PDF MAKE - Rocky Mountain Property

WJR 26

77

t

COLORADO DIVISION OF WATER RESOURCES THIS FORM M UST BE SUBMITTED

1313 Sherman Street

WITHIN 60 DAYS OF COMPLETION

RECEIVED

Room 818

AUG 2

Denver Colorado 80203

OF THE WORK DESCRIBED HERE ON

TYPE OR PRINT IN BLACK

WELL COMPLETION AND PUMP INSTALLATION REPORT

INK

PERMITNUMBER

IWTER RESOURCES TALE ENGINEER

116248

gOtp

i

WELLOWNER L

ADDRESS

nv

Williasr

s1

iinn

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Cozad

Staten

T

I if

19 8 L

DATE COMPLETED

G of the

1yt

3

R

73

n

to

b

P M

HOLE DIAMETER

9

WELL LOG

17

of Sec

in from

20

ft

1 7 n

ft

Water

From

To

Type and Color of Material

0

12

Decomposed

1 2

27

tray Crani te

27

28

Fractured

28

65

Red f ranite

65 115

11 1 40

Loc

23 to

in from

radii e

Air Percussion

CASING RECORD

Plain Casing

Quartz

Size 1T

2

ft

to

DRILLING METHOD

Fractured Quartz ray

din from

kind

Steel

from

kind

P1C

from

0

to

20

ft

to

14n

ft

ranite

Size

4

Size

7

from

kind

ft

to

Perforated Casing Size

4

kind

P C

from

90

to

1 in

ft

Size

kind

from

to

ft

Size

kind

from

to

ft

GROUTING RECORD Material

Cement

Intervals

in

Placement Method 1 a

GRAVEL PACK

Size

Interval

TEST DATA

Date Tested

ly

Static Water Level Prior to Test

Type of Test Pump 0s

r 49P91 b pf Sustained Yield

TOTALDEPTH

Metered

1404

Use additional pages necessary to complete log

Final Pumping Water Level

otal Li acrrlowt

19

Fi ft

PUMP INSTALLATION REPORT

Pump Make Type

Sta Rite

SuTrcrsil le HP 1 3

Powered by Electric Pump Serial No Motor Serial No

Date Installeo

iiily 1901

Pump Intake Depth 11 0 Remarks

WELL TEST DATA WITH PERMANENT PUMP

Date Tested

Static Water Level Prior to Test

Length of Test Sustained yield

Hours Metered

Pumping Water Level

o1

54 7

GPM

t a s Cwn

Remarks

CONTRACTORSSTATEMENT

The undersigned being duly sworn upon oath deposes and says that he is the contractor of the well or pump installation described hereon that he has read the statement made hereon knows the content thereof

and that the sa

Signature

Is true of his own knowledge

al

License No

SS

State of Colorado County of Subscribed and sworn to betore me this

My Commission expire44r C mh

ee MI T P

day of

19

W ON 19

Notary FORM TO BE MADE OUT IN QUADRUPLICATE WHITE FORM must be an original copy on both sides and signed WHITE AND GREEN copies must be tiled with the State Engineer PINK COPY is for the Owner and YELLOW COPY is for the Drliler

WRJ s Re

COLORADO DIVISION OF WATER RESOURCES

76

818 Centennial Bldg

1313 Sherman St

RECEIVED

Denver Colorado 80203

sEP a 21980 PERMIT APPLICATION FORM Application

11111TER RMWRM SEATE ENGINEER

must

X

be complete where

applicable

Type or

print

BLACK

in

A PERMIT TO USE GROUND WATER

Colo

X A PERMIT TO CONSTRUCT A WELL

FOR

K A PERMIT TO INSTALL A PUMP

INK No overstrikes or

erasures

I REPLACEMENT FOR NO

unless

initialed

OTHER

WATER COURT CASE NO

1 APPLICANT

NAME L

mailing address

ifir

STREET

0 11 w yo

j jy c

Basin

30 t

Dist

913 D

Mt te

3

TELEPHONE NOY

DO NOT WRITE IN THIS COLUMN

tt 9 4

Receipt No

el

LSQX

CITYY

4

FOR OFFICE USE ONLY

CONDITIONS OF APPROVAL

Zip

7 Py

33G 9

This well shall be used in such a way as to cause no material injury to existing water rights The

2

issuance of the permit does not assure the applicant

LOCATION OF PROPOSED WELL

that no injury will occur to another vested water right or

e

County

SS W

Ya of the

3

Twp

preclude another owner of

a vested water

right from seeking relief in a civil court action Ya Section

APPROVED FOR HOUSEHOLD USE ONLY

N Rug

P M

I

1

FOR ONE

SINGLE FAMILY DWELLING AND NOT TO BE

E VV

W SI

USED FOR IRRIGATION

3 WATER USE AND WELL DATA

THE

THE SAME STREAM SYSTEM IN WHICH THE WELL IS LOCATED

15

Proposed maximum pumping rate gpm

THE RETURN FLOW FROM

USE OF THIS WELL MUST BE RETURNED TO

Average annual amount of ground water

THE MUNICIPAL OR COUNTY GOVERNMENT

to be appropriated

SHALIt HE CONSULTED PEN LOPATP T p

acre feet

THIS Wdf

Number of acres to be irrigated

BND THEIR REGULATIONV

SHALL BE COMPLIED WITH Proposed total depth

I

feet

Aquifer ground water is to be obtained from

pia g is E

Owner s well designation x L Lt F

i

t

1 b

GROUND WATER TO BE USED FOR

C K HOUSEHOLD USE ONLY no irrigation 0 I DOMESTIC 1 I LIVESTOCK 2 COMMERCIAL OTHER

1 1

4

1 INDUSTRIAL 5 1 IRRIGATION 6 1 MUNICIPAL 8

9

APPLICATION APPROVED

DETAIL THE USE ON BACK IN

11 PERMIT NUMBER

4

DRILLER DATE ISSUED

Name

6z

Street

Ha x

City 4

d

s

ldR

Yd u t

G

116848

0 C i 20 1980

EXPI

G9

Aye

d

State

Zip BY

Telephone No

KM6

Lic

No

45 I D

COUNTY

1

5 THE LOCATION OF THE PROPOSED WELL and the area on which the water will be used

6

must be indicated on the diagram below

Use the CENTER SECTION 0 section 640 acres

THE WELL MUST BE LOCATEQBELOW by distances from section lines

for the well location

S 7oO

ft from

sec

line

sec

line

or south

f

1 MILE

Z20

5280 FEET

ft from Z

s 74 least or west

I

T

T LOT I

7 I

I

TRACT ON WHICH WELL WILL BE

LOCATED Owner x L 4 i

NORTHI T I

3

No of acres

N

J

I

FILING n

SUBDIVISION

NORTH SECTION LINE

i

BLOCK

I

I

e

I

m

i

0 n

I

Ozr

the only well on this tract

1

T

8 PROPOSED

CASING

k t Will this be

i s PROGRAM

Plain Casing Y

T

in

C I

I

from

in from

ft to

Z

ft

ft to

ft

in from

ft to

ft

in

ft

Perforated casing I

I

I

oxa

I

from

to

t

9 FOR REPLACEMENT WELLS givedistance

I

4

and direction from old well and plans for plugging

4

4

it

The scale of the diagram is 2 inches 1 mile Each small square represents 40 acres WATER EQUIVALENTS TABLE

Rounded Figures

An acre foot covers 1 acre of land 1 foot deep 1 cubic foot per second

cfs

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 grim pumped continuously for one day produces 4 42 acre feet

10 LAND ON WHICH GROUND WATER WILL BE USED

Owner s 3 L G

ri

1 d ls

L

11

No

of acres

Legal description

11

DETAILED DESCRIPTION of the use of ground water

system to be used

12 OTHER WATER RIGHTS used on this land Type or right

iy

Household use and domestic wells must indicate type of disposal i

Used for

i

including wells Give Registration and Water Court Case Numbers purpose

Description of land on which used

e

13 THE APPLICANT S

STATE S

THAT THE

INFORMATION SET FORTH

TRUE TO THE BEST OF HIS KNOWLEDGE

SIGNATUlW OF

Use additional sheets of paper if more space

is required

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