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HomeMy WebLinkAbout1.0 ApplicationBEFORE THE BOARD Of COUNTY COMMISSIONERS OF GARFIELD COU NTY, COLORADO PETITION FOR EXEMPTION Pursuant to C.R.S. ( 1973) Section 3-28-101 ( 10) (a) -( d) as amended , and the Subdivision Regulations of Garfield County , Colorado, adopted April 23 , 1984 Section 2:20.49, the undersigned Sgr]'f-ps flrnri-yd-respectfully petitions the Board of County Commissioners of Garfield County , Colorado , to exempt by Resolution the division of c23 · 3? acre tract of land into _2 __ · ___ _ h·acts of approximately ?d ct"t/5.o o Ac acres each, more or less , from the definitions of "subdivision" ahd "subdivided land" as the tenns are used and defined i.n C.R.S. (1973) Section 30 -28 -101 (IO) (a) -(d) and the Gadield County Subdivision Regulations for the reasons stated below·: SL'BMITT.-\L REQLIREMENTS: .-\n application which satisfied the review c1iteria must be submitted with all the following i_nformation: 'I\ F . )(. H. Skc:tch map at a mir.imum scale-of 1 "=-2 00' showi.ng the legal de scription of tile property . dimension and area of all lots or separate interests to be created. acces s to a public right-of-way. and any proposed easements for drainage. inigation. access or utilities: and Vici.nity map at a mjni.mum scale of I "=2000' showing the general topographi c and geographic relation of the proposed exemption to the sunounding area within t\vo (2) miles. for which a copy of U.S.G .S. quadrangle map may be used: and Copy of the deed showing O\vner ship by the applicant. or a letter from the property owner(s) if other than the applicant: and \iames and addresses of owners of record of land immediatel y adjoining and with in 200 feet of the propo sed exemption. mineral owners and lessees of minerals ow11ers of record of the property to be exempted, and tenants of any struchire proposed for conversion: and Evidence of the soil types and characteristics of each type ; and Proof of leg~ and adequate source of domestic water for each lot created. method of sewa~ disposal. and ~tter of approval of fire protection_plan. from appropriate fire district: and If connection to a community or municipal water or sewer system is proposed. a letter from the governing body stating a willingness to serve: and Nanative exp laining why exemption is being requested: and I. It shall be demonstrated that the parcel existed as described on January I , 1973 or the parcel as it exists presently is one of not more than three parcels created from a larger parcel as it existed on J anuaiy 1, 1973. l A $300.00 fee must be submitted with the application. fe~cWJ_e;?4 055 :A c 0 J?J, 85J.. Mailing Address ~ j±/f ,, ColoRadO Cicy State q70 -0b5 -0 I loD Telephone Number [ l3 ~ YY\. 'f\-6 ~I J 97-o -a-5 ro -7 /o 0 r EXEMPTION APPLICABILITY The Board of County Corrunissioners has the discretionary power to exempt a division of land from the definition of 'ubdivision and thereby from the procedure in these Regulations. provided the Board Je1.enr1ines rhaI such ex e::1ption will not impair or defeat the stated pw-pose of the Subdivision Regulations nor be denimental to the general public welfare. The Board shall make exemption decisions in accordance with the requirements of these regulations. Following a review of the individual facts of each application in light of the requirements of these Regulations. the Board may approve. conditionally approve or deny an exemption. An application for exemption must satisfy. at a minimum. all of the review criteria listed below. Compliance with the review c1iteria. however. does not ensure exemption . The Board also may consider additional factors listed in Section 8:60 of the Subdivision Regulations . . -\. No more than a total of four ( ...J.) lots . parcels. interests or dwelling unjts will be created from any parcel. as that parcel \Vas described in the records of the Garfield County Clerk and Recorder's Office on Janua1y L 1973 . In order to qualify for exemption. the parcel as it existed on January I. 1973 , must have been 35 acres or greate r in size at that time and not a pan of a recorded subdivision: however. any parcel to be divided by exemption that is split by a public right-of-way (State of Federal rughway . County road or railroad ). preventing joint use of the proposed tracts. and the division occurs along the public right -of-way. such parcels thereby created may. at the discretion of the Board . not be considered to have been created by exemption with regard to the four ( .+) lot. parcel. interest or dwelling unit limitation otherwise applicable . For the purposes of definition. all tracts of land 35 acres or s1reater in size. created after January 1. 1973 will count as parcels of land created by exemption since January I. 1973 B. All Garfield Co unty zon in g r e quir ements will b e met; and C. All lots create d will have l egal access to a public right-of-way and any nece ssmy access easements have be en obtained or are in the process of being obtained; and D . Provision has been m ade for an adequate source of water in terms of both th e le gal and physical quality, quantity and dependability, and a suitable type of sewage disposal to serve each proposed lot. Proof of a legal s upply shall be an approved substitute water supply plan contract; a ugm en tation plan ; an approved well permit; legally adjudicated domestic water source or a contract for a permanent legal supply of domestic water to be h a uled from an outside site for a cistern. Proo f of the physical supply from a well for the public me e ting, may be documentation from th e Division of Water Resources that demonstrates that there a re wells within 114 mil e of th e site producing at least five (5) gallons /minute . Prior to the signing of a plat, all physical water supplies using a well shall demonstrate the folldwing: I ) That a four ( 4 ) h our pump test be performed on the well to be used : 2) A well completion report demonsn·ating the depth of th e well , th e characteristics of th e aquifer and the static water level: 3) The res ult s of the fo ur ( 4) h our pump tes t indicating th e pumpin g rat e in ga ll o n s per minute and informati o n s howing drnwd ow·n and recharge ; 4; A '.vri::en c pini on of th e person co nducting the well te~·~ rliat mis well s h o uld be adequa te to s uppl y water t o the number of proposed lots: 5) A n assumption of an average o r no les s than 3.5 people p er dvvellin g unit. using l 00 gallons of water per p erso n. per day : 6) If the we ll is to shar ed. a le ga l. well s haiing agreement which discusses all easeme nt s and costs associated with the operati o n and m aintenanc e of th e system and who will be responsible for pay ing these cos ts and h ow assessments will be made fo r these costs. 7) The water quali ty be tested by a n approved testing laboratory and m ee t State g ui de lin es co nc ern ing bacteria and nitrates. For water supplies ba sed o n th e u se of cistern. the tank shall b e a minimum of I 000 gallon s. E. Method of sewage disposal. and a le tt e r of approval of the fire protec tion plan fro m th e appropriate fir e district: and F. All state and local environmental hea lth and safety req uire ments have b ee n m e t o r are in th e proc ess o f being met: and G. Provi s ion ha s been made for any req uir ed road o r s to nn drainage improvem e nt s : and ' ' . H. Fire protection has been approved by the approprjate fire district; and H . Any necessaiy drainage, inigation or utility easements have been obtained or are in the process of being obtained; and I. School fees, taxes and special assessments have been paid. (The school impact fee is $200 .00 for each lot created) PROCEDURES A. A request for exemption shall be submitted to the Board on fmms provided by the Garfield County Planning Department. Two (2) copies of the application , maps and supplemental information shall be submitted. B. The Planning Department shall review the exemption request for completeness within eight (8) days of submittal. If incomplete , the application shall be withdrawn from consideration and the applicant notified of the additional infmmation needed. If the application is complete, the applicant shall be notified in writing of the time and place of the Board of County Commissioners meeting at which the request shall be considered. In either case, notification shall occur within fifteen ( 150 days of submittal. C. Notice of the public meeting shall be mailed by ce1tified mail , return receipt requested, to owners of record of land immediately adjoining and within 200 feet of the proposed exemption, to mineral owners and lessees of mineral owners of record of the land proposed for exemption , and to tenants of any structure proposed for conversion. The exemption site shall be posted cleai·Jy and conspicuously visible from a public right-of-way with notice signs provided by the Planning Department. All notices shall be mailed at least fifteen (15) and not more than thuty (30) days prior to the meeting. The applicant shall be responsible for mailing the notices and shall present proof of mailing at the meeting . D. At or within fifteen (15) days of the meeting , the Board shall approve , conditionally approve or deny the exemption request. The reasons for denial or any conditions of approval shall be set fmth in the minutes of the meeting or in a written resolution. An applicant denied exemption shall follow the subdivision procedures in these regulations . April 7 , 1997 Garfield County Building, Sanitation and Planning Garfield County Courthouse Andrew C. McGregor 109 8th Street, Suite 303 Glenwood Springs , CO 81601 Re: Amaya/Weaver/Madrid Well Sharing Agreement Dear Mr. McGregor, J.W . Weaver, Rigoberto Madrid , and Santos Amaya hereby agree to an equal share of said well . Easement for well and well location beginning at a point from which the North 1/4 Corner of Section 19 , T.6 S ., R .92 W . of the 6th Principal Meridian in Garfield County, Colorado, bears N . 88 52' 00" E. a distance of619 .03 feet , and N. 00 04' 52" W . a distance of 694 .38 feet ; thence S . 01 08' 00" E. a distance of261.77 feet ; thence S . 89 52' 00" W . a distance of30 .00 feet ; thence N . 01 08 ' 00" W . a distance of261.77 feet ; thence N . 88 52' 00" E. a distance of30 .00 feet to the Point of Beginning . Permit number 1603 03 . We w ill share equally all costs of installation, maintenance and repairs . All future successors to the same agreement. Respectfully, Qww~ r J.W. Weaver ST ATE OF COLORADO COUNTY OF GARFIELD b Mzk~ Santos AmaYa I swear the three above signed parties have appeared before me that I stand witness to the signing of this~ day of A ~R.\L , 19 97 and that I stand witnes s to the signing of t his instrument. My commission expires : Witness my hand and official seal llf COMMISSION EXPIRES SEPTEMBER 28, 2000 Notary Public .· /' . I. \\\RR\\n Dl-Y.lt --1 ·.1i1 ~ Ul ·J ·:ll. '·"" 1h1 , 111 l.,• l'l !"' 11,.i ,, 11t ,,, ·c '-.11 . ,: .1d 1t l'rl•ilt<:t!" l ·".Ii,.'' ·.I c•l h{'T" .n(>0 tf I t t hi~ .. , ' . i: I . '{ 1)1 !111 \ \II f ~I 1 l I .1 t ' i r._\\ t .r'Jt~~s 1h.:,,·,~~ ,_;-r al1h l t , (Pl :1,•d \0 I d,l'i•l l f tlll 'f "' dll ,illl\ ''~ f111d \'ti I 11i'. Le c :,,,, · l•" .·,• • ,. \I 11•' .. 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J?i ~)e Do of 3 J -t-f 13£,i. w ~y39'_ 'J -- t'D · 816 so ---9~(o 0 ~;~L e /,HYDd 'ft scs>C , L JD ) ~ <;; ~ b v\J -.:r o tf\.) b l-i Vd, .S~J £ )s,...~ h rtk e ~e,o d co <GO 1 a~ ... a~13 • l. j -· • •• • • • N me~\ C'fl-VU YlTJ, &s #).AT D q <£> tJ S -? (? J9 12. L £ n s r C!-;z:: f2 k c i.) J cl .{;>Ji;, C'o ~o 3c; -bJ/tJ ... ., .. ,; .. , -.v£";rro.t:HJt-JtiE STATE ~NGINEER GWS-20:·· -.'' ··'C0,LORAOO OIV~N OF WATER RESO~RCES ...!<'':· .. ·:818,Centennial Bldg ., 1313 Wman St., Denver. ColOfado 80203 '(303) 866-358 r APPLICANT·' WELL PERMIT NUMBER 160303 DIV. 2-_ CNTY .. 23 WO 4 5 DES. BASIN APPROVED WELL LOCATION COUNTY GARFIELD - LIC MD_ .l'.AURO &«SAN'I'OS !\MAYA ,0313 R.:J!iMMING'J:'ON DR RIFLE ·:. CO · 8l650 NE 1 /4 NW 1 /4 Section -=1=9 __ Twp 6 s , Ran e 9 2 W ~ P.M. , '· . ,. DISTANCES FROM .SECTION LINES , '4 700 Ft. from South Section Line 3 6 0 0 Ft. from East Section Line } . ~":'" .... ~;. ·-::. ,.: .. ---,,,,,.. -........ ----·-, ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDmONS OF APPROVAL 1) This: wtlf~li~~t;Js_e_d in".such a way as to cause no material injury to existing water rights. The issuance of the permif'.'does ;htii\~sure the applicant that no injury will occur to another vested water right or preclude another owoer of a veste°d 'Water right from seeking relief in a civil court action . . . . . . . .. '·''". APPROVED: . · • MOS . .. St~~ u. . 032 .4271 DATE ISSUED JUN 1 2 1991 Receipt ,No. By ... EXPIRATION DATE JUN 1 2 1993 rorm No. GWS -25 ' --" 1027 WELL PERMIT NUMBER --,,i1. ..... 9.,,,...,.,0"'°'4-9~6.___ APPLICANT DIV. 5 CNTY. 23 WD 45 DES. BASIN MD Lot: Block : Filing: Subdiv : J W WEAVER & SANTOS AM AYA 0556 RD 352 RIFLE CO 81650- (303)625-2132 PERMIT TO CONSTRUCT A WELL APPROVED WELL LOCATION GARFIELD COUNTY NE 1/4 NW 1 /4 Secti o n 19 Twp 6 S RANGE 92 W 6th P.M. DISTANCES FROM SECTION LINES 4060 Ft. from 3900 Ft. from South Section Line East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT COND!llONS 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 the 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 se ek ing relief in a civil court action . 2) The construction of this well s h a ll b e in compliance with the Water Well Construction Rules 2 CCR 402-2, unl ess a pproval of a variance has b ee n g ra nted by the State Board of Exam iners of Water Well Construction and Pum p Ins t a llation Contractors in ac cord a nce with Rule 18. 3) Approved pursuant to CRS 37-92-602(3)(b)(ll)(A) as the only well on a tract of land of 49.3 acres described as that portion of the NW 1;, of Sec. 19, Twp. 6 South , Ang . 92 West of the 6th P.M., Garfield County, being more particularly described on the attached exhibit 'A". 4) The existing well, constructed under permit no. 160303 (expired), must be plugged according to the Water Well Construction Rules within ninety (90) days of completion of the new well. The enclosed well plugging report fonn must be completed affinning that the old well was plugged. · · · 5) The use of ground water from this well is limited to ordinary household purposes inside three (3) single family dwellings, fire protection, the watering of poultry, domestic an imals, and livestock on a farm or ranch, and the irrigation of not over one (1) acre of home gardens and lawns. 6) The maximum pumping rate shall not exceed 15 GPM. 7) 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. 8) This well shall be constructed not more than 200 feet from the location specified on this permit. NOTE: Monitoring and observation hole notice no. MH-25935 (MH-25923) was acknowledged on June 14 , 1995. (Jb ID ··5-1r- APPROVED JD2 Receipt No. State Engineer 0386415 DIVISION C;()py )/ . __ _ ~r DATE ISSUED 0 c T 1 0 1995 EXPIRATION DATE 0 CT 1 0 1987 COLORADO DIVISION OF W-R RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST., RM. 818, DENVER CO 80203 phone -info: (303) 866-3587 main: (303) 866-3581 RESIDENTIAL *(Note : You may also use this form to apply for livestock watering) Water Well Permit Application Review instructions orior to comoletinq form Must be completed in black ink or tvoed 1 . APPLICANT INFORMATION 6 . USE OF WELL (check appropriate entry or entries) Name of applicant See instructions to detennine use(s) for which you may qualify - :J A1'rto.s A m t\--Y 11 0 A. Ordinary household use in one single-family dwelling (NQ outside use) Mailing Addren ~-Ordinary household use in 1 to 3 single-family 055J... c.__o. RcL 35;;.__ dwellings : 3 Number of dwellings : City State Zip code 0 Home garden/lawn irrigation, not to exceed 1 acre: i<. i f IL C!o I o ~/ b.50 area irrigated / 0 sq. ft . i& acre T olephone Number (include area code) 0 Domestic animal watering --(non-commercial) 2. TYPE OF APPLICATION (check applicable box(esll 0 c . Livestock watering (on farm/ranch/r ang e/pa sture) 0 Construct new well 0 Use existing well 7 . WELL DATA IB"Replace existing well 0 Change I Increase Use Maxim1.n1 pUTiping rate Annu:DI nrno unt t o be withdrawn 0 Change (source) aquifer 0 Reapplication(expir&d pennitl gpm acre-feet 0 Other: Totel depth AqUfer 3 . REFER TO (if applicable)O feet Water court case # Permit I 8. TYPE OF RESIDENTIAL SEWAGE SYSTEM J9 0 'i90 12' Septi c tank I absorption leach field Verbal I Monitoring hole acknowledgment # 0 Central system -VE-MH-District name : Well name or I 0 Vault Location sewag e t o be hauled to : 4. LOCATION OF WELL 0 Other (attach copy of engineeri ng design) County Quarter/quarter Quarte r 9. PROPOSED WELL DRILLER (optional) Ga.~ fi E)cl N E y4 N W }'4 Name I License number Section I To:ship ~ or; Range E orW Princip.111 Meridian E x l.5Ti N b \J e-(1._ 11 7)... 0 ~ /-t-"-10. SIGNATURE of appli cant(s) or authorized agent Distance of well from section lines The making of false statements herein constitutes perjury '-/Jo o ft. from 0 N ~ 3bD O ft . from~ 0 W in the second degree, which is punishable as a class 1 mis- WeU '°"tion addres11 , if d ifferent from applicant address r.t applieabiel demeanor pursuant to C.R.S . 24-4-104(13)(a). I have read the statements herein, know the contents thereof and state For replacement wells only · distance and direction from old well to nevv well that they are true to my knowledge . feet direction Must be oris,intll signat lle 5. TRACT ON WHICH WELL WILL BE LOCATED 5i ·,//)/\~ ~/VJ/) .0Vv?. /J.. A . You must check one of the following -see instructions Title c;/ I 0 :/_ 1-0 Subdivision : Name OwN EfZ ~r- Lot no. Block no. Filing/Unit OPTIONAL INFORMATION 0 County exemption (atta c h copy of county approval & survey ) USG S map name OWR map no. I Surface elev. Name/no. Tract no . D Mining claim (attach copy or de ed or surve y! Office Us e Only Name/no . DIV JZ( Other (attach legal de scription to appl ication) co B. STATE PARCEL ID# (optional): o c:~ -d '17 0,?i t)-Od.. L/ WD c. # acrea in treict D. Are you the owner of this property ? yq,3 ~ES 0 NO (if no -see instructionsi BA E. Will this be the only well on this tract? uaYES 0 NO (if other wells are on this tract-see instructions) USE MD Form GWS-44 (11/95) COLORADO DIVISION OF WATER RES.CES DEPARTMENT OF NATURAL RESOURC GWS-44 FMINST (12/95) RESIDENTIAL APPLICATIONS -GENERAL INSTRUCTIONS There are a variety of uses for ground water in Colorado. This form (GWS-44) can be used when applying for a permit for a new well or replacement of an existing well for the following types of uses: ORDINARY HOUSEHOLD USE inside one single family residence (NO outside water use allowed) OTHER RESIDENTIAL USE (sometimes referred to as "domestic" use) which may include use in up to three single- family residences, watering of up to one acre of home gardens and lawns, and watering of domestic animals LIVESTOCK WATERING on a farm, ranch, range, or pasture If you are applying for a NEW household use only well, or for a NEW 35 + acre residential well outside the Denver Basin or Designated Basins of eastern Colorado, please use simplified forms GWS-49 or GWS-50. DO NOT use this form for registration of an existing unpermitted well {Use Form GWS-12), monitoring/observation wells (Use Form GWS-46), gravel pit wells {Use Form GWS-27), or for other uses not listed above, including -commercial, industrial, crop irrigation, municipal, etcetera (Use GENERAL PURPOSE Form GWS-45). FEES Applications must be submitted with the appropriate required non-refundable filing fees . The required filing fee for most well permit applications is $60 . The filing fees for replacement or deepening well permit applications for most previously permitted residential and livestock water wells is $20. Checks should be payable to the COLORADO DIVISION OF WATER RESOURCES. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. APPLICATIONS must be completed clearly, and ~ in BLACK INK or typed. ALL ITEMS in the application must be completed . Incomplete applications may be returned to the applicant for more information . Do not change or alter the application in any way . THE LOCATION of the well in item 4 must be correctly and accurately described . The county, quarter/quarter, section, township, range, principal meridian, and distance from section lines must be provided. NOTE: Distances are not necessarily the same distances as the distances from {your) property lines . For additional assistance in describing the location of your well, review the publication entitled "How to Determine Well Location" which was provided with your packet, or can be requested from any Colorado Division of Water Resource office. A LEGAL DESCRIPTION of your lot or parcel of land is required in item 5. For tracts of less than 35 acres approval may depend upon whether the tract was created by a division of land after June 1, 1972. If your lot is less than 35 acres in size, it would be prudent to have a deed or legal description that shows your tract was divided from a larger tract prior to June 1, 1972. This may be accomplished by obtaining a copy of a deed for the tract issued prior to June 1, 1972. An ORIGINAL signature must be on each application . The applicant's authorized agent may sign the application, if a letter signed by the applicant is submitted with the application authorizing them to act as agent for the purpose of obtaining a well permit . 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- 945-56651 , Steamboat Springs (970-879-0272), or Durango (970-247-1845). DETAILED INSTRUCTIONS ARE AVAILABLE UPON REQUEST COLORADO DIVISION OF WATER RESOURCES, 1313 SHERMAN STREET, ROOM 821, DENVER, CO 80203 PHONE 303-866-3587 (Information), 303-866-3581 (Main), 303-866-3447 (Well & Water Rights Records), 303-866-3589 (Fax) FORM STATE OF COLO.O e For Office Use only NO . OFFICE OF THE S E ENGINEER GWS-9 12/95 818 Centenn i al Bldg ., 1313 Sherman St., Denver, Colorado 80203 13031 866-3581 TYPE OR PRINT IN BLACK INK WELL ABANDONMENT REPORT (To Report Plugging and Sealing Wells) PERMIT NUMBER OF PLUGGED WELL 1 . INDIVIDUAL/COMPANY RESPONSIBLE FOR PLUGGING NAME(S) S A-N+os AmA"j..A Mailing Address o5SJ... C'__o l Rel. '35J.... City, St. Zip '\<._ ; :f l E.-Co\o ~lb60 Phone ( 9:i-o l (o ~e;--0 I lo D 2. ACTUAL WELL LOCATION: COUNTY G~rfiE-I~ PROPERTY ADDRESS 055~ C,o, R_d, 85~ ~~-f-/ L. c_c) 1 6 ~//:SO (Address) (City) (State) (Zip) NE' 1 /4 N'v/ 1 /4 , Sec. 17 Twp . b D N. ~ S., Range 9:L DE.~W. fu +It. P.M. . Distances from Section Lines 11._0bO Ft. fromDN . IZJs. Line , ,3200 Ft. from~E. orOw. Line 3. I (we), report that an existing well was plugged and sealed for the following reason(s): D The well was plugged and sealed as requ i red under the conditions of approval of Well Permit No. ~ The well was not in use and was plugged and sealed. D Other (please explain) 4. The well was plugged and sealed according to the Water Well Construction Rules on ' 19-1.k_. 5. The well was plugged with the following materials placed at the indicated intervals: AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT INTERVAL from feet to feet from feet to feet from feet to feet from feet to feet INTERVALS OF CASING REMOVED/RIPPED IN FEET from feet to feet from feet to feet 6. I (we) have read the statements made herein and know the contents thereof, and that they are true to my (our) knowledge. [Pursuant to Section 24-4-104 ( 13)(a) C.R.S., the making of false statements herein constitutes perjur, in the second deoree and is punishable as a class 1 misdemeanor .] Name!Title (Please type or print) Signature Date SANto.5 A ll1 AyA 5~ Cmt:J.&0 f-(-</1 --INFORMATION--It is the responsibility of the well owner to have the well ~o perly plugged and sealed . The Well Construction Contractor is responsible for notifying the well owner of the plugging and sealing requirement . This form may be reproduced by photocopy or word processing means. STANDARDS FO.UGGING AND SEALING WELLS AND a.L EXCAVATIONS April 1, 1995 RULE 15 15.1 General -The plugging and sealing of all wells, monitoring and observation wells, monitoring and observation holes, and test holes, which are no longer intended to be used , is necessary to prevent contamination of ground water and the migration of water through the unused borehole. It is the ultimate responsibility of the well owner to have a well properly plugged and sealed. The well construction contractor or authorized i ndividual is responsible for notifying the well owner of these plugging requirements. Persons authorized to install pumping equipment may plug and seal wells which do not require the removal of casing from more than one aquifer or the ripping or perforating of casing opposite confining layers. All materials used for backfilling shall be clean and free from contaminants. The well casing may be cut off below land surface so that it will not interfere with the anticipated use of the land . If the casing i s cut off below land surface, a watertight cover shall be permanently attached to the remaining casing and the excavation shall be filled with materials which are not more permeable than the surrounding soils. 15.2 Unconfined Wells -Wells completed into unconfined aquifers shall be plugged and sealed by filling with drill cuttings, clean sand or clean gravel to the static water level, then with clean native clays , cement or high solid bentonite grout to the ground surface . A permanent watertight cover shall be installed at the top of the cas i ng . 15.2.1 Cathodic protection holes, dewatering wells , horizontal drains, monitoring and observation holes, percolation holes, piezometer holes, sump pumps and test holes shall be plugged and sealed either pursuant to Rule 15.2 or by removing all casing which was installed and by filling the hole(s) with drill cuttings , clean native clays, cement or high solid bentonite grout to within five (5) feet of the ground surface. The top five (5) feet of the hole shall be sealed with materials less permeable than the surrounding soils . 15.3 Confined Wells -Wells which were constructed through more than one aquifer shall be plugged and sealed by placing a grout plug at the confining l ayer above each aquifer. If records do not show that the casing opposite each confining layer has been grouted when originally insta l led, the casing shall be either completely removed from the hole, or perforated or ripped opposite such layer prior to placing the grout plug . No plug shall be less than twenty (20) feet i n length and shall be designed to withstand the maximum potential pressure differential between the aquifers. The well casing except for the grout plug intervals shall be completely filled to the land surface with clean native clays, cement or high solid benton ite grout . A watertight cover shall be permanently welded or attached to the top of the casing. e -- ,) :. e • e -e --• e e e e ---· ~ 'Rr ""'-';+ # J lo03C>3 -'B~;,,_, Vs .. ol/fc)l'l"~e,,f /oe&.1-fit1N ?-erm-i'+-t:i:. I 90~ 9/o -j:)r) / Not i 11. U.se. ,M t-1 # ~5 935 M rt#. J.-5 9:J.J JoW'i\.o"""-. i+ ~ C.O<lc..<W ~ .:J h..:o ~ la 0-v ~ Xe ~ l.J..Q.Jj_ ~~- .J.,~ ~~ ~~~~~- sq/'lf o::J l?mlfyl'f 066;.... Co fCd 86~ R:-fl e._ Cd c) '8-/t.s-o 910-,;sr:, -91d:>7-In-fdr. 9T-0-(:,~· OJ b6-f+.o""'--e... 11-pr-,'/ 7-I I q 9 r- ~ c,J~) '1'1A ~ a-v,J ~ lQ,...i:_ -J?1A ~ (_~~1<>-~ ~ CAJ.LJ..R.~#.;9o't'9k~ ~ ~ fl()..f-IM, 1...1....Q..Q.1 W.L.. ~ ~ ~ c:k..v/iv a.-w/ lUew~ /11.A. s~ (~~ ~ ~ ~~ ~ ~ ~ ~ .::t'C? (.A..(L1 k ~ p~ 1f I 9 tJ '?' 96 D-'L- (o ;J.,l.....t.. G~~ccl ~ ~+.,·c-e. .I OA. ~ ~ t.v--l.. ~ • So v...t-~ ~ c/eJi., 1 7Y7 ~ ""' in+~rvcJ. ~ 1:-Ct;mpfoef th.•'.s r-cpor+ L.U4-~ riof f!.u<'11.isA..&/ f-o h>--e... Ol)fL. Wq.f e-ft.. is be ,·,11 ·f:vr/1.~ h y fJ.fi!Jm11-.:#z-I b 030.3 jh~c y()IA... fofL (o v.. 11</fJ q,11..c/ Urzol-ercS~tfrnJ- S ~ ~ /l-pr,/ ~ 9r •• • e • e e --• e -:. e e 06 wrt.o~ _;;t -ma ~; Sa,rn 05 /1rn117.4 065 ;;.._ Co ((o/ 361- 12,, ·+/ e_ Colo (}-/ /,S"o CJ::ro -bCJ-S-OlbO I 0 "-'-~ 'i'.l-Jl--K~ "° ~ ~.~ xro ~~~ &o ~ ('Y\-o-h.o......Ul. s~ H ~ ~ ;fo nu_ ~ ~ °} ~ a_,.,J .XO ~ ~ _p,.~~ ,yl'l~ ~ ±)M_ ~~.JUJ ~~ ~~~~~.kJl,I, cvJ;C'~ ~~~- -~~~~1U· 1 WELL CONSTRUCTION AND lEST REP.ORT For OITlce UM only STATE OF COLORADO, -c1cE OF THE STATE ENGINEER e . ~· . .. .._ __ _. .... 1. WELL PERMIT NUMBER _-3:60JOJ · - 2. OWNER NAME(S) I,am:::o aima·!a . ' Mailing Address Q55Z Qcmnti Road 35, City, St Zip lij f J e, ~cJ cz:ado SJo50 Phone ( '3 0 3 ) 625-0160 3. WELL LOCATION AS DRILLED: r.l ~ 1/4 ~w 1/4, Sec. l 2 Twp. b s , Range 2 2 7,, " DISTANCES FROM SEC. LINES: Li.2QQ ft. from SOJit.b Sec. line. and 3LinO ft. from Eus~ ri Sec. line. OR (north Of IOUlh) (east Of-I) SUBDIVISION: ---LOT-==-BLOCK --FILING(UNIT) --STREET ADDRESS AT WELL LOCATION: Q ') ')2 Count v Road '352 4. GROUND SURFACE ELEVATION 5200 ft. DRILLING METHOD Rotary., Air DATE COMPLETED e-:z-21 TOTAL DEPTH lJ:O O ft. DEPTH COMPLETED 4 00 ft . 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft} To (ft) Depth Description of Material (Type, Size, Color, Wat« L.ocalion) P.-3/~ 0 . 20 Q-lLd 20 ~0 0 0 -16 Ia"'~o j J ' ~:..d G, ~·7 e-c', 'T'a n J ' ' J t i. J ? Cr1 Sf Cc ·11 1"' 1 c -L h3 L 'd) CJ : • r I ' 'P n 7. PLAIN :CASING ' . ( ' /, 3-J 60 ~-'d' Sb, ~~d ' '.:) OD On) Kind Wall Size From(ft) To(ft) ·Q <':£ J 6()= J 8U sc ·, Hd :~ r • ~s S t ee l .188 +l 20 r~~-28~ s%' c~' 1 -H.:: • Gr 1 2 PV C !2 22 lj ,2 v G Q 8 -29 ° ~-:: ;~=: !-·•n: 11Z 2 G P l'~ i 2 0 2-1 ~·0 (' ;'>c ' i d . Hed, C!I:. '. 3b0 -l b 7 '-•. <... .... ih ' ti · cl (J -1 12 l:P ', ) PERF . CASING: Screen Slot Size: .032 ' 367-l· 00 Sb, Cr:: ' j1o~d l..-J /Z ~~Q .~32 3QU ~Q :J a FILTER PACK: 9. PACKER PLACEMENT: Material ~1 [:JtlQ Type 1 ~0D E Size Interval Depth ' 10. GROUTING RECORD: Material Amount Density Interval Placement REMARKS:. Low Vo l um e .• r. i rr. S t a.t i c N.Cmt. 2 Sx . 1 7il 0 -20 Eand ~1 DISINFECTION: Type 6 5 ~ HTH Amt. Used 2 Cu ps ~2. WELL TEST DATA: D Check box if Test Data is submitted on Supplemental Form. TESTING METHOD li i g Aii: Static Level 2 ~5 ft. Date/Time measured 3 -?-'.;!l 1000 Hrs, Production Rate '~'w o gpm. Pumping level ~Q O ft. Date/Time measured 8-:Z -21 1 2 0 0 Hr s, Test length (hrs.) 'fiJ O Remarks ~ 3. I have read the statementa made herein and know the contents thereof, and that they -true to my knowledge. [Punsuant to Section 24-4-104 (13)(a) C.R.S., the makin~ of false statemenlll herein constitutes perjury in the second degree and is punishable aa a class 1 misdemeanor.) CONTRACTOR RQ~l-;;·i:: !:o JJ n t a i n !J r i llinr S Ervice s Phone LlQ2) 2 J...5 -J 2 7 ) Lie. No. 791 Mailing Address o . (). Bnv i 0 2 7. C:r a n d .Jun ct i on. Col o •. H 5 0 2 Name/Title (Please type or print) SiZl~g~> Date A. L. W i ~en e r •..• CM ner :!-1-91 . r ....... • -· e --• •• ---e e ~ e e :. e • • --e • • e e e e -· ----- 'K/6ob-cr+o rY\f\-~~cl /J. 0-13o>r I;~- /(_ / -/-! L Cc!,, 3-16s0 /!-,or, I r -77 <fro -~t.-?b37. ~ 17-o -6;...o--$'S-S1=f -~ ~c> ~Ml'V\..L.. ~ ~ ~ ~ .;;;) i_,_ ::i ~ ,.._.__ <>+ R..~ __A.........,"-0-' ~ ~ ~ ~ h.~ i:o 0-~\--'~ v.:i-<-o.0-0.,__ ~ ~r.. ..... , "-~ ~ ~ ~w~~-·) FORM NO. PUMP INSTAUATION AND JEST REPORT . • Fot Office Use only . GIJS·32 11/90 STATE OF COLORADO, OF OF THE STATE ENGINEER · e . - 1. WELL PERMIT NUMBER :.~Q1Q) 2. OWNER NAME(S) L~uro Amaya • Mailing Address 05 '2 2 ~011nti H'HlQ )~2 City, St. Zip ll,j f:J e • Qolm:ad.o ;~l b 50 Phone ( 101 ) 62 t:;-OloO 3. WELL LOCATION AS DRILLED: NI ·; 1/4 T·rd 1/4, Sec. l9 Twp. s , Range 92 \.; 0 " DISTANCES FROM SEC. LINES: 1,700 ft. from ~Olltb Sec. line. and ]600 ft. from East Sec. line. (north OI' south) (eat OI' -') SUBDIVISION: ---LOT --BLOCK --FIUNG(UNIT) -- STREET ADDRESS AT WELL LOCATION: ~55~ Ci;;nmtl Ho ad 222 4. PUMP DATA: Type ~J~tm~:r:::.::112le Installation Completed AU.6USt:. 7, 1991 Pump Manufacturer Elinr. ~ ··z:-,J liD~ Pump Model No. 4r o 5 ttC'Y7 Design GPM E' j :ll:e at RPM ·21. 5Q , HP 12~ , Volts 230 , Full Load Amps 5.c Pump Intake Depth .3 ~.,.-) Feet, Drop/Column Pipe Size 1 Inches, Kind ~ch. :30 ~J v..:. ADDITIONAL INFORMATION FOR PUMPS GREATER THAT se GPM: TURBINE DRIVER TYPE: 0 Electric D Engine 00ther Design Head feet, Number of Stages ' Shaft size inches. 5. OTHER EQUIPMENT: Airline Installed 0 Yes C1J No, Orifice Depth ft. Monitor Tube Installed 0 Yes I .t....f No, Depth ft . Flow Meter Mfg. Meter Serial No. Meter Readout D Gallons, D Thousand Gallons, D Acre feet, D Beginning Reading 6. TEST DATA: 0 Check box if Test data is submitted on Supplementa! Form. Pw:ip ~av •2 r Ins r.:.a .llGt-1 D~e $/7/9 1 Si?/91 Total Well Depth 11 r)Q Time 1400 lbOO Static Level ")>l-C:. R~e (GPM) ? G~il, 2 G l )i;~ "" Date Measured R /7 '/D l Pumping Lvl. 38Q 380 7. DISINFECTION: Type 6 5 ·~ l:l I' ~-j '-. ' Amt. Used 2 ... vUj2 S a. Water Quality analysis available. D Yes liJNo ' 9. Remarks pll.[lJ~~ QlJ~I,2:l,!t ,:;} )$0 ' •. ~ C} p~.~ I Pur.10 Saver Installed, Fu..:. ii Into Cistern. ~ O. I have read the statements made herein and know the cont ents thereof, and that they are true to my knowledge . [Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the seconc degree and is punishable as a class 1 misdemeanor.] CONTRACTOR h°QC~Y' !·~uunt .s in Dri lli11t; St-rv icelPtlone Ll..QJ 245-827 9 Lie. No . 'l:Jl Mailing Address '.) ,, Box J ;l 22 1 Grand Jun ct.ic c... Col11r aa -J .3I5J2 6 • ::..~. Name/Title (Please type or print) Sig"?J f~v Date • ~, ~~/7~_/ ""~ -j/.l./11 A. L. Wisener ••• GwntJr ...... , . ' SOLD TO INVOICE I : . . .. e ROCKY MOUNTAIN DRILLING SERVICES P. O. BOX 3927 GRAND JUNCTION, COLORADO 81502 LAURO AMAYA County Road 352, # 0552 Rifle, Colorado 81650 SHIPPED TO INVOICI NO . . ~.. .. ·• 6547 •' August 15, 1991 SAME NE!, NW!, Sec. 19, T6S, R92W Garfield County, Colorado .;z CUSTOMER'S ORDER SALESMAN TERMS SHIPPED VIA F.O .B. DATE Tooter Net G.J. Pre Cast Gd. Jct. 8/7 /91 l - J *** Pavment of This Invoice Is Due On Receiot Of*** '~ ,J 1 Eaa 6'X6'X8'. 1500 $650. on 1 Gal. Concrete Cistern ; ,} 3' State Sales Tax lQ. 50 l .. .. 75. 00 ~ Deliverv Chare:e \i ~ T&tal Invoice •• ••••• j ... " $7 L..L... so ~ -~ t. Thank Youl lb ~ i .;, ,, , i.". ' ' ~ -j .. , ' ,..., - ~ 4 l c. ~ ll l' ' ."2 -~ -~ t i, • ""' ·, . ct ' . ·' ~FORM . 75737 POLY PAK (50 SETS) 7P737 INVOICE I '_ I ~ ROCKY MOUNTAIN DRIL.NG SERVICES P. O. BOX 3927 GRAND JUNCTION, COLORADO 81502 SOLD TO SHIPPED TO Lauro Amaya County Road #352, # 0552 Rifle, Colorado 81650 . , CUSTOMER'S ORDER SALESMAN TERMS SHIPPED VIA Tooter Net Tooter Inst llation Materials: 1 Ea HP F&W 2 OV Submersible P Grd Subm•rsible Wire Ea, lx Brass Ni les 1 Ea. l" Galv. Union 1 Ea. 3/4" Galv. Union IN)'OICI NO . 6548 . ' .. August 15, 1991 Same NE!, NW#, Sec. 19, TbS, R92W Gsrfield C2ynty:, CQlQ:t:i.dQ F.0 .8 . DATE Ton Site a 7 91 Materials •••••• . . . . . • • • • • ax.•• T Thank You! ~FORM . 75737 POLY PAK (50 SETS) 7P737 ~ c:.CJRDcD AT 'IE!!-.. C L O:::K /) .'·.JU N 29 1991 • h c R 424 774 T r L D ~ i: ) .i . L s .. : ,:> F , c 0 u 'IJ r Y c L c: ~ , PERSONAL REPRESENTATIVE'S DEED BUO K ~(J ~ PAGE ~{) Gi\R ldD IU N 2 6 1991 Sl ate Doc, Fee $ • feJ:: THIS DEED made by Edmund H. Atkinson as Personal Representative of the Estate of Catherine M. Atkinson A/K/A Catherine Marie Atkinson, deceased, Granter, to Lauro Amaya and Santos Amaya, Grantees, as Joint Tenants, whose address is 0552 County Road 352, Rifle, Colorado 81650. WHEREAS, Granter is the quali f ied Personal Representative, Probate Case No. 91 PR 48, Garfield County, Colorado. THEREFORE, for the consideration of Six Thousand Six Hundred Sixty Six and 67/100 ($6666.67) Dollars Granter sells and conveys to Grantees the following real property in Garfield County, Colorado: An undividied 1/3 interest in Township 6 South, Range 92 West of the 6th P.M. Section 19: Lot 1 with all appurtenances subject to taxes for 1991 due and payable in 1992, patent reservations and easements and rights of way of record or in place. Executed: June /J , STATE OF CALIFORNIA } } ss. COUNTY OF CONTRA COSTA } 1991 . (') J ()rl.../) . By:~//~ Edmund H. Atkinson as Personal Representative of t h e Estate of Catherine M. Atkinson A/K/A Catherine Marie Atkinson, Deceased The foregoing instrument was acknowledged before me this , day of June, 1991, by Edmund H. Atkinson as Personal p ntative of the Estate of Catherine M. Atkinson A/K/A Catherine Marie Atkinson, deceased. WITNESS my hand and official se9l. My commission expires: /l.lavem12 ie ( l:l; ;9q I ••• ·~ OFFICIA L SEAL C/;11/]11 J ~~I} • L , ) ' ·~~-·~-,~~~-. TR ACY ST. JO HN ("+ (\, ~ ~. Notary Publ1c-Cal1forma N t b r .... ,; ., ,..~· CONTRA -~OSTA COUNTY 0 ary u l I -~ ' I "c.-,~{;;.. My Comm. Exp. Nov. 12, 1S91