HomeMy WebLinkAbout1.30 Well Permit Testing.
Form No.
GWS-25
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-3581
APPLICANT
CMH HOMES INC
67123 ROAD
GRAND JUNCTION , CO 81505-
WELL PERMIT NUMBER __ ..... 2=9 ... 9-..26-..2.._ ____ _
DIV. 5 WO 45 DES. BASIN MD
APPROVED WELL LOCATION
GARFIELD COUNTY
SW 1/4 SE 1/4 Section 13
Township 6 S Range 92 W Sixth P.M.
DISTANCES FROM SECTION LINES
Ft. from Section Line
Ft. from Section Line
1095
UTM COORDINATES CMeters.Zone:13.NAD83l
PERMIT TO CONSTRUCT A WELL Easting: Northing :
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONQITIONS OF APPROVAL
1} This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit
does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from
seeking relief in a civil court action.
2} The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval
of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation
Contractors In accordance with Rule 18.
3} Approved pursuant to CRS 37-92-602(3}(b}(ll)(A} as the only well on a tract of land of 36.3 acres described as that portion
of the SW 1/4 of the SE 1/4, Sec. 13, Twp. 6 South, Rng. 92 West, 6th P.M., Garfield County, more particularly described on
the attached exhibit A.
4} The use of ground water from this well is limited to fire proteooon, ordinary household purposes inside not more than
three (3) single family dwellings, the watering of poultry, domestic animals and livestock on a farm or ranch and the
irrigation of not more than one (1) acre of home gardens and lawns.
5) The pumping rate of this well shall not exceed 15 GPM.
6} The retum flow from the use of this 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.
7} Pursuant to Rule 6.2.3 of the Water Well Construction Rules, the well construction contractor shall submit the as-built well
location on work reports required by Rule 17.3 within 60 days of completion of the well. The measured location must be
accurate to 200 feet of the actual location. The location information must include a GPS location (UTM coordinates}
pursuant to the Division of Water Resources' guidelines.
NOTE: Parcel Identification Number (PIN): 23-2179-134-00-016
NOTE: Assessor Tax Schedule Number: R005392
APPROVED
DMW
Recei t No. 9504023
State Engineer
DATE ISSUED 10-23-2015
By
EXPIRATION DATE 10-23-2017
f \ ----re:-iu. yGI .. ~o1.;._n --COLORADO DMSION OF WATER RESOURCES B .1o1-1r1.....,.i
DEPARTMENT OF NATURAL RESOURCES 31 .3 ! i8JvES 0 NO Pf no --...-.1
1313 SHERMAN ST., RM 818 , DENVER, CO 80203 -
18lves D NO lifno -lstllhr .... l D. Wll lhl9 be 1he on1r -on 11111 pmai11 "ptione -Info: (303) 866-3587 main : (303) 866-3581 -fax : 13031866-3589 httft:J/www.watar.state.co.us ::~\.tU
RESIDENTIAL Note : Also use lhiS form Fonn GWs-44 (0712009 ) ~ce J;':"'on1v RECE\VED Water Well Permit Applicat1u11 \\G" a S 1\\'~ Review form Instructions prior to completing fonn .
The fonn must be completed In black or blue Ink or hlnAd.
1. Applicant Information s0u~"~ SEP 2 8 '15 ~RE EJI r..meot~ 'IJl>-'tE:. . t;\'.\Gl\'.\E
CMH Homes Inc. s1,..1Eco\.O -W'li\'tEFl RESOURCl::.t # 9504023 STA'IE E N.G INEER
-GLENWOOD
Momngaddrua
671 23 Road 6. Use Of Well (check applicable boxes)
City I s-I Zlpc:oda
----·--
Grand Junction Co 81505 See lnstruc1ions to determine use(s) fot which you may qualify
---D Telepllonel I E·mel fopllonal ) A. Ordinary household use In one slngle·famlly dwelBng
( I (no outside use)
2. Type Of Application (check applicable boxes) 181 B. Ordinary household use In 1 to 3 single-family dwelings:
181 Construct new wel D Change ~;;;e (11-;i;;,---Number of dwellngs: ~
0 Replace exla1ing weD D Reapplication (expired permit) 181 Home garden/lawn ~ation. not to exceed one acre: 0 Use existing well D Rooftop precip. coUection area Irrigated 1 sq. tt.181 acre
0 Chanae or Increase use DOthar: D Domestic animal watamg -Cnon-commen:lal) 3. Refer To (if applicable)
Welpermlll W-Coultcuel 0 C. Livestock -arfnQ Ion fann/ranch/ranaelA--1
7. Well Data (proposed)
Deslgrmbid Bain Dellm*ldon ' Wllnemeorl MuiNlm pun11(ng rate Annual amount 111 be wllhdtwwn
15 gpm .3 acre-feet
4. Location Of Proposed Well (Important! See Instructions) Total dlplh Aqullm
150 feet Tributary County
Garfield SW 1/4ollfHI SE 114 8. Water Supplier
S..:tlan I ~ NmS lleng• E .. w I Prlncip.I,....... Is this parcel within boundarlea of 11 water service area? YES~NO
13 0181 92 D~ 61h If .,.., .......im name of sunnller.
~ af WlllramMCllonlkln l..ilon ..... typbllvnot~ .... , 9. Type Of Sewage System
Ft. tromD N D s FLtramDEDw ~ Septic tank I absorption leach field
For ,....__I Wiii onty-dll-end dhclan flOmold wtl 111 new woll
D Central system: District name:
feet direction 0 Vault: LOC1111on sewage to be hauled to:
Wd locallon addnu (lncklda City, s-. Zip) LJ Ch..:klfwlllld""'ssls..,. ••In hmm 1.
D Other (attach COf>Y of engineering design and report)
10. Pronosed Well Driller License #(ootional):1095
Opllonal: GPS wdklcatlon lnfarm8llan In UTM famlM. GP& unlt-*!11* .. as folowt: 11. Signature Of Appllcant(s) Or Authorized Agent
F-mustbe UTll The making of false statements herein constitutes perjury In the second
Dz-12mD zone13 Ealdng:6.2.3 degree, wtti! Is punishable es a class 1 misdemeanor pursuentto C.R.S.
244-104113Ka). I have read the atlltamants herein, know the contents
Unil!l-beM-. Nordlkt11:6,2,3 thereof and state that 1hev are uue to mv kn-.r.Me.
De!Um must be NAD83 ~~:orlt I Dalll
Unltlftlllbe Mt ID-'*"' Remember to aet Datum to NAD83 9l16l 15' -
DvES Sh-l(uSf
. ' W• GPS unll chacbd tar ebowa7
5. Parcel On Which Well Will Be Located ~\\)~ G.M. -
(YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) Office Use Only /'lf.T P ,,,,, # CIC-' 1-'l.J..1
A You must check and complete one of the following: USGS 1111P _,. I DWR IYllP no. 1 lk111_.,,_
0 Subdivision: Name / __
" Lot Block Fi Ung/Unit -IV'" ,..,v , .> Receipt area only
D County exemption (attach copy of county approval & survey}: , c.ll~J "7114'.
Name/I Lot# ~r fr1:111-;eirfron # '3fl71Ht
I '/ r £-« > Olllo 1113120 1[, 127211f'M D Parcel less 1han 35 acres, not In a subdivision. attach a deed with met9a (). . r 1 all!l;:ir. uu11 r 01a1 , stoo on and bounds description recorded plot to June 1, 1972, end II current CliECKtr.IJJ:s Stoo oo deed
D MHng claim ldadl • !!!!!!!otlha died m -1: N.,.,,./#
D Squarv 40 acre parcel as described In Item 4
D Parcel of 35 or more acres 1.-ti • -and bounda ~or auneyl
l2?J Other 18118Cb -&boandll de-'Plfan m anay encl IOIPPOlllnll documlnlll
~II ~ :i.. ~ -2.t 7 ·f3'1-0fl -·IJ(
10/23/2015 ..
·Account: R005392
Loqtion
Account Nu
Situs Address
City Silt
Tax Area 023 • 2HD-SF -023
Legal Summary Section: 13 Township: 6
Range: 92 THAT PT OF SWSE, LYING
WESTERLY OF THE RIGHT-OF-
WASY LINE OF COUN1Y RD. 311
Transfen
Sale Price
iQ
$225.QOO
Taxffistoey
Tax Year Taxes
*2015 $141.76
2014 $141.76
*Estimated
Account
OwnerNameCMH HOMES INC
Owner Address 5000 CLAYTON R AD
MARYV lLI..E, TN 37804
Sale Date Doc Type
08/03/2015 fil
08/03/2015 fil
01/15/2015 m
0512112010 173
Images
• Q!S.
htlps:J/ect.ga'field-county.can/assessorllaxwebfccount.jsp?acc:ounlNum=R005392
9~04023
Assessment History
Actual (2015)
Assessed
Tax Area: 023
$10,510
$3,050
·: 46.4850
Type Actual Assessed ~cres SQFI' Units
Land $10,510 $3,05 36.300 0.000 0.000
Book Page
RECElVED
NOV 0 s 1615
. ~ATER RE:-SOURCES -
Sl'ATE ENGINEER
COLO
1/1
-• . l • ., 9504023
AQUAMAP
Color.ado Division of Water Resources section
9504023 CMH HOMES INC Tax no R005392 1131w1
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UTM X, Zone 13: 276432
UTM Y, Zone 1324378310
Long: -101• 36' 3.r
~ \ I I Lat 39• 31' 31.3"
UTM and Geographlc(LL)
coordinates in NAO 83
I -_. .______ ~
'I I I DAIADIS LAY
D Background ~ Counties D Water Well Appllca
I Quad Maps IT I ~ PLSS D DWR Pan:els
® Low 0 High D Roads 181 EPA Well Notltlcatl
0 Hydrogniphy 0 011/Gas Well Locatl --.~ ---·--· --~,,,__ . ,1-----------l
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Transparency 181 County Parcels (No Public Access
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LOCATION
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Title [95o4023 CMH HOMES INC Tax no-R005392 I
Note: The woll loc:atlons displalf'911 on AquaMap aro basod on location
lnfannatlan piavldad by well permit appllca1ion farms and are anty
as accunde as the lnforma!lan praYlded. The actual phyalcal locaUons
of all wells heY8 oot been l1ekl verified and may VIII)' from Iha loc:aUon
dlsplayod. Refer to a copy oflha orlglnal woll pcwmlt lio, avallablo
an Iha Division of Wlllllr RllSOUnl8S wabsfflo. rar well locatlon delails •
~~ 7,118ft •
Address locaUon by Bing Maps
AquaMap Version 3.0 .1Ju!y5, 2009
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WELL CONSTRUCTION AND TEST REPORT FOR OFFICE USE ONLY
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER QECE,VF.[I
1. WELL PERMIT NUMBER 299262
2. Owner Name(s): CMH Homes Inc l.JEC 3 i 2015
Mailing Address: 671 23 rd WATER RESOlJRCES
STATE ENGINEER
City, State, Zip: Grand Junction, Co 81505 COLO
Phone# .
APPROVAL# GWS31-91-03 .
3. WELL LOCATION AS DBIIJ,ED SW 1/4 SE 1/4 Sec: 13 Twp: 6 s Range: 92 w 6th PM DISTANCES FROM SEC. LINES
ft. from Sec. line and ft. from Sec. line OR Easting: 2 75 463 Northing: 43 78 063
SUBDIVISION: LOT: BLOCK: FILING (UNIT):
STREET ADDRESS AT LOCATION
4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Air Rotary
DATE COMPLETED: 1211412015 TOTAL DEPTH: 120 DEPTH COMPLETION: 120
s. GEOLOGIC LOG 6. HOLE DIAMETER (in) FROM (ft) TO (ft)
Deoth 'fYl)e of Material (Sae, Color, and Twe) 9.0 0 45
000-034 Clavs. Cobbles 6.5 45 120
034-121 Wasatch Formation
7. PLAIN CASING
OD (m) Kind Wall Size From (ft) To (ft)
7.0 Steel 0.188 -1 45
s.s PVC 0.250 40 60
PERF. CASING : Screen Slot Sae
5.5 PVC 0.250 60 120
8. Filter Pack 9. Packer Placement
Water Located: 60+ Material : Type:
Sae : Depth :
Remarks: Interval :
10. GROUTING RECORD
Material Amount Density Intmval Placement
Cement 7sks 6 pVsk 10-40 ooured
11. DISINFECTION : Type : HTH Amt. Used: 4 oz.
12. WELL TEST DATA : () Check Box If Test Data Is Submitted On Supplemental
TESTING METHOD : Air Compressor
Static Level : 38 ft. Datetrime Measured 12/1412015 Production Rate 7 gpm
Pumping Level : Total ft. Date/Time Measured 12/1412015 Test Length : 2bours
Test Remarks:
13 I~ read the.-..-. made herein and k;now t!ie '10Dlmls tbcRof, ll!ld 1bat they 11111n1eto my kaowlcdp. (Pmsuaat to Sccticm 24-4-1-4 (13Xa) CRS, the malda1 uffidse stalmnmds
• comtilulcs TR:ecr m the llCCOlld ~and IS~ U a clus 1 nusdcmcanor.)
CON OR : Shelton Drilling Corp. •Y8\' Phone: (970) 927-4182
Mailing Address : P.O. Box 1059 Basalt. . 8 621 Lie. No. 1095
A ,f
Name I Title (Please Type or Print) Si7!7ti~-A. Date
Wayne Shelton I President / 12/1512015 __.,,... __
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ORIGINAL