HomeMy WebLinkAboutWell Permitre@t COLORADO
Division of Water Resources
Departrnent of Natural Resowces
WELL PERAAIT NUMBER
RECEIPT NUAABER
204416--A
0423538
DWPJ306090 - DwR_43 06060.pdf https ://dnrweblink. state. co.us/DWR/PDF/j sz4pevs4j c5h5 s24 lwgfyu ".
APPROVED WELL LOCATION
Water Division: 5 Water District: 38
Designated Basin: N/A
Management District N/A
County: GARFIELD
ParcelName: LOOKOUT MOUNTAIN RANCH
PhysicalAddress: N/A
SE 1/4 SE 1/4 Sec'lion 12 Township 6.0 S Range 89.0 W Sixth P.M
UTlt COORDINATES (lleters. Zone:13. NAD83)
Easting: 305073.2 Northing: 4379116.8
ORIGINAL PERilT APPLICANT(S)
WAYNE RUDD
e perm can
ng the I Permit Search Tool at hths//dwr-colorado-gov/
See@nal Pernl Date lssued:
Explration Date:
11 t7 /'1997
11 17 11999
lssued By
08-28-2024 CHANGE IN OWNER NAMHMAILING ADDRESS. CHANGED TO KBBS HOLDINGS, LLC (KARA A.
BYRNE)
Page 1 of 1
lofl
Printed (ts-28-2024 For quertions abor.rt this permit catl 303.866.3581 or go to https://dwr.cotorado.gov
1211312024,10:35 AM
DWR-1047190-DWR_IS47l90.pdf ' ftttps://dn_rw_eblinkstate.-co.us/DwR/PDF/jsz4pevs4jc5h5s24lwgfyuw...
uAy-z3-gfFRI 9:b4 AM $rrELloN DRiLLIITG C0 FA)( N0, 9709273801 P, 4 :
NoTtcE oF INTENT TO COI{STRUCT MONITORING HoLE(sl RECEIVED
D
fr4AY 28 1997
lrndovmet's Namc V\tayne Rudd Well Omels Name Samg
Locaiion; sE %, 3E %,sedion-!?-Township;[!-Range---:9l Yf- qth PM, Courty Gadlold
Hole(s) to be constructad: Number-!:L Estmat€d o6plh upto 700 Ft' Type . HousehokuDolncstic usPs ., .
Pupme of Monilroring nolE(s) Tesling for Water aua$ty,ald Qu€ntrY (F
Apprcximats Date ot Construction l/lEet(ol W2U97 Drlller Lic. No. (if apCicable)1095
Consullnt or Dtillet Shelton Drillino Corp.Phonc /o70te27-4102
Conbct Whyne Shellon Fax No.(970) 927-3601
Addrgss P.O. Bor 1059 Sent o5ng97
City. Slate, Zp Basalt Go. 81621
303-866-3889
ACKNOVVLEDGEMENT FROM STATE ENGINEER'S OFFICE
FOR OFFICE USE ONLY
MH 30751 PROCESS BY
DATE NOTfcE RECEI\IEo 5'23, ';n 9^X
Drv.s eot)NT( ?1 u,D 3{
DATE
GROUND ELEV-ttscs MAP NO.-
CONDITIONS OF MONITORING HOLE ACKNOW,.EDGEMENT
A COPY OF THE IA'RITTEN NOTTCE OR ACKNOWLEDCEi'ENT SHALL AE AVAII.ABLE AT THE DRILLINO SITE'
Noticc tyrE provkled b the State Erulmrr et lisd3 days Frlotto_aonElructlon otlngll?rlnS & obervrtbn hoh (E).
Construatonotthehoh(s)ruJ*ionrpletedwltrin$iCiylotth.datcnoticcgivenbtheStalcEng;nacr.'. -..iiiii,i,J"rfrrip,imping'*iarr notl&c"Ja ioer ot m nours untess prtorwdttedappm-val ls obbln€d lromthc stato Englncor.
vvlEr divenod durlng tesung srriri*t oo used br Eneildd purposc'a -Tq 9*tlt-{!" hols(s) i$ fcsFnsibb lorobt8lntng Petmn(3, tnd"--rplyfni
",pt ifirulea ina rcguHionr pertalning to_the disclraqn of-lluid_e-poduccd duirlg tesdne.
All wort mud comlu wnn rne rnaLrvlb[ ciondn cdon Rubs. 2 CcF .m-2. Mintmum cottdrurlion st8nda]ds mljtt ba mrl or i vaisn8
obtaincd,
utrll conqfrlctiona,rd rcst RcprtB (clrrts€l) muEil be Eubmned to thb otncc by thc.licuued contnclor orlutholild hdlvidlalwilhln d)-l.y""f d;iiiirtin;iifri trori. lpptcoiion ro pgmli exHlng monllotins d'rd obcaflalion holes should refercno the MH numbe(
unierwhiar thc irporr wos filed or bc accompanled by a copy of h Fpo-l:
unhss a !ve1 permir b outcirffi]i-; r,"Li"r ."& tJ qt"Ga iia seana iuurin one (t ) year altar condnrdion. An Abandonrncni RtDort
(form GwSiol mud bo gubmlltcd wthtn 60 davs-ot plttgEiqg I Eoallng'
nd oirrei ortri hoh(s) shoub- ;hrbin rccooJorwduiq-ua'itty testin{and €ubmtt thb dBb lo lhe shtc Engince_r upon requcst.
Tho monlio.hg hole numuer,-orur;7;e,t.rtfi "amc,
and liolc iwners name and addrese musl bo prpvidcd on all wtll Pttmlt
apfrrcltoifd. well cons{rucilon and abandonmcnl repodc
Lno-,ir'to';nd iloj-,i can iror * .onu"neclol proauaion witer rell (othsr than a Ecovery wcll) unless the holc or wGll w!! oliginally
cmsnded by a lkztls€d lY.ll construclim oonlrac{or'
THIS ACKNOI\ILEDGEMENT OF NONCE DOES NOT INDICATE TI{AT WELL PERMIT(SI CAN BE APPROVED'
Addltion8l Cotdnions
2 of2
coLoRADO DIVIS|ON OFWATER RESOURCES.1313 SHERMAN ST-RM 821-DEWER-C0 80203 303'806-3581/Fru(
12/1312f.24,1ft39 AM
DWR_I 0471 90 - DwR_l 047 l90.pdf https ://dnrweblink. state.co.us/DWR/PDF/j sz4pevs4j c5 h5 s24 lwg$zqw..
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DWP,:_l55 1 382 - DWR_I 55 I 3 82.pdf https ://dnrweblink.state.co.us/DWR/PDF / jszfipev s4jc5h5 s24lw gp...
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ilt84'
./ ., puMp rNsTAu-AltoN AND TEsr REpoRT.
STATE OF COLORADO, OFFICE OF THE STATE ENG]NEER
I WELL PERMTT NUMBER 204416
z
City, St. Zip. nasalt, Co 81G21
Phone ( 970 ) 927 -9'119
Wavne Rrrdd
132 Park Ave-
owNER NAME(S)
Mailing Address
RFCEIUED
sEP I ? 1997
"#^H$trgtr
For Offlce Use only
3-WETILOCAJIONASDRITIED: sE. 1/4 sE U4,Sec. 12 Tu,p., 6 s
DISTANCES FROM SEC. LINES:400 ft. from South Sec. line. and 500-IrdErErsTEFf
SU
8q br 6fh
leasl' 0r wR5I,
LOT_ BLOCI(_ Ft U NG(UN|T)
SAEETADDRESS AT WELL LOCATION:
ft. from East Sec. line.
4.
HP_3__, Vofts23-0_, FullLoad Ampsl5._4_ .
Pipe Size 1+" lnches, Kind _gch 80 pVC,
,.Pump lntake Depth
Shaft size
Other
inches.
PUMP DATA: Type Submersible
Design GPM 1O
lnslallation Completed el5/e7
Pump Manufacturer Pump Model No. 1 0Gs3041 2
Number of
Gorr'l dc
455 |Fea, Drop/Column
Electric EngineTURBINE DRIVER TYPE:
Design Head
at RPM 3450
5.OTHER EQUIPMENT;
ffinNo,oriliceDepthlt.-'MonitorTubelnstallednvof]No,Depthft.-
Gattons, lTltno*"nd Gallons,l--1R"r" feet, l-l Beginning Reading
Meter SerialFlow Meter
Meter Readout
6 Check box if Test data is submitted on Supplemental Form.Date 7le197
nTEST DAIA:
341 |
340 I
7lele7 Pumping Lvl.
4601 TimeTotalWell Depth
Static Level
Date Measured
Rate (GPM) ., 1B _
2 I'R
7.DISINFECTION: Type . Q4lorox Arnt.Used 1 /3 Cup Drv
8.Water Quality analysis available. Dyo ! f,fo
9.Remarks
10. I have read the stdements made herein and know the contents thereof, and that they are true to my knowledge
[Pursuant to Section 244-104. (tSXa) C.R.S., the making of false statements herein constitutes pe{ury in the seconc
degree and is punishable as a c-lass 1 misdemeanor.l
Lic. No.1 196Phone (970J I 4s-61 s9
601l]I on .Qnrrc On RO?,LI Co Rti 16Mailing Address
CONTRACTOR
Date , Ia/ttflzSionatnre4,/*/ /) ///*6
Name/Title (Please type or print)
Richard A Hol-ub Owner
1551382 - DWR_l55l382.pdf https://dnrwebtint
INSTRUCTIONS FOR PU]I'P INSTAI.IATION REPOHT t I ;' . I
The report must be typed or printed in BtaQKtlK All changes on the form must be initialed end dated. ntt""nt 't j
additional sheets if more space is requirGl-Each additional sheet must be identified at the top by tne lveLl I
owner,s narne, the permit numbel, torm name/number and a sequential page number' Reporl depths in leet ;
below ground surface.
This form may be reproduced by photocopy methods, ot by comPuter generation with prior approval by the
a"tr rngine6r. pnotocopy reproiuaions'rirust retain margins and print quality otthe originalform.
The ofuinal form must be submited to the State EnginEer's office $,ihin 60 days after completing the well or
7 days frerthe permit elpirdion date, whidrwer is earlier.
A oopy of lhe lorm must be provided to lhe rrell wler'
fi this form ls submitted in conjunclion with the Well Gompterton and Test Report, fiom number Glftls'Sl, oNLY
fXf penr,ln NUMBER At{D O,lrl.lER }.lAtlE NEED TO BE COMPLETED Lr ft6ms 1 and 2-
1. Complete the Pernit Number in full.
2.
3.
4.
6.
Flll ln Name and Mailing Arldrcss ol wdl onnrer where correspondence should be sent.
Gomplete the blocks for the actual location ol the well. For wells located in subdivisions the lot, block
and subdivision inlormation must also be provided.
lndicate the type ol pump installed and cornplete the requested information' When installing pumps
greater than 50 gpm, complele the additional lnformation in this area.
provide the inlormation on other equipment which may be installed in the well.
Report test data as required by Rule. 13.9. Spaces are provided to report all measurements made during
rhe test. The report sirould ihow that the test complied with the provisions oJ the rules. lf a test was
not pe,t red explain when it will be done. lf available, report clock time when measurements were
taken.
7. Record the type and the amount ol dlsinfection used, how placed and the lengflh of time left in the hole'
g. lndicate if a water quality analysis was performed and submit a copy ol the report if available.
g. Use the remarks area to note any additional information including additional equipment installed, water
supply construction Problems
tO. Fill in Company Nanre and Address ol Contactor who installed pumping equipment. The report must
be signed Uy ttre licensed cdntractor responslble for the installation of pumping equipment'
' cor{oRADO DMSTON OFWATER RESOURCES, DEPARTMENT OF NATI'RAL RESOI'RCES
-- . 1313 SITERIUAN ST., RM.8tE,IrEI\tltER CO g0203
phone - info: (303) 866-3587 main: (3031 866-3581
RESIDENTIAL *Notc,'you mly lbo uac this lom to rpply tortit. toak
https ://dnrweblink.state.co.us/DWfrpffijglpevs4j c5h5 s24lwgfy...
RECEIVED
mT 29 g7
Nov t I 09r
r Well
Office Use Only
l-ot',P n*p Rn/Aorl't_!*6n, lt*$ry {r
' coe3
filirfxs 1R$423338 litl9? ,nru'siBa
IilJ",Ff $AIER RE$!l|rt
BA
MD
Form GWS-44 (11/95)
!
1 . APPLICAITT INFORMATION 6. USE OF WEIL lcheck aporopriate cntrv or emies)
Ntn! ot appliffi
Wayne Rudd
Mdli466*
"132 Park Ave.
Basalt , CO 81 621
ZpordpCity6tft!
Td?hoil Nmb? flridud..ril codol(970)927-9119
2. TYPE OF APPIICATION (check applicable box(es)l
Sce lnstdctbns to dstomllrlc ure(al for whhh you mly qurllfy -
E A. Ordinary household use in one single-lamily dwelling
INO oufsid" r'$al
E S. Ordinary household use in 1 to 3 singte-famity
dwellings:
Number of dwellingst 3
f, Home garden/lawn irrigation. not to exoeed I acre:
area inigated El sq. ft. f acre
tr Domestic animal watering .- (non-commerciall
E C. Livegtock watgring (orr farm/ranchlrange/pasturot
7. WELL DATA
15 gpm
Amrdaadbb+w$m_ -
1.. 5 acre-fcet
El Construct new well
E-nedace existing-well
E Ctrange {souroe) aquifer
E.Orher:
E Use existing well
E Change'/-lncrease l.!se
E Reapplicatiohteoetod pcmitt
3. REFER TO (if applicable)O
To0l rl.pttt
430 feat
|ldht
Maroon formation
wrtcr coun eraa ,Fcmh I
20441 6
Vcrbd t
VE-
Monitoring holc acknowledgmont #
MH- rzosz
Aoknoelos(2,.1 1d/z-t/qzWoll nrmc or I
4. LOGATION OF WELL
Septic tank I absorption leach field
Location 8swaoo to bc haulod to:
E Central system
8. TYPE SEWAGE
E other of
District name.-
E Vauh
9. PROPOSED WELI DBILLER (optionat)Csunty
Garfield
Ouarte/qualtcr
SE Y+
Ou!rtct
.qF: y+
SHeIton Orlllinq Corp.
Nlm LlffiMb€
1 09s
12
56qtion Tor^rnship ll or S
6 trE
Range E orW
8e tr0
ftircipll Maidi|n
6th J0. SIGNATURE of applicant(sl or authorized agent
11oo ft,rromEnEs trw
lcttion !ddr.s.
Distanoc of wcll frcm *ction lines
lddrd (if .ppliabl.l
1 00' fi.
The making of false statements herein corrstitutes periury
in thc second degree, which is punishable as a dass 1 mis-
demeanor pursuant to C.R.S. 244-104l13lla). I have read
the statements herein, know the contents thereof and state
knowledge.that they arc true toFor rcahcmant wdh only - dirt H lad diraction trom oH wdl io ncw wdl
800 feet NE direction
5. TRACT ON WHICH WEIL wlLL BE I-OCATED (a*-nu-TidG
/o I ;n>D!tc
OPTIONAL INFORiNATION
USGS mep mmc Ilirt R mD s,Su{edw,
A. You muat elreck oaa of {rc iollowing . sec imtuctiom
E Subdvision: Name
Lst no.-_ Block no, FilingAJnit_
E County exemption (aftsch copy of county apprwal & surveyl
Name/no. Tract no.
E tvtining claim (attach copy oi d€od or survcyl
Name/no.
legal dascription to epplicationlSec 12, T 65, R 89W
I Other tattactrsE*, sE+,
B" STATEPARCEL
lD# lop'tonatl:
C. # acnr ln tract
40 acres
D. Are you dtc owncr of th-rs propcrty?
IIYES tr NO (if rro - see insrructonsl
E. l/Vill thls be the only well on this tract?
SVES tr NO (if other weils are on this tract- see inrtrucrionel
est copy US
1551382 -DWR l55l382.odf
DIVISTON OF WATER RESOURCES
https://dnrweb
COLORADO
DEPARTMENT OF MTURAL RESOURCES t
:
RESIDENTIAL APPLICATIONS . GENERAL INSTRUCTIONS
There are a variety of uses for ground water in Colorado. This form {GWS44! can be used when applying for a permit for
a new well or replacement of an existing well for the followang types of uses:
ORD|NARY HOUSEHOLD USE lnside one single family residence (NO outside water use allowed)
OTHER RESIDENTIAL USE (sometimes referred to as 'domestic" usel which may include use in up to three single'
family residenc€s, watedng of up to one acre of home gardens and lawns, and watering of domestic animals
LIVESTOCK WATERING on a farm, ranch, range, or pastute
lf you are apptying for a NEW household use only well, or for a NEW 35 + acre residential well ouuide the Denver Basin or
OesignateC'Baslni of €astem Colorado, please use simpllfied forms GWS-49 or GWS-SO' DO NOT use this form lor
registration ot an existing unpermifted well tUse Form GWS-121, monitoring/observation wells {Use Form GWS'46), gravel
pit-wens luse Form GWS:271, orfor othsruses not listed above, including - commercial, industrhl, crop irrigfiion, municipal,
etcetera lUse GENERAL PURPOSE Form GWS-451'
FEES Applications must be submitted with the appropriate required non-refundable filing faes. The required filing fee for
most well permit applications ls 96O. The filing fees for replacement or deepening well permit applications lormost
previously permitted resident'nland livestock water wells is $20'
bnecns should be payable to the coLoRADO DlvtsloN oF WATER RESOURCES.
Applications are evaluated in chronological order. Please allow approximately six weeks for proeessing'
AppLlcATtoNS must be compteted clearly, and !99!![6 in BLACK INK or typed. ALL IrEMS in the appl'rcation must be
completed. lncomplete applications may
-U"
retumeo to the applicant tor morc information. Do not change or alter the
application in anY waY.
THE LocATloN of the well in item 4 must be correctly and accurately described. The county, quarter/quarter, sestion,
township, range, principal merldian, and distance from section lin6 must be provided.
NOTE: Distances ite not neceSSarily the same distances as the distances from (your) property Iines.
For additionat assistance in describing the location of your well, review the publication entitled "How to Dstermine
welt Location. which was provided with your packet, or can be r€quested from any colorado Division of water
Resource office.
A LEGAL DESCRIPTIoN of your lot or parcel of tand is required in item 5. For tracts of less than 35 acres approval may
,-- *: depend,upon.whefrher the,tfact.was.crcate*by-a-divisian'of-land,aftsr-June'l;-1 97-2:s lf-your-lst'is'tess-than 35'acres'Ht"sizg,'
it would be prudent to heve a deed or legal description that shows your tract was divided f rom a largsr trast prior to June
1, 1972, This may be accomplistred bytbtaining a copy of a deed for the trast issued prior to June 1 , 1972.
t..:+
An oRIGINAL Signature must be on each application. The applicant's authorlzed agent may sign the application, if a letter
sioned bv the aoolicant b submitted with the application authorizing them to act as agent for the purpose ol obtaining a well
permit.
lF you HAVE ANy ouEsTloNs regarding any item on the application lorm, please call the Division of water Resources
Ground Wator lnfonnation Desk (303€66-358?), or th€ nearesr Division of Water Resources Field Office located in Greeley
(g7o-352-g712), Rrebto {71g-542-336gf, Atamosa (719-589-6683), Montrose {970-249-6622}, Glenwood Springs (970-
945-56651, StSamboat Springs (970-879-02721, or Durango l97O'247 -1 8451.
DETAILED INSTRUCTIONS ARE AVAILABLE UPON REOUEST
COLORADO DIVISION OF WATER RESOURCES, I313 SHERMAN STREET, ROOM 821, DENVER, CO 8O2O3
PHONE 3OG-866-BSBZ (tnfomgtion), 30g-986-9581 (Mahl, 309-A66-3447 (W6ll & Water Rights Hccotds), 303'966-3589 (Fsx)
DWR 1551382 - DwR-l55l382.pdf https : //dnrweblink. state. co.us/DWR/PDF/j sz4pevs4j c5h5 s24lwg{y"
-'WELL G_oNSTRUGTION AND TEST REPORT
$TATE OF COI.ORADO, OFFICE OF THE STATE ENGINEER
1
WELL PERMIT NUMBER rq4H€s754* &ay/16
APPROVAL# G\'\831€1&
FOR OFFICE USE ONLY
AUo 2I p97
"J,t##.IFtr6"
RECEIVED
2.
.i
Ourner Name(s) :
Mailing Address :
. City, St. Zp:
Phone
\llhyne Rudd
0132 Park Place
Basalt, co.81621
(970) 927-91 1e
3.Sec. 12 TwP
DISTANCES FROM SEC- LINES:
fl. ftom Sec. line. and fi. trom
SUBD1VISION: LOT BLOCK
STREET ADDRESS AT TfvELL LOCATION :
Range 89W
Sec. line. OR
FTLTNG(UNrT)
06s
4 GROUND SURFACE ELEVATION
DATECOMPLETED o7lo3l97
fi.
TOTAL DEPTH
DRILLINGMEIHOD AirRotary
460 n" DEPTHcoMPLETED 460 fl.
FROM ffi}TO ffi)6. HOLE DIAM.lin)5. GEOLOGIC LOG
609.0 0Type of Material (Size, Golor, and Type)Depth
60 4606.5000-040 Clays
040-460 Maroon formation
7. PLAIN CASING
From (n)To (ft)oD (rn)Kind \rvall Size
o.240 -1 607.O Steel
5.5 PVC 250 40 350
PERF. CASING: Screen Slot Size:
PVC .zffi 350 4605.5
9. Padcer Placement
Type :
DeSh
8. Filter Pack
Material:
Size:
lnterval:
10. GROUTING RECORD :
lnblval PlacalErilIttabrblArnountD.ttdty
3 sks 16 gal 10-30 pouredcement
345 +WATER LOCATED
REII,IARK$ :
11. DISINFECT]ON: Type: HTH Arnt.Used: 3 oz.
-G Submitted On SupplementalForm.
TESTING METHOD : AirGomPressor' Static Level : 338 fi. Date/Tirne Measured : OTtOgtgT Production Rate
Pumping Level : Total fi. Date/Time Meesured : O7lO3l97 Test Length :
Remarlc :
hns.2
15 gpm.
'tFffrayaetrcunrY
I g-
,cdrry in the sccond dsg'e sd is Fni$abL 93 I ctags 1 tr*dclrrano..)
CONTRACTOR
Basell-
bo iadge. (RrrsuartbSrdior 24-+104 {1O(.)CRS,lhc mting of ElsssEEnDnts con3iilDs
Phone : (970) 9274182Shelton Ddlling Cop.
nn *oo14 j----7-/)I ia Nn {dqsMeilinnAd.lrAss' P() BnriOSO
07t20t97
DateWWayne Shelton / President
Name or
ORIGINAL
THE STATE ENGINEER https://dnrweblink.state.co.us/DWR/PDF/j sz4pevs4jc5h5 s24twgfr ...
GWS125.,COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 8O203
{3031 866.3581
APPLICANT
WAYNE RUDD
132 PARK AVE.
BASALT, CO 81621
(97O)927-9119
PERMIT TO USE AN EXISTING WELL
ro95
WELLPERMITNUMBER 2OLA 16
DIV. 5 CNTY. 23 WD 38 DES. BASIN MD
Lot: Block: Filing: Subdivr
APPROVJD WELL LOCATTON
GARFIELD COUNTY
SE 114 SE 114 Secrion 12
Twp 6 S Rng 89 W 6th p,M.
DIST,ANCES FROM SECTTON LrNEq
4OO Ft. from SOUTH Section Line
5O0 Ft. from EAST Section Line
1)
2t
3)
4l
5)
6l
7T
8)
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
coNprTloNs oF APPROVAL
This well shall be used in such a way as to cause no material injury to existing water rights. The issuance ol
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 actaon.
The construction of this well shall be in compliance with the Water Weil 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 lnstallation Contractors in accordancs with Rule l B.
Approved pursuant to CRs 37-92-602(g)(bl(ll)lA) as the only weil on a tract of land of 4O acres described as
the SE y.,SE 7r, Sec, 12,Twp.6 South, Rng.89 Wast, 6th P.M., Garfield County. please NotB, Section 12
is an irregular section.
The use of ground wator from this well is limlted to fire protection, ordlnary household purposes inside up to3 single family dwellings, the irrigation of not more than one acre of home gardens and lawns, and the
watering of domestic animals.
The maxlmum pumping rate shall not exceed 1S GpM.
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.
This well shall be constructed not mor6 than 2OO feet from th6 location specified on this permit.
Approved for the installation of a pump tn nd the use of an existi ng w ell co nstructed on 7 to3t97 to a de pth
of 460 feet,u nde I monitori ng hole notic6 M H-30 7 5 I f acknowledged 5t27 197 *q
N OTE Parcel 1d entificatio Num ber g(<L_n 2 3-2 1 85 1 24-O2-O34 l4
Receipt No
{
Ey
4\-
EXPIRATION DATDArE rssuEo AUG 2
'flAPPROVED
DMW
' €olon^noo DrvlsroN oF wATER REsouRcEs
i . - DEPARTMENT OF NATIIRAL RESOURCES
. t3l3 SHERII&{N ST., RM. E18, DENVER CO 80203
phone - info: {303) 866-3587 main: (303} 866-3581
NEW 35+ ACRE RESIDENTIAL
https ://dnrweblink.state. co.us/D)WWPDF/j sz4pevs4jc5h5 s24lwgfr ..
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1 . APPLICANT INFORMATION 6. USE OF lrllELL (check aooronriate entw or effiriesl
Addrres
Namc of rppllolnt
w
0132 Park Ave.
gtv
BasaIt Strt.
CO
Zip codo
81 621
E A. Ordinary household purpoeos in up b 3
single-family dwellings, dre watering of
domeslic animals. and the inigatfun of not more
tfran ona (11 acre ol home gardens nd lawns
El B. Livestdc watering (on farm/ranchlrango/paeturcl
7. WELL DATAT.lophoni Nsmbcr {includc rrua codc)
(9701 927-9119
2. TYPE OF APPLICATION
MA]XIMUI/I PRODUCTION RATE OF THE WEIL
S}IAtt NOT EXCEED 15 GPM
8. TYPE OF BESIDENTIAL SEWAGE SYSTEMCONSTRUCT A NEW WEIL ON A TRACT OF
LAND OF 35 ACRES OR MORE
3. REFER TO til aoolicablel:
Monltor{ng holr rokmwlodgmdrt t
MH- 30751
4. LOCATION OFWETL
E Septic tank / absorption leach field
E Central system
Locftion sswrgo to bc harllC tot _ , ,
E Othef {anrch copy ol cngincodng dcaign}
Dirtdct namal
E Vault
9. PROPOSED WEIL DRILLER (oodonatlOounty
Garfield
Ourrtcrrqurrtcr
Sq tA 1t4
Ou!rtar
SE Nrm
Shelton Drillins eorD-
licctro nqnbcr
1 095S.sdm
12
Townehlp il or S
6 EA
EorW
trt
Rango
89
Frincipal Moridiin
6 10. SIGNATURE of applicant(s) or authorized agent
Distarro of wcll lrom acdtbn lin e
400
Wcll locltion ltom .pplb.nt addtrls ('d applicablcl
50
The making of false statements herein constitutes periury
in tlre second degree, whictr is punishable as a class 1 mis-
demeanor pursuantto C.R.S. 24.4-f 04{f 3l{al. lhave read
fie statemerts herein, know tfie contents ttercof and state
that they are Uue to my knowlefge.
5. TRACT ON WHICI{ WELL WtL BE LOCATED
-r+?
D$n Mlp No.
31- t{
A.
ATTACH LEGAL DESCRIPTION FOR 3E+ ACITE TBACT
E Development
Eottrerse{ SEd Section 12 T6S RggW 6th
Lot no,Unit #
Name
B. ATATEPARCEL
lD# topton ttr
C. # torca in trt
4A
D.
THIS WILL BE THE ONLY WELL ON TTI]S TRACT
vailablecopyA
Offioe Use Only
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6lt/,^.raae SPRfi/l,*Sr ( P
J:rli{f; ,-:.......;iv:i'}qT
irlU 0F UATER ffiEflFrjET.'' "----'-;'B
clEcrs Tail420610 09029?
IIU OF IIATER RE$OURIEs
DIV t
co 23
6t.:s--
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dAo.$0
MD
FormGWS-SAGZEI)
This form should l$ be used in the following casss'.
HOUSEHOLD USE ONLY' Use lorm GWS-49
REPLACEMENT of a residential or livestock well - Use form GWS-44
FEES Thls Application must be submittcd with the required 060 non+efundable filing fec.
Applications are evaluated in chronological order. Please allow approximately six weeks for processing.
APPLICAT|ONS must be completed clearly, and leoiblv, in BISCK INK or typed. ALt ITEMS ln the application must
be completed. lncomplete applications may be returned to the applicant for more information' Do not change or aher
the application in anY waY.
THE LOCATION of the well in itEm 4 must be cOrrecdy and accurately described. The county, quarter/quartsr, section,
township, range, principal meridian, and distance from section lines must be provided-
NOTE: Distances are not necessarily the same distances as the distences from lyourl property lines.
For additional assistance in describing the location of your well, review the publicatton entitld 'How
to Determine Well Locations' which was provided with your packet, or can be requested from any
Colorado Division of Water Resource office.
A LEGAL DESCRIPTION or survey plat of your lot or parcel of land is reouired in item 5
--' _'- - :,.'.,3El-_--L-':;-.'s-ssa---::-:='.=!-**-+'e-+5Y::l':.-:l-T'+---';r'i- s'\'45:<t-.ri*
An oRIGINAL signature must be on each application. The applicant's authorized agent may sign the application, if a
lettergj@issubmittedwiththBapplicationauthorizingthemtoactasagenttorthepurposeof
obtaining a well Permit.
tF you HAVE ANy OUESTIONS regarding any item On the application form, please call the Division of water Resources
Ground Water lnformation Oesk tCG-866-35871, or dre nearest Division of Water Rcsoutccs Field Office iocated in
Greatey lg7o-352-g712), puebto 1719-542-33681, Alamosa (719-589-6683), Monrose (970-249'68221, Glenwood
Springs (970-945-5665l,.Steamboat.Spri4gs (970-879-02721, or Durango 1970'247'18451-
DETAILED INSTRUCTIONS ARE AVAII.ABLE UPON REOUEST
COLORADO DIVISION OF WATER BESOURCES, 1313 SHERMAN STREET, ROOM 821, DENVER, CO 80203
PHONE 303-g6S9587 flntormationl, 303.86&3581 (Mainl, 303-866-347 Wdl & Watot Rights Records), 3O3-88e3589 (Fod
https ://dnrweblink. state. co.us/DWR/PDF/j sz4pevs4j c 5h5 s24
Townshlp: 2185
Section: 12
l/4 Section: 4
Blockr 02
Lott 034
County:
Sehedule: 030041
Districfi 005
Neme-l : LOOKOUT MTN. RANCH VENTURE
Name-2: ATTN: LA HELLERSTEIN
Address-l: I 139 DELAWARE ST
Adderss-2: DENVER
State: CO
Zip: 80204-3607
Street #:
Street Name:
SubCode: 0048
Condo Code:
TotalLand: 340
Total Improv: 0
Total Acres: 40
Total SQ F'T: 0
TTL Land Act: I160
TTL Imp Act: 0
Year Built:
Wcll Permit#: MH-30751
DrJVR ID: AP 8l1l/97, AU8/11/97, AR 8i 15/97
RECEIVED
stP 0 a 097
WATER FESOURCES
STATE EI{GINEER
coLo.
8489
https ://dnrweblink.state.co.us/DWR/PDF/j sz4pevs4j c5hj s24
DIESION OF tr'IATER RESOURCES'P O Box 396'Gienwood Springs, Co 8f5O2
Phone: 303*945-5665
RETURNEDTO:
; I'ROM: DI{IGET WIITEHEAD;
RECElvt'u $arER.coltMrssrol*K ($ELL')
APFU0ANT( ) vrtrU DnrrER( )
sEP 0I $g?
-.$lFf+ffi:$E8F
€/r+/g 7DATE
APHTCANN
Secalpr No.t
AGEMr()ATT
flE: Woll Pomrlt AS4rllcatlon
Your app[carlon for a wdl pomrh le bolng rcturncd lor ths reason(a! lndicated bolow. Tha addhlonal da(a and
corroclions whlch wc are requorting wlll ald us ln the evqluatlon c( your application. Prompt comde(on o(
conodlon ol ALl. lcms chocked and ttre Immcdlato r06ubmlttal ol tho correaed eppllcation to (hls ofilce wil[
cr<pocltto ita proc.erslng. Pleaso maka cocrocdons on the app{caloq (.{OT on tfus flyar. Thank you (or your
aRan{on. When mattng taloptrorxl tnqutros rogardiing thls apglfca{.ton, please refercnco the abovo recolpt numbec.
FLEASE lr{r'tl^L /iLI CtlAl.{GEB . f'rul'{T COtlREGflONS lN tltl\OK INK
A4dlo4tfllrfil€]r
.' 1T "- _-',:"'::]":i::'" :"ffIff"'; -H#ffi;:x :;H ,:,T,J:SJ::'- -
TIte 1/4 ol l/q (ltem 2) doos not ag(oe wtth dlstances lrom s€cilon [nes.' Dlsrances
flacewUt ln
--_-1/4 o( 1/4.
( ) For a HOUSEHOLD USg ONLY WEU- rr lrrl6tiea {cr hwo er 3*{rn k rllcrr( ('zero'i
( ) For a tlOl'tES f1C WctJ- no morc then (1) acro of lawo or gardons can bo lrdgal€d.
( ) Oistancas {rom oclc.tloq (0os. rrrt lrrp{rtf liar, {tluSt b€ grl(rffn.
'J#
r€plac€ment vrolls. lho old odsrtng wuU must bo plugged and abandoned according to rut€s
roqulatlrrns. Pleass lnclude tho dista're and dlrectlon from the old wotL
5 ( ) tl thts well l: io trc 0ir onty welt on {5 acras or rnom. e€ASgAIfACH A FUIL MEIES-.AUo.
(o( th€ 35+ sc(q t(act lhis eurvey should
cloer{y {ndiqalq u (io (o a rsctton comer or poht readily disco(flabls oft s U.8.G.S.. (scale
1'o .6' topoSreph(c map.
10 e{gnanre ol tho rpptlcrnt b teqtlred on ths apptlcatlon lf someona othor than the uppllcant
b/l ras slgnod tho appllcailoq fien th€ appflcafim mu$l be accompanled
lndtvtdual algnlng the appllcetlon to act as'
by a algnod tettorlrom
the gpplloont adlrcrtrlng tha agerrt' lcJr purpos€s ot
obtalnlng av+dl prormlt(s) for tho tublact Frop€(ty.
For re$sttatlon ol edsilng w€113, th6 sxlstencs ot thts s/eU and [s nlstorlc and/orpfopos€d uss
MusT a€ VeRlt(E0 BY A REt0 lt(SPtc'n0ll. Fleass contsct ths Water Cornrnisstonsr or DMslon
O0lc€ nsned bolow ro mat{s anangemefls to hav€ th€ lnspection corrcluaed. The completod
tl€ld hspedlm repo.l $houtd accompsny thls appllcaltol when it ls re-submitted to {hls offico
for rerrrlew.
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ronu mrfiHgcnlnt ffi.;1. I J'
ctls- 45 ( ), cl{s-46 ( )' CWS- 49 ( ), 'GWS-50 ( )
https ://dnrweblink. state. co.us/DWR/PDF/j sz4pevs4j c5h5 s24lwgfy
Map
Place
Holder