HomeMy WebLinkAbout6. Water and Waste WaterMay 23, 2016
Kenny Meyer
4784 County Road 312
New Castle, Co. 81647
ATTN: Kenny
On 5/20/16, a well test was conducted on a well at 4784 County Road 312. The
following information was obtained;
Well Depth 30'
Casing Size 30"
Standing water level 23.97'
Total test time 4 Hours
Drawdown to 28.37'
Production is 1.93 GPM
This test was conducted with the existing jet pump. The well water level recovered back
to 27.06 in 60 Minutes. This well has approx. 300 gal of storage and the well will deliver
2780 gal per day. The average use per person per day is 100 to 150 gal. per day. If you
have any questions please call me, Raun Samuelson at 970-945-6309.
Sincerely;
Raun E Samuelson
Samuelson Pump Co.
PO. Box 297 • Glenwood Springs, CO 81602 • (970) 945-6309 • Fax (970) 947-9448
Water Systems • Sales, Service & Installation
An Employee -Owned Company
Revised May 20, 2016
Kenneth Meyer
4784 County Road 312
New Castle, CO 81647
Email: kenny@doormangws.com
Re: Accessory Dwelling Unit (ADU) Septic System
HCE Project No. 2161037.00
Dear Kenny;
On May 1st, 2016 High Country Engineering Inc. visited your property to look at the exiting
wastewater system serving the Accessory Dwelling Unit (ADU) at the site.
Mr. Kelly Gessele, was present and had recently pumped the septic tank. The septic tank cover
had been uncovered and removed. The existing plastic, single compartment septic tank
measured approximately 3 -feet in diameter and 10 -feet in length, and had an approximate
capacity of 500 -gallons.
A 4 -inch diameter polyvinyl chloride (PVC) effluent pipe exiting the existing septic tank was
noted. The effluent pipe led to a 4 -inch by 4 -inch tee manifold which then connected to two (2)
parallel rows of Infiltrator Equalizer 36 Chambers, in bed configuration.
The width of the chambers was measured to be approximately 22 -inches wide, and the lengths of
the two (2) chamber rows measured to be approximately 40- feet. The absorption area beneath
the existing chambers measured to be approximately 146 square feet.
The existing septic tank and the Infiltrator Equalizer 36 Chambers appeared to be in good
condition.
Please let us know if we can be of further assistance.
olottritoo
O9rj tires.
c .n c0 r
▪ 3&39313
Thomas S o # t.V.0%• 5 k,
Project Manager' `t &ioNpL
�
l011i111t0
Sincerely.
1517 Blake Avenue, Suite 101
Glenwood Springs, CO 81601
Telephone (970) 945-8676
Fax (970) 945-2555
Form
No.
GWS-11
8/2005
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
818 Centennial Bldg., 1313 Sherman St, Denver, CO 80203
Phone - Info: (303) 866-3587 Main: (303) 866-3581
Fax: (303) 866-3589 http:/lwww.water.state.co.us
For Off c Uu Only
tGEIVED
DEC 1 8 2O6
wATEH kc6uurtl:ES
sTATEENGMIEER
RECEIVED
DEC 0 4 2006
at '-'6a0urtc
COLO, h p
of the well permitted as referenced above.
-
CHANGE IN OWNERSHIP/ADDRESS
CORRECTION OF THE WELL LOCATION
Review instructions on the reverse side prior to completing the form.
Name, address and phone of the personryclaiming ownership of the well:,ll
NAME(S):
Mailing Address:
City, St. Zip:
Phone (
ct'�+ i P. ala irc J. lni"
' { .1
4'1 4 C[`C,I-.i`1t d -v_'t. a-i-}-
--et, (OHf.CO1c4L /
Qi
C.))6114._ 14.-_5 0
claiming that they are the owner
-
This form is filed by the named individual/entity
This filing is made pursuantto C.R.S. 37-90-+143.
WELL LOCATION: Well Permit Number: 1$ 1 ag(p Receipt Number: 0373002 A'-t
County (4-RFiEth Owner's Well Designation
4784 Oburriii b 312, N-.4.2.) ( s'— Co 8i q
(Address) (City)
N1,01/4 of the WLL) 1/4, Sec. 955 , Twp. 4' 0 N. or S., Range q
(State) (Zip)
6 P.M.
• E. or 114 W.
Distance from Section Lines: / 1 bp
Ft. From
Ft. From 11 N. or ■ S., /00
■ E. or CX W. Line.
, Filing/Unit
Subdivision
Name Ni9-- Lot , Block
The above
the following
IXL Change
8, 1972 and
Please see
listed owner(s) say(s) that he, she (they)
reasons:
in name of owner X Change in mailing
non-exempt wells permitted before
the reverse side for further information
own the well described herein.
The existing record is being amended for
for exempt wells permitted prior to May
well location.
address ■ Correction of location
May 17, 1965.
regarding correction of the
I (we) claim
herein,and
fife cantents
and say that I (we) (are) the owner(s)
state that they are true to my (our)
of the well described above,-know
knowledge.
oofTie staiements made-- -I-
`herein,
Signature(s) of the new owner
' 19.4 , 7 ..-- .
,�
2��
Please print the Si ner's Name & Title
K04-16-04-- P rnEy64
b o Rb T. mEye
Date
I l ,�J
I, is th�orisibility of the ne' owner of this well to complete and sign the form. Signatures of agents are acceptable if an
original letter ofdye' it y signed by the owner is attached to the form upon its receipt.
For Office Use Only
7,6L`t�DItOli R M !rNAF.I t1.\��;1 N tNS.OWNERSHIP
t
4 D o
State Engineer By Date
Form No.
GWS -25
APPLICANT
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-3581
MARK & CHERYL FISCHER
P 0 BOX 981
NEW CASTLE CO 81647
( 303)984-2435
REGISTRATION OF EXISTING WELL
LR
WELL PERMIT NUMBER 18j 2nig
DIV. 5 CNTY. 23 WD 45 DES. BASIN MD
Lot: Block: Filing: Subdiv:
APPROVED WELL LOCATION
GARFIELD COUNTY
NW 1/4 NW 1/4 Section 25
Twp 6 S RANGE 91 W 6th P.M.
DISTANCES FROM SECTION LINES
1100 Ft. from North Section Line
100 Ft. from West Section Line
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDII7ONS 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 seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation 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 17.
3) This well is recorded, and permit approved, in accordance with CRS 37-92-602(5) for historic use as indicated
herein and described in CRS 37-92-602(1)(b), being a well producing 15 GPM and used for ordinary household
purposes inside two (2) single family dwellings, fire protection, the watering of domestic animals, poultry, and
livestock on a farm or ranch, and the irrigation of not more than one acre of home gardens and lawns,
4) The average annual amount of ground water to be appropriated shall not exceed 3 acre-feet.
c Sag --1(
APPROVED
JD2
StnEngineer
Receipt No. 0373002A
By JJL'i�
DATE ISSUED Alla 10 .1994 EXPIRATION DATE /17/04-
GWS-12
50!89 ,
y
STATE OF COLORADO
OFFICE` OF THE STATE ENGINEERRORMEn i
1r
'''818 Center nist Bldg., 1313 Sherman St, Denver, Colorado 80203 ez4
(303) 866-3581
For Office Use only
NUMBER ///,Z1.7(-7
�o Rco
RECEIVED
JUL 2 9'94
WATER
STAATTER iiRt
EN t4ER
COLO.
lieaeipt No. 3 7300
; ` , \c-5- 7?^
,,0 .7
0--)9Q
��
9 .�
S. t3 <1 ,
`frE )fc r,� :.
S
a-- -#.
FOR INSTRUCTIONS SEE REVERSE SIDE
REGISTRATION OF EXISTING WELL
1.
WELL OWNER
NAMES) F�y"ici��i/ Y'1 SL �iQ
Mailing Address Ei op( 9 i
City, St. Zip J1) Q.A.AD ('a. s + Le C0 -8/ I/ 4/7
Phone ( 2/)) %Ey_- 2y
2.
WELL LOCATION: COUNTY rdGe� f() OWNER'S WELL DESIGNATION rr`5r.�2.1
*-/
:,
g'j6/?
(Address) (Cih') (State) TIP)
NW1/4 of the J/ W1/4, Sec. 2`} Twp. 6 ❑ N. or ES., Range ❑ E. -11‘P.M
RW.
or /j
//oma (---
,
Distances from Section Lines ��� Ft. from N. ca ❑ S. Line, )F4:71-444/
tom L_.. E. ®,W.
or Line.
3.
The well has historically been sed for the following purpose(s): 7?3 d ,,,Oi'YI(2a i
4.
Water from the well was first used beneficially by the original owner for the above described purpose(s)
on r. --X 19' ).
5.
The total depth of this well is ij/O feet.
6.
The pumping rate is /3 gallons per minute.
7.
The average annual amount of water diverted is _3 acre feet.
8,
The land area of home lawn and garden irrigated from this well is: (}YL
?1,1).e FT Acre or
II
Square feet,
(Number)
described as: 0 aylik.J2. . ILO 41)f --
(Legal Description)
OZ' as Subdivision Lot(s) Block Filing/Unit
I (we) have read the statements made -herein, know the contents thereof, and state 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 degree and is punishable as a Class 1 misdemeanor.}
9.
Name/Title (please type or Print)
Che co- li j'iSGknrr
Signature/��f
t�4 �. � r'Sf. e
Date -
"7, `ot.,cia
Co. -1 ..02 2 FOR OFFICE U ONLY
CHECKS lR43731O2 O7299 120,00
DIV OF 'ATER RESOURCES
State Engineer
By Date
Court Case No. Div. Co. -2.7 WD ...5" -Basin MD ' Use
GWS -13 pm)
COLORADO DIVISION OF WATER RESOURCES FIELD INSPECTION REPORT
Please complete this form in 1Nii app!. receipt no(s). /f/Oit/E TO Qr}%
DI WD {
DATE OF INSPECTION: 7/ 'i 7,,V0 el PURPOSE OF INSPECTION: LATE REG. `� C)IHER � A e
L • .77- 4 -----
APPLICANT /17 ct' /& t' Fse'rr- person contacted if not applicant:
ADDRESS:
,' a. 19° x f 3 ( flEteone #: , 2 ; 4i- E - iii ke.t
et/ '.— Cis f / l C' 9/ 6,r 7JU.2 9'94 e
03� Q u..` 3 6 6 s—
phone: WATER RWURU
STATE ENGINS.Ei'
EXISTING WELL LOCATION: COLO 7 S.
N kJ 114, /V Iv 1/4, Sec. .2- --, Twp, 6. So «f k , Rng. ?/ 14-41 6' P -M
/ .
N
DIST. // ®0 fron S sec_line, / 0 0 from E W, f ec.liine; County � a r , ' / tor."(
/Li ,e 4___ rpt // w . '// 6 c.—
(if
(if rept., give dist. & dir. to new well site - 44.--s f 4 • `^- •2, a o :4--i O -F a//rte e //
circle type 0/ existing well: DRILLED,(1 {BIND DUG)SPRING WELL, GALLERY WELL, GRAVEL PIT, OTHER
any other wells are located on this parcel? (yes) how many ✓ (no); permit *,casaI,us&?
EST. DATE WELL CONSTRUCTED / c DATE OF FIRST USE /71. EST. PUMPING RATE /S gpnr
f O TAL # OF ACRES IN Tl -IIS TRACT/PARCEL ¥'' ACRES
address of property (if different than applicant address): 719 C ",et. A'' a .. 2° 3 / 2
8/6
8/6ere
add. subd/parcel info.:
# acres irrigated (non-exempticrop irr)
/1�/i¢ NAME OF AUG. PLAN?
USE OF WE
ou
ous old use in (indicate flow many) -Z single family dwellirrg(s)
ate ng of poultry andlor domestic animals (`dotnestic animals' would include a lew cows, horses, etc.)
tering of livestock on a farm or ranch - approx. how many head? t$`�✓
is s a feed lot? ,t/p , how many head?
tt is important to specify estimated historic iawn/garden irr.) irr. 9f 3, S• 0 acre of lawn andlot garden
.__. rotection
commercial - drinking & san_ only? (write details in 'comments' section)
other (write details in 'comments' section)
(res 1 no WERE THE USES CHECKED ABOVE INITIATED PRIOR TO MAY 8, 1972?
NOTE: IF ANY CHANGE IN THE HISTORIC USF OF THIS WELL IIAS 0CCUftflLI) SINCE MAY 8, 1972 poi's
indicate the date(s) the use changed, and discuss this chanpelaml/or expansion of the currentlnr proposed ris
in the 'comments' section of this form
signed :
dated: '7 1 .271 9474
additional comments and/or information: -/V 7 e .%- %1 E S *� - - .c.,_-. p w'i-€''-_
6t. -1/4,e,, / c -c /' C 4- .r. _s- J ,(j c- , V'! PL-7!®�/ �{ s
/J' -,e,(0-1_,:e (/t /�-' ,i/e>" f -c ti i. 5 ie e- f Gc e -s l` `'' 11/
tz? 6.4- 7 -0 /Qore�� C t, "...c— -, .)t. L. C //
room for contnteirts on the back
GWS -13 A (W92)
Page 2, FIELD INSPECTION REPORT
2-41(sF)
2-HD(SE)
T
2399. 034-00-087
c.
APPROVED
2399-024-00-091
---- A
/17
7/
CO. ASSESSOR
—4,
s-2399 -122-00-054
T. 6
181
R.9 I W.
Form No, OFFICE OF THE STATE ENGINEER
GWS -25 ' * COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bidg., 1313 Sherman St, Denver, Colorado 80203
(303) 868.3581
APPLICANT
MARK & CHERYL FISCHER
P 0 BOX 981
NEW CASTLE CO 81647
( 303)984-2435
PERMIT TO CONSTRUCT A WELL
SELF
WELL PERMIT NUMBER
DIV. 5 CNTY. 23 WD 45 DES. BASIN MD
Lot Block: Filing: Subdiv:
APPROVED WELL LOCATION
GARFIELD COUNTY
NW 1/4 NW 1/4 Section 25
Twp 6 S RANGE 91 W 6th P.M.
DISTANCES FROM SECTION LINES
1090 Ft. from North Section Line
90 Ft, from West Section Line
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 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 seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction and Pump Installation 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 17.
3) Approved pursuant to CRS 37-92-602(3)(c) for the relocation of an existing well, permit no. /Y Z
The old well must be plugged and abandoned according to the Water Well Construction and Pump Installation
Rules within ninety (90) days of completion of the new well. The enclosed well abandonment report form must
be completed affirming that the old well was plugged and abandoned.
4) The use of ground water from this well is limited to ordinary household purposes inside two (2) single family
dwellings, the watering of poultry, domestic animals, and livestock on a farm and ranch, and the irrigation of not
more than one acre of home gardens and lawns.
5) The maximum pumping rate shall not exceed 15 GPM.
6) The average annual amount of ground water to be withdrawn shall not exceed 3 acre-feet.
7) This well shall be constructed not more than 200 feet from the location specified on this permit, being on a parcel
of 5 acres described as the S 1/2 of the SW 1/4 of the NW 1/4 of the NW 1/4 of Sec. 25, Twp, 6 South, Rng. 91
West of the 6th P.M.
8) Emergency verbal approval, #94VE305, was given for the construction of this well on July 28, 1994.
APPROVED
JD2
Receipt No. 03730028
DATE ISSUED AUG 3
By
194 EXPIRATION DATE AUG 3 0 1995
26 2lzg,,
. WRJ._�.R.v.•i6' • COLORADO DIVISION OF WATER.RESOURCEpS 4� �
818 Centennial Bldg,, 1313 Sherman St., Denver, c t; (.... 'ti l
U 1994
Application must PERMIT APPLICATION FORM -, n in4
.e complete where (`f�ERMIT TO USE GROUND WATER reroSAI
„ ,17,
applicable. Type or ( ) RMIT TO CONSTRUCT A WEWATEB%E" c., yy `;3
print in BLACK FOR: ( A PERMIT TO INSTALL A PUMP STATE C'.
INK. No overstrikes COLA
or erasures unless
initialed.
( REPLACEMENT FOR NO Ccc i/!.t f %.
( ) OTHER
WATER COURT CASE NO
/,?
/64
(1) APPLICANT • mailing address
IC�%%
NAME (�!'/_[eiv
STREET 1,7%,
i�
CITY 1/1v'W nnous
00
(Stat.) (zip)
TELEPHONE NO
(2) LOCATION OF PROPOSED
WELL
County At p�• • L (t/t
N
'd of the
Twp. rP 5, Rng.
t N. St
Y Sectibn
9( w
(E.W)
P.M
(3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm)
Average annual amount of ground water
to be appropriated (acre-feet)'
3
Number of acres to be irrigated:
Proposed total depth (feet): /ate
Aquifer ground water is too be obbtaineed/from:
!
(i#t( fl4✓� e. Y rc9 j/`drTs't/i� e/`.e
Owner's well designation f'S Gt P
GROUND WATER TO BE USED FOR:
HO HOLD USE ONLY • no irrigation (0)
OMESTIC (1) ( ) INDUSTRIAL (5)
) LIVESTOCK (2) ( ) IRRIGATION (6)
COMMERCIAL (4) ( ) MUNICIPAL (8)
) OTHER (9)
DETAIL THE USE ON BACK IN (11)
(4) DRILLER
Se /F
Name
atreet
City
(State) (Zip)
Telephone No. Lic. No
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
°eceipt No. 373 C6 -6,
Basin Dist.
CONDITIONS OF APPROVAL
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 seeking relief in a civil court action.
ba 71
614i VF Sas
APPLICATION APPROVED
PERMIT NUMBER
DATE ISSUED
EXPIRATION DATE _
4n Ir f,o iL??`t
DIV OF DATER RESOURCES
(STATE ENGINEER)
BY
I.0
r
COUNTY -2- 3
(5) THE LOCATION OF THE PROPOSED -WELL and the area on
which the water will be used must.be indicated on the diagram below,
Use the CENTER SECTION (1 section, 640 acres) for the well location_
f
-- — }-- +---
1 MILE,5280 FEET
! 66a
-1— i - -2
J
Z
_0
t -
U
- lil —1—±- 1-
to
Ijut
— —
+ f +
NORTH SECTION LINE
I 1
- I
i
1
I
SOUTH SECTION LINE
-1- 4
- I - -{- - -+ - f- -
4
— + — -}—
The scale of the diagram is 2 inches = 1 mile
Each small square represents 40 acres.
(6).THE WELL MUST BE LOCATED BELOW'
by:distances from section lines_
J`29 2 ft. from
9 ft, from
LOT
/11/oR 7-124
sec. line
(north or south)
(east or west)
BLOCK FILING x
sec. line
SUBDIVISION
(7) TRACT ON WHICH WELL WILL BE
LOCATED Owner. e4 c -y->/ € "t. -k /47%44e^
No. of acres J ♦ 0 Will this be
the only well on this tract? J' e
(8) PROPOSED CASING PROGRAM
Plain Casing
cn in. from fr' ft to ft
4
-7- in from
Perforated casing
T 2- in from ft to
ft to 8(7 ft
in from
ft to
ft
WATER EQU[VALENTS TABLE (Rounded Figures)
An acre•foot covers 1 acre of land 1 foot deep
1 cubic foot per second [cfsl ... 449 gallons per minute (gpm)
A family of 5 will require approximately 1 acre-foot of water per year.
1 acre-foot ... 43.560 cubic feet ... 325,900 gallons.
1,000 gom Dumped continuously for one day produces 4.42 acre-feet.
(9) FOR REPLACEMENT WELLS givedistance
and direction from old well and plans for plugging el
it: f'— - L.✓- �� i f .6 i-
o 2 F t 05- Oe".,/ G -f(
o/'/ ----'(l 00 6r.. i.e `Af
/
GC d// a` f� 2 Z./0,1. L aCG Bre/r t S
7`D xcr Q.�/c < t _s-
(10)
(10) LAND ON WHICH GROUND WATER WILL BE USED:
Owner(s): ex e.--7./.
.--7 ( ' snot- ,& F' s 64 C No. of acres- +-5"—: O
Legal description -S3 OItLcr-sem% 45-z4,t- 4/ f/)t--,C 4' - W4 SZ -C.2 7.1—,4 6" 5,...,1- A''., ?iiJl
(11) OETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate tof dip I --
//:‘-,,,_s-type of dtsp�af
- system to be used. /�!.7 L✓a / N�
Tu=o S. � cc_ ,�ea�... 7,5: -co-. ' 0 � /Lb -t ~C�r
571 DC k oC --t 401,--f-- G t- /4 4..---. ` 9' a of L .-, i ✓' / � yC `o -\ ,c il/- .fes 'a,.r f
s� s f t+ u-, '`7' �.t___ 0 ,$) s %0 1-d_ lG .._c t F� e Pe"(
(12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers.
Type or right
Used for (purpose) Description of land on which used
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE O THE BEST OF HI: KNOWLEDGE.
SIGNAT
/..
OF APP,JANT(S)
72
Use additional sheets of paper if more space is required.
C 'G
COLORADO DIVISION OF WATER RESOURCES EMERGENCY VERBAL REQUEST INFORMATION
GWS -24 (9/92)
to be completed in INK DIV 5_ ,co a3 ,WD 45
_ ,BAS ,MD
verbal receipt # 23954
FAXED r`
DATE CALLED IN % / Z7 / t Approval # VE
TAKEN BY ' ,NAME OF CALLER ,' ,, ..; ,- , Sri . prove! Given 7 /.28 / ? { ; Given By J
(1Nn1AL.S)
APPROVAL GIVEN TO (name, company)
APPLICANT:
QY�+C,�IPx� Fier
ADDRESS: j ( gal COMPANY ADDRESS:
Che / c4 K
CONTRACTOR: 7 5 lP
phone:
Se -L -14-1e. czS Q /1(fro*,k
A2 (0si4 Co g16117 UC #: — ; phone: + e
303 Q S' ! VI -3r (H) / (0) APPL RECEIPT # & DATE --
USE OF WELL bOl4,1 PERMIT # Ll
PROPOSED LOCATION OF (new) REPLACEMENT WELL AUG PLAN NAME
;CASE#
m r/a /rr, Ht � 7/Z t;*
Nil iA) 1/4, & J 1/4, Sec. Z , Twp. 6 S , Rng, q(( , P.M.
DIST. (6 70 from S sec. line, q) from E , / . line; County Cat-- rl✓ (c
distance & direction from old well to new well site See Or c.'iC_ ; DEEPEN (circle if deepen)
subdivision info:
total # ac. lot(s)
bk. fig. subdv.
_.clonal parcel info. / ADDRESS OF WEU., if different than applicant add:
REASON FOR EMERGENCY: OF WATER CCUPIED RESIDENC
(circle) 0 '-
no) STOCK ON PASTURE CROP IRRIGATION
CASING INFO: DEPTH OF OW WELL? 676 ; PROPOSED DEPTH? l0C) ; AQUIFER?
CASING? plain plus 1'T, (QG pert•.] - frry DATE TO START?
y 60-66 ityz
=IELD INSP. REQ.? (NO) fever for field inspection report information; called in? - date
/ 1
EVALUATING STAFF COMMENTS: Per vim, . f T ts!f R<.r J1 �T iitf/7( / �1 d (l (Y 5) )
n cc) Vr44.- Cp
:.0NDITIONS OF APPROVAL
1-07Larcr dyrfftic) Cir J�� �� vre 791-E1r' rc� c.4-51rc cf �1 ltielfo
1
PLUG AND ABANDON THE OLD WELL PER RULES AND REGS WITHIN 90 DAYS OF
CONSTRUCTION. SUBMIT LATE REGISTRATION FORM AND REPLACEMENT APPLICATION
REFERENCING THIS VERBAL APPROVAL NUMBER WITH $60 FEE WITHIN 10 DAYS. SUBMIT
ALL WORK REPORTS (REFERENCING THIS VERBAL APPROVAL NUMBER) WITHIN 60 DAYS
OF CONSTRUCTION. THIS VERBAL APPROVAL EXPIRES 60 DAYS FROM DATE OF ISSUANCE.
THIS WELL MUST BE CONSTRUCTED IN ACCORDANCE WITH THE RULES AND
REGULATIONS. IT IS HIGHLY RECOMMENDED THAT THE APPLICANTS OBTAIN A COPY OF
THE RULES AND REGS (APPLICANTS OWN A DRILLING RIG AND WILL CONSTRUCT WELL
THEMSELVES). USE OF THIS WELL IS LIMITED TO HOUSEHOLD USE IN TWO SINGLE FAMILY
DWELLINGS, THE IRRIGATION OF 1 AC OF HOME LAWNS AND GARDENS, AND THE
WATERING OF POULTRY, DOMESTIC ANIMALS, AND LIVESTOCK ON A FARM OR RANCH.
:VALVA 1 ED BY: (9`.1)
(INITIALS)
; DATE: a7- 9y ; APPROVED BY:
NATURE)
; DATE: 7 -c -7-9y
4VS-24 A (919 2)
COLORADO DIVISION OF WATER RESOURCES EMERGENCY VERBAL FIELD INSPECTION REPORT
!'lease complete this form in iNK
DiV. 5 WD 4/5—
OF
/sOF INSPECTION: 7 / .27 / 92/
APPLICANT:
app/. receipt no(s). —1
PURPOSE OF INSPECTION: LATE REG. >( . OTHER
Ma r/ + Ci -e -vv/ 1;3 cher- person contacted if not applicant
ADDRESS: BO x %"(
phone:
/V6w asf/q) 8/6 (i7
EXISTING WELL LOCATION:
}CIA, TION:
tU w 1/4,
DiST. t k CC from
1/4, Sec. ,
S sec.line, 1(O
(if rept, give dist. & dir. to new well site —
W.C. name &phone #: it n /i f 6--17 ;Veil cad
`h'S- s-66 5-
J
Twp. S , Rng. 1l , ( P.M.
from E line; County Gar r ' €' I d
:ircle type of existing well: DRILLEI' . PRING WELL, GALLERY WELL, GRAVEL PIT, OTHER
(no) permit#,case#,use?
-ST. DATE WELL CONSTRUCTED } t c -Id DATE OF FIRST USE EST PUMPING RATE 15--
gpm
ACRES
, HAND DUG,
my other wells are located on this parce
TOTAL # OF ACRES IN THIS TRACT/PARCEL 146
zr -4,ess of property (if different than applicant address):
?dd. subd/parcel info.:
k acres irrigated (non-exempt/crop in:)
NAME OF AUG. PLAN?
ISE 9F WELL:
household use in (indicate how many) ' f! single family dwelling(s)
• watering of poultry and/or domestic animals ('domestic animals' would include a few cows, horses, etc)
▪ watering of livestock on a farm or ranch — approx. how many head?
/is this a feed lot? 1)0 ; how many head? SZ)
V (d is important to specify estimated historic lawn/garden itr.) in: I 116rsquare feet/acre of !awn and/or garden
V. fire protection
commercial — drinking & sari. only? (write details in 'comments' section)
other (write details in 'comments' section)
port taken by:
WERE THE USES CHECKED ABOVE INITIATED PRIOR TO MAY 8, 1972?
NOTE: IF ANY CHANGE IN THE HISTORIC USE OF THIS WELL HAS OCCURRED SINCE MAY 8, 1972, please
indicate the date(s) the use changed, and discuss this change/and/or expansion of the current/or proposed use
in the 'comments' section of this form
(I1
iditional comments and/or information:
; dated: 7 / a7 '71/ ; called in by: J) •r9 f1T 4 r %ea d
1al:i21(t/')-1-'1!
Kt 1-zj7 4Tro,t
DIVISION m1 7 tZ SOIRCS
C
CHEMIST &T FOR WELL PERMITS
REC E
jag 9'94
t1;(1 ,• ICI 4.1 t.'rc1 1 11 tt 1 i.. 1 'iu: 7/��
Date forwarded to iJejtv.r:
Name of applicant:
r..rS eh/6-4 G.MME'/P /7/Pk-
Application typed or neatly printed .in black ink
ECJ Correct_Ooxes checked for appropriate action
Previou( permit number correct for replacement wen, etc.
U Court case number listed for decreed wells
U Field inspection completed and attached (fee or late reg.)
(1) Applicant Mailing Address
1015 /trailing address correct and legible (printed or typed)
❑ Telephone number correct and current (local number if possible)
(2) Location of proposed well
;11r./Location correct according to information supplied by applicant
Location consistent with items (5), (6)~ on application
note: distances and 1/4, 1/4 must be measured from
SE corner of section for irregular sections
(3) Water use and well data
(4)
,5)
"Proposed pump. rate" completed (15 gpm
"Amount of appropriation" completed
"Acres irrigated" completed & matches
"Proposed total depot" completed
Aquifer information completed ("unknown" 3.f not
Owner's well designation completed (optiona.i. )
Grounjsater to be used for:
Domestic or household use well
❑ non-overappropriated area
overa ropriated area
35 acres or more (must
subdivided before June
- county (attach copy of exemption)
subdivision date & l.ot if
note: must include descriptions of parcels
not in a subdivision (plat or metes
and bounds)
❑ Other (comme'rcial, municipal, etc.)
for exempt dom. and
type of wellapplied
sture)
for
include description)
1, 1972 or exempted by
Driller
D Designated driller- a copy of permit sent to driller indicated
0 "Colorado Licensed"- all copies of permit sent to applicant
Location of proposed well (map)
LT Completed and consistent with items (2), (6) on application
Location of proposed well (distances from section lines)
Completed and consistent with items (2), (5) on application, ar
supplied information
❑
Subdivision information completed (when applicable)
(7) Tract o which well will he located
Comple
n te: if 11. 1f. use or domestic on 35 acres in over --
appropriated area can only have one well per tract
(check to verify no other wells in the 1/4, 1/4)
(8) Proposed casing program'
21 Completed
1J- Minimum casing size of 4" I. D. with 20' solid steel surface
casing (1' above ground, 19' below)
❑e Variance request (letter and diagram) attached if applicable
(9) For replacement wells
Completed if applicable - distance 'and -"according to rules"
(10) Land which groundwater will be used
❑ Completed if applicable (for irrigation only wells)
note: can be used to describe only well on 35+ acres
(11) Dat description
❑ Completed correctly and in detail
note: be specific about uses, especially number of houses
to be served, stockwater, irrigation - must be
consistent with type of well requested. Remember to
indicate type of disposal for domestic and 11.11.
(12) Other wa er rights (include well permit number if answer in #7 was no)
Completed if applicable
(13) Signatureurline
U Signed/dated by APPLICANT OR REPRESENTATIVE (w/written
autiiori,,ty-print name and title of representative)
(1 4) Comments % /1c Gam- r -c Q Gc c s ,Cor L /� -.sfra2`s7)`
�C I Lt- G G L ti./ o
/47(t <i 4.- /1 ev
Application fee attached: Check # 44 i
Application taken by:
Application checked by:
aw,15 44o /je- es k.,„/L r`s s4c -- `t,
/��! //-e
.� La l! c r `� 7�, a 7� - `� ,,, /'[ L�lat G t L ti'j �/�' , 1� a 'tre(%y
}� e _ .9 sJa / e a Y e•�e . e ! !-'/c ` e- 0 S ,4 f G— o - /g S
z7'G
Amount $ /(.1 4, ____