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HomeMy WebLinkAbout1.23 Well information appendix MWSA -BLUE PIT EXPANSION 2012 [Appendix M] WELL INFORMATION DESCRIPTION /DETAILS: This section provides information pertaining to the existing wells and potable water source located at the Blue Pit. THIS SECTION INCLUDES: This information is from the Technical Completion Process (2D,2G) : v Form No. OFFICE .OF THE STATE ENGINEER • GWS-25 ' COLORADO DIVISION O} WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver. Colorado 80203 • (303} 886-3581. • APPLICANT • JEAN M. BLUE 0404 COUNTY ROAD 104 • CARBONDALE, CO 81623 • (970)963-2653 PERMIT TO CONSTRUCT A WELL WELL PERmiT NUMBER 20 4.4 3 3 DIV., 5 CNTY.. 23 WD 38 DES, BASIN • MD Lot: Block: Filing: Subdiv: Sunnyside Gravel Pit (Office) APPROVED WELL LOCATION GARFIELD COUNTY SE 1/4 SW 1/4 Section 25 Twp 7 S Rng 88 W 6th P.M. DISTANCES FROM SECTION UINES 450 Ft. from SOUTH Section Line 3405 Ft. from EAST Section Line 4" r • ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL • . 1) This well shall be used in such 'away 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 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. • 3i• Approved.pursuant to CRS 37-92-602(3)(b)(I) and the policy of the State Engineer for appropriation of ground water tributary to Roaring Fork River system. • 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, office for gravel pit operation. Water from this well shall•not be used for lawn or landscape irrigation or,for any other purpose outside the business building structure. . 5) The maximum pumping rate shall not exceed 15 GPM. • 6) . The maximum annual amount of ground water to be diverted• by this well shall not exceed 1/3 acre-foot • (108,600 gallons). • 7) Approved as the only well on' a site of 36.188 acres (Paroel'No. 3) described as attached Exhibit "A', Garfield • County. • 8) • 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., • 9) A totalizing flow meter must be installed on this well and maintained in goad working order. Permanent records • - of all diversiona must be Maintained bythe well owner (recorded at !east annually) and submitted to the DiVision Engineer upon request. • • • • • • 10) This 'well shall be constructed notmore than 200 feet from the location specified on this permit. • NOTE:. This *It is known as the Sunnyside Pit Well No..2 (Parcel No. 3) . • Parcel Identification Number (PIN): 23-2393-254-0�265 . Assessor Tax Schedule Number: 111584 - APPROVED .DMW Receipt No.42,1 DATE ISSUED SEP 1 7 1997 EXPIRATION DATESEP 1 T1999 COLORADO DIVISION OF WAu K RESOURCES i ' DEFARTMEN:' OF NATURAL RESOURCES = x1313 SITERMAN ST., RI. .818, DENVER GO 80203 -phone - info:. (303) 866 -3587 main. (3.03)866 -3581' WATER ResouRCes GENERAL PURPOSE Water WeU P 4pplicati 4 ENGINEER (Please note: other forms are available far specs?c uses inct itiing residential, livestock, rnonitoringlobeenr., gravel Fits, iegksaratfori of atd welts) Review instructions prior to.completing corm Must be completed in black ink or typed n�i:i =EV�E3 SEP 10 '97 EP 2 41997 1. APPLICANT INFORMATION 6.. USE OF WELL. (please attach detailed description) f tw of viiPG:ait Mr. Jean M. Blue - • © INDUSTRIAL ❑ OTHER: COMMERCIAL ❑ M(1NICIPAL• 0 IRRIGATION . LI FEED LOT — number of head : • Nrat riq Addree. • 0404 'Road' 104 7. WELL DATA lrliiilijillill191E1M11!1 city sure Xpcode Carbondale", Co. • -$1623 • . - S. LAND ON.WHICH GROUND WATE.• WILL RE SED 2. TYPE OF APPLICATION (check applicable boides)1 • A. LEGAL DESCRIPTION (may he provided ac an attachment): see attached ' • (If used for crop irrigation. attach :cited trap that shows irrigated area.) KT Construct new well ❑ Use existing well - D Replace existing well D'Change or Increase Use D Change (source) Aquifer 0 Reapplication (exPfrad Peen$) • 0 Other:' . 3. REFER.TO (if applicable): liiiiiiMMINTIFFiall iiiiiiielliiiiiiiiiiiii W:II mama or t 'Sunnyside Pit Well •8- s acres C. owner D. Lint any other wain', or water light/ peed nn thin land: ' /111/0 . . No.. 2 .9: PROPOSED WELL DRILLER (optional) mice Shelton Drilling Corp Ucervenumber fOnS! 4. LOCATION OF WELL County - • Oarfield . - ►'�v' r, ;A, . 7`�$!,t!Y. 10. SIGNATURE of applicant(s) or authorized agent The making of false statements herein Canst tines Petry in the second degree,.which is punishable as a lass 1 rigs- demeanor pursuant to C.R.S. 24-4-104(13)(a). I have read . the. statements herein, know the-contents thereof, and state . that tfleyr are true to my knowledge. • Toms)* H or 5 7 D Range E or W 88 El ` • ?r:+Opar Oh?dwen ' . 6 • . . • Distance of Weil from section Ones 4(, i tro,nr o N ...s . 34.05 ft from E D 1 r ,wfw _ �rr/i ` _ Afr .� . . . I3w Own bate . V IJ Por esesleeirem tree. Ofir • - • time and eirotdaa trona OM mil to MW W$ _ • feet direction OPTIONAL INFORMATION '�a 5. TRACT ON WHICH WELL WILL SE LOCATED M'S" name' e"6¢ei0- 64480.4 t i- . 6, A: LEGAL DESCRIPTION (may be provided as an attechment): - �� / p • See- 'off 8criCeL Office Use Only { .. .- Ltge.: ity'N - • • • - DEIEUS jR1142 ?02 097497 DIIT OF A€(TehEMOR:ES . . DIV '. CO 23 L. STATE PARCEL - • • ID# WD 3' p- iii 1 -'i IJ2r BA E. WRi this be the only .well on this tea ct? "" -= . , • :r YES El NO ('ii other wills anion this tract, see irisfruotiorls). '60.00 ' MO Fatal GWS45 (12/95) 2P vz. `o e rS••, Pn 2 88W .Selo!' 2^ PAVP• 4-t _ham t ., .:• Pe tte! Actual Location r'unnyside Indus €eir t !Well Y -r Decreed Location G`,,, . 7y pole inchis rI / Well h'.1'1 x-4 &A .i. F 'g ?;... .41-r- 4' ,s s, � 1. , d ry{ >Fy ri�.- a a� • dys. "' .eN..r' -" i 3- ._ :aTy tY ice "E' =`li, • I, x �x. �yw ""44 Iry �`t:. � �x... -.,s -� • "ieI `� i ,..tom € first'. „3;r ^.: g,.- , 6xa � �-r-�� Decreed Location ('- stin.qvside. industrial Well .er-- 200' Radius Proposed New L O.C8ti:)r1 Sunnyside Industrial Well #1 . Proposed New Location Sunnyside Industrial Well #7 . 8O0' Radius Permitted Location Sunnyside Pit Weil #2 200' Radius € _. �.. te.- ..Y.R�SN -.__ Sr P ▪ Cn ne; .. Section .25 3- i[N€ R1? Ei s ucrkrmai.ro4t PO Sox 1301 Rifle, CO 81650 Tel 970 - 625 -4933 Fax 970 - 625 -4564 Well Location Photo Sunnyside Industrial Well No. 1 f• CURE. VO. Fife Name: Wi-I1Idrvtinn.dwg Job No: 645.2 Dsamu by'' Mil IApprovcd by: CM Datc: Nuc E5, 20(0 Client: WSA Twp 7S' Rng 88W • Section 25 A t • 1;l. Permitted/Actual Location •, Sunnyside Industrial Well #1 2- IN �eq t wt , i Decreed Location Sunnyside Industrial Well #1 Proposed New Location Sunnyside Industrial Well #1 Proposed New Location Sunnyside Industrial Well ##1, 600' Radius ,, ��*- y� L /-. • Decreed Location • Sunnyside Industrial Well #1 ' 200' Radius. Perrrlitted Location Sunnyside Pit Well #2 200' Radius • ScaUe i.n ..fie p w ... ..: .. --:... -a -: , : ;L= 1 . -, f s A-- / -Sjk? ::e - tt ,ta r+:itc.s3 K$ ,1e11 ' ` PO Box 1301 Rifle, CO 81650 Tel 970- 625-4933 Fax 970- 625 -4564 Map Location IV1a Sunnyside Industrial Well No 1 File Name: WellLocation-dwg kb No: 645.2 Client VISA Drawn by: Mi# Approved by- GM ' Date Nov I5.2010' Rag 38W Section 25 •due- rr g it -�''?. Pelm," te^-i'ictual Location'� �unnvside Industrial Well #1 u et a Decreed Location 1 !`nL.i15'l "!3'' Well it i r. � f�rii °K' rrtt¢ 12s— 441 <X 4y Decreed Lf7:7c1i1on Stun /side M.dus • a' Al 200 Radius E Sunny/side Indusr ial We!i 111 Proposed New Location Proposed New Location Sunnyside Industrial Weil #1 600' Radius - FC A-90 iwee Permitted Location Sunnyside Pit Well #2 200` Radius .,5E .rr Sen r � 0: u S cto: 25 eoi M PO Box 1301 Rifle, CO 81650 Tel 970-625-4933 Fax 970 -625 -4564 Sunnyside Industrial Well No. 1 Wrl1 I nrntinn -dw'g qINS-32 itim • • PUMP INSTALIAT1ON AND TEST REPORT , . STATE OF COLORADO; OFFICE OF THE STATE:ENGINEER Fol:Office Use on . . . RECEIVED . fltiV 6 197 • • le6S%ilEaSt4gRfri 5 . • comf • . WELL PERMIT NUMBER • -• .7hitall. . 2. OWNER Melling City, Phone NAME(S) Jean M. Blue Address . 0404, Co Rd 104 St.. Zip Carbondale, co 81623 . (970 ) 963-2653 3. WELL.LOCAT1ON AS DRILLED: - .sE . 114 sw 1/4, Sec. 25 .Twp. 7 .5 Range . 88 W 6th . DISTANCES FROM SEC. LINES: • 450 ft. from ' ' smith' Sec. line. and 3405 . ft. from- East Sec. line. SUBDIVISION: STREET ocimeirsomm) teastorm.al . Sunnyeide• Gravel Pit (office) ' LOT BLOCK . FILING(UNIT) ADDRESS AT WELL LOCATION: 4. • • • PUMP DATA: Type. Submers ible • Installation Completed 9/29/97 . - Pump Design Pump ADDMONAL:INFORMATION Manufacturer • Goulds Pump Model NO: 1 OGS07412L • . GPM 10 at RPM 3450 • HP 314 , Volts • 230 : , Full Load Amps 8.2 Intake Depth 118 ' , Feet, Drop/Column Pipe Size •r" • Inches, Kind soh 80 PVC • FOR PUMPS GREATER THAT 50 GPM: . • TURBINE DRIVER TYPE: 0 Electric .0 Engine Design Head. ' 'feet, Number of 0 Other . Stages • . ., Shaft size ' inches. . S. OTHER EQUIPMENT: . Monitor Tube Installed Depth ft. Airline Flow Meter Installed0 Yes El No, orifice Depth ft. Meter Mfg. Master Meter' • • • • Yes El No, . ' Meta Serial No. .2169574 • ReadoutO Gailons, :3-Thousand Gallons, 0 Acre feet, MI Beginning Reading. 0 . 6_ TEST DATA: 0 Check box it Test data issubmitted on Supplemental Form. ' 9/29197 • Total Static Date -• * Date • . . Weil Depth 120 ' Time • . 2 " 8R Level . 61' . Rate (GPM) . •• 12 . Measured 9/29/97 Pumping Isl. • . L 7. DISINFECTION: Type. Chlordx. • • . AM: Used 1 / 4 Cup- Dry . 8. Water No . . Quality analysis 'available. MI Yes 0 9. Remarks .., • ' . • to. : CONTRACTOR . Mailing Nameffitie Richard 1 have 'Pursuant . degree Address. read the statements made herein and. know the .contents thereof, and that they are true to rny knowledge. to Section 244,-104 (13)(a) C.R.S., the making of false statements herein Constitutes perjury in the second and is punishabie as a class 1.misdemeanor.) . .. • • - • . - • • . ,-T g 1.4 pump Co . . • • . , . . • Phone (370 ) .945-'6159 Lig. No 119,6 ... 0241 . Co Ra 167 . Glen .Spcis Co :81601 , . - .. • - - - (Please type or print) A Holub • - Owner Sign - 4.. . Date • 1 4z43.19:7, 'WELL CONSTRUCTION AND TEST REPORT • STATE OF COLORADO, OFFICE OF THE.STATE ENGINEER . .:ElVED • tiv r 1 el ,... • OCT 0 6 1997 7?-4 1 ../ iiitti..PISTEEFIS - . . APPROVAL 6 GINS31-91-03 WELL PERMIT NUMBER - 204433 . Owner Name(s) : Jean !Ale : .. Mailing Address : 0404 County Road 104 • City, St. Zip : Carbondale, Co. 81623. Phone • . (970) 963-2663 WELL LOCATION AS DRILLED- SE 114 SW 114 Seo. .25 Two. 07S Range 88W . line. and 3405 ft. from East Sec. line. OR - ' LOT ' BLOCK • FILING(UNIT) : .. DISTANCES FROM SEC. LINES: 450 ft. from South Sec. SUBDIVISION: . STREET ADDRESS AT WELL LOCATfON GROUND SURFACE ELEVATION ft.. DRILLING METHOD Air Rotary • DATE COMPLETED 09/25/97 '• . TOTAL DEPTH 120 ft. • DEPTH COMPLETED 120 - ft_ 5. GEOLOGIC LOG : . • 6. fickg DIAM. finl FROM CU TO MI - Depth Type of Material ($,Color, and Type) , 9.0 • 0 67 000-120 " Sand,. Gravels, Rocks . 6.6 . 67 120 . 1111.111110111111111111111111111.11111111.111MMIMEME 1.111111111 IMMMUNIIII■111•11.1111111011111 • IIIIIIIIIIIIOIIIIIMIMIIMIIIIIIIIMIIIIII 11.11111111.1111111111111111111.111111.111111111.111111111111111111111111.111.111...- IIIIIIIIII,_________MIMIIII.MIIIIIIIIIIIIIIIMIIII MIIIMMIIIMIIIM=1.11111= IIMIMIIIIIIIIIIIIIIIIIOIIIINIIIIMMIIIIZIIIIIIILIZIIII IIMIIMUIIMIIIIIINIMIIIIIIIIIIIIIMIIIIIIIIIIIIIMIIIIIMIIIIOMIMIIHIIIIIIIIIIIIII MIN 7. PLAIN CASING OD (in) Kind Willaill -Run a . To (tl) - 7'0 1111=31111 • • 0240 MEM 67 . 5.5 PERF. CASING 6. Filter Material Size: Interval 1.11=.1111111EM : Screen Pack : :. Slot Size: 50 105 • 111111111 um - IMIIIIIIIIIIIIIIMIIIIII - - .188 . 9. Packer Placement Type : Depth 105 120 WATER LOCATED : 105 + REMARKS : . . . . . • 10. GROUTING RECORD 10=11111=. E=11 3 sks : IMIIIIIIMIIIIIMIIIIIIIINIIMIM IIMIIIIIIIIIIIIIIIIIIIMIIIII.111.11.11 - : . l'iacelimt • Dent RE= • 16 gat 10-30 Amt. Used : ,_ . poured 1 oz. 11. DISINFECTION : Type: HTH • 12. WELL TEST DATA :11 Check Box-If Test Data-is Submitted On Supplemental Form, . TESTING METHOD: Air Compressor • • ' • ' - Static Level ; 98• ft. -DatefrimeMeasured :. "09125197 • . Production Rate : 15 90-rn- . Pumping Level. : Total* -11. • Date/Time Measured : 09f25/97 Test Length : . 2 hrs. Remarks ; - : • . .i3.. lore zr statements raze tarn and =it% . ._. . That theiBCOIrostoinykelowledge. (Pursuant toSOCliOn 24-4404 (13X* PA the .. Mg . : - Se = - - • Cbtahttitos CONTRACTOR . : . Shelton Drilling Corp. Phone : (970) 927-4182 • :f• . I • ;_,- 1 1,.. h a V i r 4 . - k • 0.411 - ' • . Name /Title (Please Type Or Print) Wayne Shelton ! Presi - dent -Sig .41111r/1"1— Date . loio2isi .40",jor 4.6.........." f- 1 ORIGINAL F 1■11111■1■■••••■■•■1•1110•1111, Form No. GWS -25 APPLICANT MC OFFICE OF THE STATE ENGINEER Lo COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866 -3581 DOLORES "DEE" BLUE 0406 COUNTY ROAD 104 CARBONDALE, CO 81623- (970) 963-2653 PERMIT TO CONSTRUCT A WELL 1095 1 WELL PERMIT NUMBER 57204 -F DIV. 5 WD 38 DES. BASIN MD APPROVED WELL LOCATION GARFIELD COUNTY SW • 1/4 SE 1/4 Section 25 Township 7 S Range 58 W Sixth P.M. DISTANCES FROM SECTION LINES 739 Ft. from South Section Line 1739 Ft. from East Section Line UTM COORDINATES (Meters,Zone:13,NAD83) Easting: Northing: ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT • CONDITIONS OF gPPROVAL 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 wets shall be in compliance with the Water Wet 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 -90- 137(2) for the replacement of an existing well, permit .no. 57204 -F (decreed by the Division 5 Water Court as the Sunnyside Industrial Well no. 1, case no. 87CW0365). Upon completion of the new well, the old well ( permit no. 57204 -F, constructed on March 27, 2002, to a depth of 134 feet) and the original well (permit no. 36147 -F (canceled), constructed on September 04, 1991, to a depth of 100 feet ); must be plugged and abandoned in accordance with Rule 16 of the Water Well Construction Rules. A Well Abandonment Report form must be submitted within sixty (60) days of abandonment of the old well. 4) Approved on the condition that the well be operated in accordance with the ,lean Blue and Dee Blue Augmentation Plan approved by the Division 5 Water Court in Case No. 87CW0364. If the well is not operated in accordance with the terms of said decree, it wit be subject to administration including orders to cease diverting water. - • 5) The use of ground water from this well is restricted to industrial, mining, dust suppression and manufacturing purposes in a gravel pit operation. 6) The maximum pumping rate of this well shall not exceed 450 GPM. 7) The average annual amount of ground water to be appropriated shall not exceed 7.4 acre -feet. 8) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer, and court case number(s) as appropriate,. The owner shall take necessary means and precautions to preserve these markings. 9) 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. 10) This replacement well shall not be constructed any closer to any other existing well than the well it is replacing, if such other well is within. 600 feet of the replacement, is completed in the same aquifer, and is not owned by the applicant. 11) This well shall be constructed not more than 200 feet from the location specified on this permit and not more than 200 feet from the location decreed for Sunnyside Industrial Well no. 1, in case no. 87CW0365 (decreed location is 860 feet from the South section tine and 1655 feet from the East section line). NOTE: Finding of Reasonable Diligence for the. Sunnyside Industrial Well no. 1, was decreed by the Division .5 Water Court, case nos. 93CW0182, 99CW0192 and O6CW0133 (50 gpm absolute and 400 gpm maintained conditional). �. NOTE Parcel Identification Number (PIN): 23 -2393- 254 - 00-265 . �' NOTE: Assessor TaxSchedule Number: Ft111584 (totaling 259.02 acres) Wiz! ;45re''.10!/ APPROVED DMW Recei i t No. 9503430 State Engine eP' By EXPIRATION DATE .02-08 -2012 J . DATE ISSUED 02 -08 -201.1 • ,Ay 0-• vIIV4V,I • • yrU- yL / -.50U I P.1 WELL CONSTRUCTION AND TEST REPORT . STATE OF COLORADO, OFFICE OF THE STATE ENGINEER • . FOR OF=FICE :SSE ONLY tir r E LL % ! WELL PERMIT NUMBER 57204 -F.-R . s APPROVALa GlYS31- 91.03. 2 Owner Narrle(s): Delores "Dee". Blue Mailing Address: 0406 County Road 104 City, Stale, Zip : Carbondale, Co 81623 Phone 14 WELL LOCATION AS DRILLED DISTANCES FROM SEC. LINES SW 1/4 SE. 1/4 Sec: 25 Twp: 7 S Range: 88 W 6th PM ft. from Sec. line and ft. from • Sec. line OR Easting 3 13 358 Northing: 43 64749 SUBDIVISION: LOT: BLOCK: FILING (UNIT): STREET ADDRESS AT LOCATION GROUND SURFACE ELEVATION ft. DRILLING METHOD Mr Rotary DATE COMPLETED: 3/25/2011 TOTAL DEPTH: 135 • • DEPTH COMPLETION: 135 5. GEOLOGIC LOG 6. IIOLE DIAMETER (in) FROM (ft) TO (H) Depth Type of Material .(Size, Color, and Type) 9.0 0 60 000 -085 Cobbles, Boulders 6.5 60 135 085 -122 Brown Sandstone • 122 -135 Eel: a Valley Eva: orites 7. PLAIN CASING . 01) (in) Kind Wall Size To (fl) 1111111 7A Steel 0.240 60 IINIIIIINIMMIIIIMIIIIIIIIIIMIIIIIIIIIIVIII 5.5 Steel 0:188 55 97 5.5 . Steel 0.188 127 135 PERF. CASING : Screen Slot Size 5.5 Ste! ' 0.188 97 127 Water Located: 90 - 115 Remarks : . 8. Filter Pack Material : Size : • Interval : 9. Packer Placement. Type : Depth it). GROUTING RECORD • Material Amount Density Interval Placement Cement 6 sks • 6 gallsk 10 -40 poured 31. DISINFECTION : Type : HTH Amt. Used : 3 oz. 12. WILL TEST DATA : ( ) Check Box If Test Data Is Submitted On Supplemental TESTING METHOD : Air Compressor . Static Level : 89 €L Date/Time Measured 3/25/2011 . • Production Rate 20.1- gpin Pumping Level : Total f , Date/ Time Measured " • 312512011 Test Length : 2 hours - " • Test Remarks 13, Via/ lead the StatriehniS made herein and know die contents ttxrcof and that the/)arc two to my-knowledge.. (Pursuant to Seetion 21 -4 -14 (13)(a) CRS, the making orfalm sratemcr15 -ansiitlite5 patju in the cold de�cc and is pim;shabte as a 01as 1 misdemcsno CONTRA OR :. Shelton Drilling Corp. . Phone : (970) 927 -4182 Mailing Address : P.O. Box 1059 Basalt, .Co. 81621 Lie. No. 1095 Name! Title (Please Type or Print) Wayne Shelton / President Signature • Date 4!4,'20 [ 1 Z -W Sll'¢I f,0RM No. GWs.32 08/2008 PUMP INSTALLATION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1313 Sherman St., Room 818, Denver, CO 80203 - Info (303) 865 -3587 Main (303) 866 -3581 Fax (303).866 -3589 - http:f /www.water.state,co.us For office use Only 1. WELL. PERMIT NUMBER: ,'7n7,L/ i? . /.311/ /---- 2. WELL OWNER INFORMATION NAME OF OWNER Q7r11/9r2j 5. 7 MAILING ADDRESS r -15ft r) } / ,. . • ,! i el At re .E HONE.# SPAT ZIIIPP ODE > .. 6' ih . 3. WELL LOCATION AS DRILLED: :5(411/4„-5g 114 Sec.e, , Twp. ! ❑ N or lA, Range r5 ❑ E orW or (UNIT) 0 W section line. DISTANCES Sl.UBD1VISION: Optional GPS be meters, 'TRE1:T ADDRESS FROM SEC. LINES: 3`) ft. from •0 N or S section fine and % -%7q ft. from 141E . LOT BLOCK • FILING Location: GPS Unit must use the following settings: Format must be UTM, Units Datum must be NADO3, Unit must be set to true N, ❑ Zone 12 or ❑ Zone 13 Northing: AT WELL LOCATION: 4. Pa' A i : Type: �./..e6 I O 5 hit ' Date Installed: r-9 7 f 1 Pump Manufacturer, Design GPM: :Pump intake )1262, At_1( (A/2019D Fa5 Pump Model No. 2o Full -; l 2 0 30, at RPM HP Depth. )'32_ Feet,. • OroplGolumn Q MATION FQ.R PUMPS GREATER tf . 7 • . Volts &.3/2 load Amps jc2s 6.9 , 'l Pipe Size f ! � Inches, Kind of Drop Pipe Driver Type: 0 No. 5eh &o PUe , THAN 50 GPM: Turbine ❑ Other 0 Electric • Engine Shaft size Yes 0 No, Depth ft. . Design Head • feet . Number of Stages inches • O.: OTHER EQUIPMENT: Depth ft, Monitor Tube Installed Airline Installed Flow Meter Mfg, -Meter Readout: ❑ Yes ❑ No, Orifice Meter Serial ❑ Gallons, 0 Thousand Gallons. ❑ Acre feet Beginning Reading _ ... ..... 6. TEST DATA: 0 check box if Test Data . . Date: J ft. Time: is submitted (gpm): on Supplemental Form_ e k1%p% ' Total Well Depth: Static Level: ,2 hiz ft_ Rate a 67 • Date Measured: . 2 / Pum•in• Level ft : / h 7. DISINFECTION: T' ..e • Amt. Used. B. Water Qualit ❑ No . If es, ' lease submit with this re • ort. anal sis available: • Yes 9. Remarks: 10. I have read the statements made herein and know the contents thereof, and•they are true to my.knowledge. This document is signed and certified in.accordance-with Rule 17.4 of the Water Weil Construction Rules, 2 CCR 402 -2. [The fling of a document that contains false • . statements is a violation of section 37- 91- 108(1)(e), ORS.; and.is,punishable by fines up to $500 0 and /or revocation of the contracting license. . . . II ompany Name :— "—:-.1 rn :1I rhpone_ e: q s vi Lice�n ber . -. Mailing Address: Isla1f: 1 7 lc / C6- )/A1aod /2q5. ... (-'cam. g'/&O/ Sign /. f)ll.' GAG f7 T Print Name and Title f`�j /is / /4he..Z i ic'L`.j-De% Dale. • (5)1,16111 aw \I\15- f Send to: Division of Water Resources 1313 Sherman Street, Room 818 Denver, Colorado 80203 Fax:. 303 - 866 -3589 Phone: 303-866-3581 OWNER'S NOTICE OF CONSTRUCTED. WELL Construction of my well underPOrmit`No„ ' �' `� 4 • completed on :e2L K • '15 20 t\ -oath) (day) (year) The well w °eonsti-u.cted by . p I ., L.L.;,a 4- • C i (driliing company) • was If the um ping equi pneurt s been ..... The pus IQ?hi -i uv`e by: on &.US: 2 ' h:; 201- (i jpth) ' (day) • Pu nti P :t ' i §tip (pump eompany),_.. The well must be constructed and pump installed by license water well construction: and . urn u installation contractors, OR the well may be. constructed and/or the pump may be installed by the well owner if the well is constructed and/or pump is installed using equipment owned and operated by the well owner and the well is constructed on his/her own property for his/her own use ( "private driller " /"private pump installer "). Work reports must be submitted to the Division of Water Resources in accordance with Rule 17 of the Water Well Construction Rules. Mountain Clear Water Company P.O. Box 1943 Grand Junction, CO 81502 970- 433 -2060 E eon o- •I Western Slope Materials P.O. Box 1319 Carbondale, Co 81623 Customer No. 1327 Open Item Statement Page: 1 InvNum InvDate Location Baled Paid Balance Location 1327 Western Slope Material 227028 07/19/2011 1327 734 1.55 6.19 233885 08/16/2011 1327 7.74 5.34. 2.40 268525 02/07/2012 1327 15.48 0.00 15.48 ACC Monthly Activity For 1327: 24.07 • • Current 0.00 30day 0.00 60day 0.00 90day 24.07 Balance 24.07