Test holes were drilled on 10/24/2014 with 4-inch diameter continuous flight augers.
2) Locations of the test holes were measured approximately by pacing from features shown on
the site plan provided.
3) Elevations of the test holes were not measured and the logs of the test holes are drawn to
depth.
4) The test hole locations and elevations should be considered accurate only to the degree
implied by the method used.
5) The lines between materials shown on the test hole logs represent the approximate
boundaries between material types and the transitions may be gradual.
6) Groundwater level readings shown on the logs were made at the time and under the conditions
indicated. Fluctuations in the water level may occur with time.
7) The material descriptions on this legend are for general classification purposes only.
GROUND
ENGINEERING CONSULTANTS
LEGEND AND NOTES
JOB NO.: 14-0028 I FIGURE: 3
CADFILE NAME: 0028LEG.DWG
C-10 Deep Injection Well
Percolation Testing
Appendix A
Ground Engineering Consultants,Inc.
GRCIlump
ENGINEERING CONSULTRNTS
C10 Deep Injection Well Site near CR 74 and CR 47
PERCOLATION TEST RESULTS
14-0028
I lint• Hole Length of Time at Start Water Depth Water Depth Drop in Average
iin,hri Depth Time Interval at Start of at End of Water Percolation
Interval Interval Level Rate
inches (minutes) (inches) (inches) (inches) (min/in)
I I 29.5 10 8:41 18.50 19.25 0.75 40.0
() 9:11 19.25 20.25 1.00 30.0
30 9:41 20.25 21.13 0.88 34.3
30 I0:1 1 20.13 21.88 1.75 17.1
30 I0:41 21.88 22.63 0.75 40.0
30 11:11 22.63 23.25 0.63 48.0
30 11:41 23.25 24.00 0.75 40.0
30 12:11 21.88 22.63 0.75 40.0
2 I 2') ) 30 8:43 20.25 22.50 2.25 13.3
30 9:13 22.50 24.25 1.75 17.1
30 9:43 22.50 24.25 1.75 17.1
30 10:13 20.88 22.63 1.75 17.1
30 10:43 22.63 24.25 1.63 18.5
30 11:13 22.13 23.50 1.38 21.8
30 11:43 23.50 25.63 2.13 14.1
30 12:13 23.25 24.88 1.63 18.5
3 I 31.1 30 8:46 21.63 23.00 1.38 21.8
30 9:16 23.00 23.75 0.75 40.0
30 9:46 23.75 24.38 0.63 48.0
30 10:16 24.38 25.50 1.13 26.7
30 10:46 23.25 23.63 0.38 80.0
30 11:16 23.63 24.13 0.50 60.0
30 11:46 24.13 24.88 0.75 40.0
30 12:16 24.88 25.75 n tit 34.3
I I 31.8 30 8:48 23.75 25.38 1.63 18.5
30 9:18 25.38 _ 26.38 1.00 30.0
30 9:48 23.63 25.13 1.50 20.0
30 10:18 25.13 26.13 1.00 30.0
30 10:48 23.00 24.63 1.63 18.5
30 11:18 24.63 25.75 1.13 26.7
30 II:48 25.75 27.25 1.50 20.0
30 12.18 24.88 25.75 0.88 34.3
Job Number: 14-0028 Final Percolation Rate Average 31.8
Date: 10/27/2014
Tested By: AC
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