12865 crowfoot springs road we...
FORM No OW
PUMP INSTALLATION AND TEST REPORT
32
L4VED
MAY 17 2000
218437
WELL PERMIT NUMBER
1
For Office
STATE OF COLORADO OFFICE OF THE STATE ENGINEER
area
WATERRESOURGES
2 OWNER NAME S
STATE ENGINEER
a
Mailing Address
1
City St Zip lk C Phone
R
E
mnm6 TX
Z
COLO
a
i 14L 4 1
434o
3 WELL LOCATION AS DRILLED S g 1 4 N r 1 1 4 Sec
Range
Twp
n5
pl
DISTANCES FROM SEC LINES
2 7CY
ft from
Sec line and 460
ft from
Sec
line
e
SUBDIVISION
BLOCK
LOT
FILING UNIT
j
STREET ADDRESS AT WELL LOCATION
4
t
PUMP DATA Type
Pump Manufacturer Design GPM I Pump Intake Depth
Inm
Installation Completed
t 11
Volts
23r
Inches
l T
Z
L
Pump Model No
4 iC7 HP Feet Drop Column Pipe Size
at RPM
Full Load Amps
C
Kind
ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM TURBINE DRIVER TYPE
Electric
Design Head 5
feet
Engine
Number of Stages
Yes
Monitor Tube I
No Orifice Depth ft
Meter Readout
Gallons
Thousand Gallons
Check box W Test data is submitted
Total Well Depth
00
Static Level
DISINFECTION
alled
Yes
No Depth ft
Beginning Reading
Supplemental Form
o
Time Rate GPM
025 0
Date Measured
9
Acre feet
TEST DATA
Date
8
inches
Meter Serial No
Flow Meter Mfg
7
Shaft size
OTHER EQUIPMENT Airline Installed
6
Other
Pumping Lvl Type
Water Quality analysis available
H
N Yes
Amt Used
OZ
No
Remarks
0 1 have read the statements made herein and know the contents 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 secon degree and is punishable as a class 1 misdemeanor
CONTRACTOR
Phone
o
Z0 Lie No
J8
Mailing Address Name Title
Please type or print
Sign
Date
0 00
INSTRUCTIONS FOR PUMP INSTALLATION REPORT The report must be typed or printed in BLACK INK
additional sheets if more space is required name
the permit number
All changes on the form must be initialed and dated
Attach
Each additional sheet must be identified at the top by the well owner s
form nameinumber and a sequential page number
Report depths in feet below ground
surface
This form may be reproduced by photocopy methods
or by computer generation with prior approval by the State
Engineer
The original and one copy of this form must be submitted to the State Engineer s Office within 60 days after
completing the well or 7 days after the permit expiration date whichever is earlier
Another copy of the form must
be provided to the well owner
If this form is submitted in conjunction with the Well Completion and Test Report form number GWS 31 ONLY THE PERMIT NUMBER AND OWNER NAME NEED TO BE COMPLETED in items 1 and 2 Complete the Permit Number in full
2
Fill in Name and Mailing Address of Well Owner where correspondence should be sent
3
Complete the blocks for the actual location of the well
For wells located in subdivisions the lot
block and
subdivision information must also be provided 4
Indicate the type of pump installed and complete the requested information than 50 gpm
When installing pumps greater
complete the additional information in this area
5
Provide the information on other equipment which may be installed in the well
6
Report test data as required by Rule 14 4 test
Spaces are provided to report all measurements made during the
The report should show that the test complied with the provisions of the rules
performed explain when it will be done
If available
If a test was not
report clock time when measurements were taken
7
Record the type and the amount of disinfection used how placed and the length of time left in the hole
8
Indicate if a water quality analysis was performed and submit a copy of the report if available
9
Use the remarks area to note any additional information including additional equipment installed water supply construction problems
10
Fill in Company Name and Address of Contractor who installed pumping equipment signed by the licensed contractor responsible for the installation of pumping equipment
The report must be
WELL CONSTRUCTION AND TEST REPORT
GM 31
hi
2 OWNER NAMES
Mailing Address
1 o
city St ZizDl ppp Phone
RECEIVED
9 1 9 Li
14 WELL PERMrr NUMBER t
r
WATERRESCL s STATE EAQNELR COLO
3
DISTANCES FROM S
Uti 1 4 Sec
Sec
m w as
line and
ft from nn
SUBDIVISION C1 O STREET ADDRESS AT WELL LOCATION GROUND SURFACE ELEVATION
1
C7
BLOCK
FILING UNIT
a
i ti
DRILLING METHOD
TOTAL DEPTH q
GEOLOGIC LOG
ft
Description of Material ry e Size Color Water Location
r5
DEPTH COMPLETED
6 HOLE DIA
O
w 0
Range J
Sec line OR
LOT 4
a
ft
DATE COMPLETED
Depth
S
Twp
LINES
Q 7 ft from
5
MAR 2 7 2000
pl2ctc j
W
3 WELL LOCATION AS DRILLED 3W 1 4
4
For office Use only
STATE OF COLORADO OFFICE OF THE STATE ENGINEER 1313 Sherman St Rm 818 12enver CO 80203
10 94
From
In
ft
left
To ft
lYT
U
7 PLAIN CASING
r
10 l7
0
oa
in
Kin
Wall Size
From ft
To ft
S P
I
FIR CASING Screen Slot Size U
C3
CD
OD
S FILTER PACK
9 PACKER PLACEMENT
Material
Pa L
Type
Size
y J
Interval 10
Depth
GROUTING RECORD
Material
Amount
Density
Interval
Placement
REMARKS
1
DISINFECTION
Type
WELL TEST DATA
Amt Used
Z
Check box if Test D to is submitted on Form No GWS 39 Supplemental Well Test
TESTING METHOD Static Level
ft Datefrime measured
Production Rate
Pumping level
ft Date Time measured
Test length
e gpm
hrs
Remarks
3 1 have read the statements made herein and know the contents thereof and that they are true to my knowledge Pursuant to Section 24 4104 13 a
C R S the making of else tatements herein cy stitutea eriury in the second degree and is punishable ae a class 1 misdemeanor Phone aD Lic No
Dr
CONTRACTOR Mailin
Name Title rJ 1
ll
t
Address Please type or print
l
Si
a
Date
Z a7
G v
INSTRUCTIONS
FOR WELL CONSTRUCTION
Rev Oct
AND TEST REPORT
94
C
The report must be typed or printed in BLACK INK additional owner s
name
the permit
number
All changes on the form must be initialed and dated
Attach
Each additional sheet must be identified at the top by the well
sheets 9 more space is required
form name number
arad a sRquential
page number
Report depths in feet
below ground surface t r
This form maybe reproduced by photocopy methods or by computer generation with prior approval by the State Engineer
Photocopy reproductions
must retain margins and print Qublity of the original form
Time original form must be submitted to tjte rate Engine s Office within 60 days after cornpleting the well or 7 days after the pemtit expiration
date
whichever
is earlier
A copy of the form must be provided to the well owner 1
Complete the Well Permit Number in full
2
Fill in Name and Mailing Address of Well Owner where correspondence
3
Complete the blocks for the actual location of the well where drilled
If the owner has more than one well
serving this property provide the identification Owner s Designation OWNER SUPPLIED LOCATION unless a survey has been provided the lot 4
block and subdivision
information
for this well DO NOT USE THE For wells located in subdivisions
must also be provided
Report the ground surface elevation in feet above sea level if available This value may be obtained from a topographic map Describe the drilling method used to construct the well and the date completed Indicate the total depth drilled and the actual completed
5
should be sent
Fully describe the materials encountered conjunction Examples
with a description
of descriptive
Grain size Boulders
in drilling
depth of the well
Do not use formation names unless they are in
of materials
terms include
gravel sand sift clay
Hardness Loose soft tight hard very hard Color All materials Most critical in sedimentary Depth when water is encountered
rock
t it can be determined
6
Provide the diameters
7
The outside diameter kind wall thickness and interval of casing lengths must be indicated
8
Indicate the type and size of filter
9
Indicate the type and setting depth for any packers installed
10
of the drilled bore hole
gravel
pack and the interval
where placed
The density of the grout slurry must be reported and may be indicated as pounds per gallon gallons of water per sack method should
total gallons of water and number of sacks used
i e tremie pipe or positive be reported
displacement
The
percentage
etc
Specify the grout placement
of additives
mixed
with the grout
under remarks
11
Record the type and the amount of disinfection
used
12
Report well test data as required by Rule 10 7
Spaces are provided to report all measurements made
during the test
how placed and the length of time left in the hole
The report should show that the test complied with the provisions of the rules
was not performed explain when it will be done
If available
If a test
report clock time when measurements
were
taken
13
Fill in Company Name and Address of Cormactor who constructed the well by the licensed
contractor responsible
for the construction
of the well
The report must be signed
OFFICE OF THE STATE ENGINEER
Form No
COLORADO DIVISION OF WATER RESOURCES
GWS 25
818 Centennial Bldg
1313 Sherman St Denver Colorado 80203
13031866 3581
LIC
218432
WELL PERMIT NUMBER APPLICANT
DIV Lot
1
4 Block
WD 8 1 Filing
DES BASIN
MD
1 Subdiv CROWFOOT SPRINGS RANCH APPROVED WELL LOCATION DOUGLAS COUNTY
JOHN W LABODA
SW
5526 W RIVER DR
Township 10 S
RICHMOND
1 4
NW
1 4
Section 18
Range 65 W
Sixth P M
TX 77469 DISTANCES FROM SECTION LINES
281
232 4340
2700 Ft from South
Section Line
450
Section Line
Ft from West
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL 11
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 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 Rules 2 CCR 402 2 unless approval of a variance has
3
Approved pursuant to CRS 37 92 602 3
been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18 Twp 10 S Rng 65 W 6th P M 4
b II A as the only well on a tract of land of 42 03 acre s described as part of the NW 1 4 of Sec 18
Douglas County more particularly described in attached Exhibit A
The use of ground water from this well is limited to fire protection 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 total depth of the well shall not exceed 805 feet which corresponds to the base of the Upper Dawson aquifer
6
The annual withdrawal of ground water from this well shall not exceed 1 6 acre feet
7
The return 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
8
The maximum pumping rate of this well shall not exceed 15 GPM
9
This well shall be constructed not more than 200 feet from the location specified on this permit NOTE
Based on the water requirements of 0 3 acre feet per house 0 05 acre feet per four 4 large animals and 0 05 acre feet for each
1 000 sq ft of lawns and gardens the allowed 1 6 acre feet is sufficient water to service one 1
house four 4 large domestic animals and the
irrigation of 25 000 square feet of lawns and gardens
NOTE To insure a maximum productive life of this well perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above
APPROVED JLL
Q z 9 State Engineer
Receipt No 0444226
np
hllP Ofi t
DATE ISSUED JUN 181999
BEXPIRATION DATE JUN 18 2001
V6
RECEIVED COLORADO DIVISION OF WATER RESOURCES J EPA
phone
JUN 4 q 1999
TMENT OF NATURAL RESOURCES
1313 SHERMAN ST
RM 818 DENVER CO 80203
info 303 866 3587 main
303 866 3581 ASTATEENCS L COLO
RESIDENTIAL
Water Well Permit Application
Note You may also use this form to apply for livestock watering
Must be completed in black ink or typed
Review instructions prior to completing form 1
APPLICANT INFORMATION
6 USE OF WELL check appropriate entry or entries
Name of applicant
See Instructions to determine use s for which you may qualify
A
A Ordinary household use in one single family dwelling
LaL O Q a
f
cJ O
W
NO outside use
Mailing Addnea
B Ordinary household use in 1 to 3 single family
55 2
e1 V e
W
dwellings
F
State
City
RI 1 C Iw D Number
J
C
12
Number of dwellings
Zip code
rX
Home gardeMawn irrigation
7 401
area irrigated
not to exceed 1 acre
sq ft 21 acre
1
include orca cede
TolaphoT
23 2
4 3
Domestic animal watering
o
2 TYPE OF A PLCATION check applicable box es
C Livestock watering on farm ranch range pasture
Construct new well
Use existing well
7 WELL DATA
Replace existing well
Change
Madmran pumping rare
Change source
Reapplication e pined paanit
aquifer
Increase Use
Annuei amount to M witdrown
15
Other
16 Agmfar
SO O
if applicable
Water court case
permit
acre feet
9pm
Total depth
3 REFER TO
non commercial
feet
d W so
8 TYPE OF RESIDENTIAL SEWAGE SYSTEM
61C W O S rJ
R Septic tank absorption leach field
Verbal A
Monitoring hole acknowledgment
VE
Central system
MH
District name
Well name or
Vault Location sewage to be hauled to
4
LOCATION OF WELL
Other attach copy of engineering design
County ty
Lk
S
Section
1
Township N or S
S
Quarter quarter
Quarter
SW
N
Range
1
E or W
CQ G S
10
9
W
14
E 0 w in the second degree which is punishable as a class 1 mis
from
emebn MOm ad wellaruav
80
demeanor pursuant to C R S 24 4 104 13 a
y
al
thattheyareifrU6to myknwledg6
direction
Mut
pars
tone
5 TRACT ON WHICH WELL WILL BE LOCATED A You must check one of the following
Block no
W Title
see instructions
j Subdivision Name Crow Cmo T1 Seri W
I
Namelno
Date
0 ho L
JCL
Filing Unl
County exemption attach copy of county approval
I have read
the statements herein know the contents thereof and state
f
feet
Lot no
or authorized agent
The making of false statements herein constitutes perjury
50 N W s ft Wallloostionaddraae gdifferanth rnappikentaddreealifopplicable 1 Ow P r i N sl dl tanee a d
i C e tvS e L 10 SIGNATURE of applicant s
14
ft from
For raalaanerd waua erdy
optional Liceme number
1 4neical Meridian
Distance of well from section lines
2 700
PROPOSED WELL DRILLER
Name
OwtJeh
OPTIONAL INFORMATION survey
uses map name
surfaceel
DWR map no
1
Tract no
I
v
1140
Office Use Only
Mining claim attach copy of deed or survey Name no
I
DIV
I
U li1u 21
CO y Other attach legal description to application
CO B
STATE PARCEL
ID C
optional
acme In treat
D
Are you the owner of this property
p
t 2 A33 E
YES
NO
if no
see detailed inst
Will this be the only well on this tract YES
NO
if other wells are on this tract see detaitad inst
LAN C WC
WRte MA
WO
r
pt6 1
ggp j I AF Gra
BA
S3F USE
MD Form GWS 44 11 95
GWS 44 FMINST
COLORADO DIVISION OF WATER RESOURCES
12 95
DEPARTMENT OF NATURAL RESOURCES
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 Forth GWS 46 gravel pit wells Use Form GWS 27 or for other uses not listed above including commercial industrial crop irrigation municipal etcetera
FEES
Use GENERAL PURPOSE Form GWS 45
Applications must be submitted with the appropriate required non refundable filing fees
The required filing fee for
mostwell permit applications is 560 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 Ienibly in BLACK INK or typed
ALL ITEMS in the application must be
completed Incomplete applications may be returned to the applicant for more information application in any way
Do not change or alter the
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 sinned 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 1970 352 8712 945 5665
Pueblo
719 542 3368
Steamboat Springs
or the nearest Division of Water Resources Field Office located in Greeley
Alamosa
970 879 0272
719 589 6683
Montrose 970 249 6622
Glenwood Springs 970
or Durango 970 247 1845
DETAILED INSTRUCTIONS ARE AVAILABLE UPON REQUEST
COLORADO DIVISION OF WATER RESOURCES 1313 SHERMAN STREET PHONE 303 888 3587
Information
303 866 3581
Main
303 866 3447
Well
ROOM 821
DENVER
Water Rights Recordsl
CO 80203
303 866 3589
Fax
y
EXEMPT WELL
APPLICANT
LABODA
LOCATION
NW1
PROPOSED AQUIFER SURFACE
RECEIPT
4 OF
SW1
UPPER
ELEVATION
NO
18
DENVER
BASIN
COLORAD
T
10S
R
65W
2580
SSL
450
WSL
DAWSON
7140
NUMBER
PROPERTY
IF
SUBDIVISION
IS UNDER AUGMENTATION
IF
SUBDIVISION
WAS
ON
SHEET
444226
SEC
IS
INFORMATION
WITHIN
4 OF
DATA
SERVICE BOUNDARIES
RECOMMENDED
SUBDIVISION
OR
FOR
OF
OF ACRES
CASE
OF LAND
NO
S
B
S
CONSENT
MAPS
THE
WATER
MANAGEMENT
BRANCH
RESTRICTIONS
DEPTH TO
ANNUAL
NET
APPROP
SAND
N
IS
SPECIAL
ELEVATION
42
TRACT
MUNICIPALITY
PLAN
APPROVAL BY
TRACT
IN
BOT
TOP
STAT
AQUIFER
BOT
TOP
A F
UPPER
DAWSON
6336
7001
333
804
139
27
888
LOWER
DAWSON
6210
6390
160
930
750
13
440
DENVER
5282
6167
330
1858
973
23
491
NT
UPPER ARAPAHOE
4687
5227
328
2453
1913
23
348
NT
3975
4270
192
3165
2870
12
096
NT
NNT E
NT
LOWER ARAPAHOE LARAMIE
FOX
note
HILLS
E indicates location is at aquifer boundary and values may be m indicates
All
values
are
the
proposed
interpolated
from
aquifer the
S
B
5
data
base
assembled
in Nove
4IL
Lilg2NECEIVED
EXHIBIT A CROWFOOT SPRINGS RANCH
APR 151999 WATER STATEE WEE
LEGAL DESCRFrMI
TRACT 4
A TRACT OF LAND BEING A PORTION OF SECTION 18 TOWNSHIP 10 SOUTH RANGE 66 WEST OF THE SIXTH PRINCIPAL MERIDIAN COUNTY OF DOUGLAS STATE OF COLORADO BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS BASIS OF BEARINGS
THE SOUTH LINE OF THE SOUTHWEST QUARTER OF SECTION 18 TOWNSHIP 10 SOUTH RANGE 65 WEST OF THE SIXTH PRINCIPAL MERIDIAN BEING MONUMENTED AT THE SOUTHWEST SECTION CORNER BY A NO 6 REBAR AND 3 1 4 ALUMINUM SURVEYOR S CAP
STAMPED JR ENG LTD RLS 10377 1994 AND AT THE SOUTH QUARTER CORNER BY A NO 6 REBAR AND 3 1 4
ALUMINUM SURVEYOR S CAP STAMPED
RLS 10377 1994
JR ENG LTD
IS ASSUMED TO BEAR S89 25 44 E
A DISTANCE OF 2617 01 FEET
COMMENCING AT THE WEST QUARTER CORNER OF SAID SECTION 18 SAID POINT BEING THE POINT OF BEGINNING THENCE NOO 14 2TW ON THE WEST LINE OF THE NORTHWEST QUARTER OF SAID SECTION 18 A DISTANCE OF 1305 02 FEET TO A POINT ON THE EAST WEST FENCE LINE THENCE S89 12 00 E ALONG SAID FENCE LINE A
DISTANCE OF 1607 55 FEET ftHENCE S10 00 00 W A DISTANCE OF 560 92 FEET TO A POINT ON CURVE THENCE ON THE ARC OF A CURVE TO THE LEFT WHOSE CENTER BEARS S10 00 00 W HAVING A OELTA OF 121 10 00 A RADIUS OF 500 00 FEET A DISTANCE OF 1057 38 FEET TO A POINT OF TANGENT THENCE S21 10 OOfE A
DISTANCE OF 70 00 FEET TO A POINT OF CURVE THENCE ON THE ARC OF A CURVE TO THE RIGHT HAVING A DELTA OF 22 30 00 A RADIUS OF 600 00 FEET A DISTANCE OF 235 62 FEET TO A POINT ON CURVE THENCE N88 40 00 W A DISTANCE OF 1016 40 FEET TO A POINT ON THE WEST LINE OF THE SOUTHWEST QUARTER OF SAID SECTION 18 THENCE NOO 14 10 W ON THE WEST LINE OF THE SOUTHWEST QUARTER OF SAID SECTION 18 A DISTANCE OF 215 02 FEET TO THE POINT OF BEGINNING CONTAINING A CALCULATED AREA OF 42 033 ACRES
TOGETHER WITH AND SUBJECT TO EASEMENTS DESCRIBED IN BOOK 1357 AT PAGE 1750 RECORDS OF DOUGLAS COUNTY COLORADO AND SUBJECT TO EASEMENTS DESCRIBED
IN BOOK 1362 AT PAGE 164 RECORDS OF DOUGLAS COUNTY COLORADO
F 5
PUMP INSTALLATION AND TEST REPORT
32
L4VED
MAY 17 2000
218437
WELL PERMIT NUMBER
1
For Office
STATE OF COLORADO OFFICE OF THE STATE ENGINEER
area
WATERRESOURGES
2 OWNER NAME S
STATE ENGINEER
a
Mailing Address
1
City St Zip lk C Phone
R
E
mnm6 TX
Z
COLO
a
i 14L 4 1
434o
3 WELL LOCATION AS DRILLED S g 1 4 N r 1 1 4 Sec
Range
Twp
n5
pl
DISTANCES FROM SEC LINES
2 7CY
ft from
Sec line and 460
ft from
Sec
line
e
SUBDIVISION
BLOCK
LOT
FILING UNIT
j
STREET ADDRESS AT WELL LOCATION
4
t
PUMP DATA Type
Pump Manufacturer Design GPM I Pump Intake Depth
Inm
Installation Completed
t 11
Volts
23r
Inches
l T
Z
L
Pump Model No
4 iC7 HP Feet Drop Column Pipe Size
at RPM
Full Load Amps
C
Kind
ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM TURBINE DRIVER TYPE
Electric
Design Head 5
feet
Engine
Number of Stages
Yes
Monitor Tube I
No Orifice Depth ft
Meter Readout
Gallons
Thousand Gallons
Check box W Test data is submitted
Total Well Depth
00
Static Level
DISINFECTION
alled
Yes
No Depth ft
Beginning Reading
Supplemental Form
o
Time Rate GPM
025 0
Date Measured
9
Acre feet
TEST DATA
Date
8
inches
Meter Serial No
Flow Meter Mfg
7
Shaft size
OTHER EQUIPMENT Airline Installed
6
Other
Pumping Lvl Type
Water Quality analysis available
H
N Yes
Amt Used
OZ
No
Remarks
0 1 have read the statements made herein and know the contents 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 secon degree and is punishable as a class 1 misdemeanor
CONTRACTOR
Phone
o
Z0 Lie No
J8
Mailing Address Name Title
Please type or print
Sign
Date
0 00
INSTRUCTIONS FOR PUMP INSTALLATION REPORT The report must be typed or printed in BLACK INK
additional sheets if more space is required name
the permit number
All changes on the form must be initialed and dated
Attach
Each additional sheet must be identified at the top by the well owner s
form nameinumber and a sequential page number
Report depths in feet below ground
surface
This form may be reproduced by photocopy methods
or by computer generation with prior approval by the State
Engineer
The original and one copy of this form must be submitted to the State Engineer s Office within 60 days after
completing the well or 7 days after the permit expiration date whichever is earlier
Another copy of the form must
be provided to the well owner
If this form is submitted in conjunction with the Well Completion and Test Report form number GWS 31 ONLY THE PERMIT NUMBER AND OWNER NAME NEED TO BE COMPLETED in items 1 and 2 Complete the Permit Number in full
2
Fill in Name and Mailing Address of Well Owner where correspondence should be sent
3
Complete the blocks for the actual location of the well
For wells located in subdivisions the lot
block and
subdivision information must also be provided 4
Indicate the type of pump installed and complete the requested information than 50 gpm
When installing pumps greater
complete the additional information in this area
5
Provide the information on other equipment which may be installed in the well
6
Report test data as required by Rule 14 4 test
Spaces are provided to report all measurements made during the
The report should show that the test complied with the provisions of the rules
performed explain when it will be done
If available
If a test was not
report clock time when measurements were taken
7
Record the type and the amount of disinfection used how placed and the length of time left in the hole
8
Indicate if a water quality analysis was performed and submit a copy of the report if available
9
Use the remarks area to note any additional information including additional equipment installed water supply construction problems
10
Fill in Company Name and Address of Contractor who installed pumping equipment signed by the licensed contractor responsible for the installation of pumping equipment
The report must be
WELL CONSTRUCTION AND TEST REPORT
GM 31
hi
2 OWNER NAMES
Mailing Address
1 o
city St ZizDl ppp Phone
RECEIVED
9 1 9 Li
14 WELL PERMrr NUMBER t
r
WATERRESCL s STATE EAQNELR COLO
3
DISTANCES FROM S
Uti 1 4 Sec
Sec
m w as
line and
ft from nn
SUBDIVISION C1 O STREET ADDRESS AT WELL LOCATION GROUND SURFACE ELEVATION
1
C7
BLOCK
FILING UNIT
a
i ti
DRILLING METHOD
TOTAL DEPTH q
GEOLOGIC LOG
ft
Description of Material ry e Size Color Water Location
r5
DEPTH COMPLETED
6 HOLE DIA
O
w 0
Range J
Sec line OR
LOT 4
a
ft
DATE COMPLETED
Depth
S
Twp
LINES
Q 7 ft from
5
MAR 2 7 2000
pl2ctc j
W
3 WELL LOCATION AS DRILLED 3W 1 4
4
For office Use only
STATE OF COLORADO OFFICE OF THE STATE ENGINEER 1313 Sherman St Rm 818 12enver CO 80203
10 94
From
In
ft
left
To ft
lYT
U
7 PLAIN CASING
r
10 l7
0
oa
in
Kin
Wall Size
From ft
To ft
S P
I
FIR CASING Screen Slot Size U
C3
CD
OD
S FILTER PACK
9 PACKER PLACEMENT
Material
Pa L
Type
Size
y J
Interval 10
Depth
GROUTING RECORD
Material
Amount
Density
Interval
Placement
REMARKS
1
DISINFECTION
Type
WELL TEST DATA
Amt Used
Z
Check box if Test D to is submitted on Form No GWS 39 Supplemental Well Test
TESTING METHOD Static Level
ft Datefrime measured
Production Rate
Pumping level
ft Date Time measured
Test length
e gpm
hrs
Remarks
3 1 have read the statements made herein and know the contents thereof and that they are true to my knowledge Pursuant to Section 24 4104 13 a
C R S the making of else tatements herein cy stitutea eriury in the second degree and is punishable ae a class 1 misdemeanor Phone aD Lic No
Dr
CONTRACTOR Mailin
Name Title rJ 1
ll
t
Address Please type or print
l
Si
a
Date
Z a7
G v
INSTRUCTIONS
FOR WELL CONSTRUCTION
Rev Oct
AND TEST REPORT
94
C
The report must be typed or printed in BLACK INK additional owner s
name
the permit
number
All changes on the form must be initialed and dated
Attach
Each additional sheet must be identified at the top by the well
sheets 9 more space is required
form name number
arad a sRquential
page number
Report depths in feet
below ground surface t r
This form maybe reproduced by photocopy methods or by computer generation with prior approval by the State Engineer
Photocopy reproductions
must retain margins and print Qublity of the original form
Time original form must be submitted to tjte rate Engine s Office within 60 days after cornpleting the well or 7 days after the pemtit expiration
date
whichever
is earlier
A copy of the form must be provided to the well owner 1
Complete the Well Permit Number in full
2
Fill in Name and Mailing Address of Well Owner where correspondence
3
Complete the blocks for the actual location of the well where drilled
If the owner has more than one well
serving this property provide the identification Owner s Designation OWNER SUPPLIED LOCATION unless a survey has been provided the lot 4
block and subdivision
information
for this well DO NOT USE THE For wells located in subdivisions
must also be provided
Report the ground surface elevation in feet above sea level if available This value may be obtained from a topographic map Describe the drilling method used to construct the well and the date completed Indicate the total depth drilled and the actual completed
5
should be sent
Fully describe the materials encountered conjunction Examples
with a description
of descriptive
Grain size Boulders
in drilling
depth of the well
Do not use formation names unless they are in
of materials
terms include
gravel sand sift clay
Hardness Loose soft tight hard very hard Color All materials Most critical in sedimentary Depth when water is encountered
rock
t it can be determined
6
Provide the diameters
7
The outside diameter kind wall thickness and interval of casing lengths must be indicated
8
Indicate the type and size of filter
9
Indicate the type and setting depth for any packers installed
10
of the drilled bore hole
gravel
pack and the interval
where placed
The density of the grout slurry must be reported and may be indicated as pounds per gallon gallons of water per sack method should
total gallons of water and number of sacks used
i e tremie pipe or positive be reported
displacement
The
percentage
etc
Specify the grout placement
of additives
mixed
with the grout
under remarks
11
Record the type and the amount of disinfection
used
12
Report well test data as required by Rule 10 7
Spaces are provided to report all measurements made
during the test
how placed and the length of time left in the hole
The report should show that the test complied with the provisions of the rules
was not performed explain when it will be done
If available
If a test
report clock time when measurements
were
taken
13
Fill in Company Name and Address of Cormactor who constructed the well by the licensed
contractor responsible
for the construction
of the well
The report must be signed
OFFICE OF THE STATE ENGINEER
Form No
COLORADO DIVISION OF WATER RESOURCES
GWS 25
818 Centennial Bldg
1313 Sherman St Denver Colorado 80203
13031866 3581
LIC
218432
WELL PERMIT NUMBER APPLICANT
DIV Lot
1
4 Block
WD 8 1 Filing
DES BASIN
MD
1 Subdiv CROWFOOT SPRINGS RANCH APPROVED WELL LOCATION DOUGLAS COUNTY
JOHN W LABODA
SW
5526 W RIVER DR
Township 10 S
RICHMOND
1 4
NW
1 4
Section 18
Range 65 W
Sixth P M
TX 77469 DISTANCES FROM SECTION LINES
281
232 4340
2700 Ft from South
Section Line
450
Section Line
Ft from West
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS OF APPROVAL 11
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 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 Rules 2 CCR 402 2 unless approval of a variance has
3
Approved pursuant to CRS 37 92 602 3
been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18 Twp 10 S Rng 65 W 6th P M 4
b II A as the only well on a tract of land of 42 03 acre s described as part of the NW 1 4 of Sec 18
Douglas County more particularly described in attached Exhibit A
The use of ground water from this well is limited to fire protection 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 total depth of the well shall not exceed 805 feet which corresponds to the base of the Upper Dawson aquifer
6
The annual withdrawal of ground water from this well shall not exceed 1 6 acre feet
7
The return 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
8
The maximum pumping rate of this well shall not exceed 15 GPM
9
This well shall be constructed not more than 200 feet from the location specified on this permit NOTE
Based on the water requirements of 0 3 acre feet per house 0 05 acre feet per four 4 large animals and 0 05 acre feet for each
1 000 sq ft of lawns and gardens the allowed 1 6 acre feet is sufficient water to service one 1
house four 4 large domestic animals and the
irrigation of 25 000 square feet of lawns and gardens
NOTE To insure a maximum productive life of this well perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above
APPROVED JLL
Q z 9 State Engineer
Receipt No 0444226
np
hllP Ofi t
DATE ISSUED JUN 181999
BEXPIRATION DATE JUN 18 2001
V6
RECEIVED COLORADO DIVISION OF WATER RESOURCES J EPA
phone
JUN 4 q 1999
TMENT OF NATURAL RESOURCES
1313 SHERMAN ST
RM 818 DENVER CO 80203
info 303 866 3587 main
303 866 3581 ASTATEENCS L COLO
RESIDENTIAL
Water Well Permit Application
Note You may also use this form to apply for livestock watering
Must be completed in black ink or typed
Review instructions prior to completing form 1
APPLICANT INFORMATION
6 USE OF WELL check appropriate entry or entries
Name of applicant
See Instructions to determine use s for which you may qualify
A
A Ordinary household use in one single family dwelling
LaL O Q a
f
cJ O
W
NO outside use
Mailing Addnea
B Ordinary household use in 1 to 3 single family
55 2
e1 V e
W
dwellings
F
State
City
RI 1 C Iw D Number
J
C
12
Number of dwellings
Zip code
rX
Home gardeMawn irrigation
7 401
area irrigated
not to exceed 1 acre
sq ft 21 acre
1
include orca cede
TolaphoT
23 2
4 3
Domestic animal watering
o
2 TYPE OF A PLCATION check applicable box es
C Livestock watering on farm ranch range pasture
Construct new well
Use existing well
7 WELL DATA
Replace existing well
Change
Madmran pumping rare
Change source
Reapplication e pined paanit
aquifer
Increase Use
Annuei amount to M witdrown
15
Other
16 Agmfar
SO O
if applicable
Water court case
permit
acre feet
9pm
Total depth
3 REFER TO
non commercial
feet
d W so
8 TYPE OF RESIDENTIAL SEWAGE SYSTEM
61C W O S rJ
R Septic tank absorption leach field
Verbal A
Monitoring hole acknowledgment
VE
Central system
MH
District name
Well name or
Vault Location sewage to be hauled to
4
LOCATION OF WELL
Other attach copy of engineering design
County ty
Lk
S
Section
1
Township N or S
S
Quarter quarter
Quarter
SW
N
Range
1
E or W
CQ G S
10
9
W
14
E 0 w in the second degree which is punishable as a class 1 mis
from
emebn MOm ad wellaruav
80
demeanor pursuant to C R S 24 4 104 13 a
y
al
thattheyareifrU6to myknwledg6
direction
Mut
pars
tone
5 TRACT ON WHICH WELL WILL BE LOCATED A You must check one of the following
Block no
W Title
see instructions
j Subdivision Name Crow Cmo T1 Seri W
I
Namelno
Date
0 ho L
JCL
Filing Unl
County exemption attach copy of county approval
I have read
the statements herein know the contents thereof and state
f
feet
Lot no
or authorized agent
The making of false statements herein constitutes perjury
50 N W s ft Wallloostionaddraae gdifferanth rnappikentaddreealifopplicable 1 Ow P r i N sl dl tanee a d
i C e tvS e L 10 SIGNATURE of applicant s
14
ft from
For raalaanerd waua erdy
optional Liceme number
1 4neical Meridian
Distance of well from section lines
2 700
PROPOSED WELL DRILLER
Name
OwtJeh
OPTIONAL INFORMATION survey
uses map name
surfaceel
DWR map no
1
Tract no
I
v
1140
Office Use Only
Mining claim attach copy of deed or survey Name no
I
DIV
I
U li1u 21
CO y Other attach legal description to application
CO B
STATE PARCEL
ID C
optional
acme In treat
D
Are you the owner of this property
p
t 2 A33 E
YES
NO
if no
see detailed inst
Will this be the only well on this tract YES
NO
if other wells are on this tract see detaitad inst
LAN C WC
WRte MA
WO
r
pt6 1
ggp j I AF Gra
BA
S3F USE
MD Form GWS 44 11 95
GWS 44 FMINST
COLORADO DIVISION OF WATER RESOURCES
12 95
DEPARTMENT OF NATURAL RESOURCES
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 Forth GWS 46 gravel pit wells Use Form GWS 27 or for other uses not listed above including commercial industrial crop irrigation municipal etcetera
FEES
Use GENERAL PURPOSE Form GWS 45
Applications must be submitted with the appropriate required non refundable filing fees
The required filing fee for
mostwell permit applications is 560 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 Ienibly in BLACK INK or typed
ALL ITEMS in the application must be
completed Incomplete applications may be returned to the applicant for more information application in any way
Do not change or alter the
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 sinned 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 1970 352 8712 945 5665
Pueblo
719 542 3368
Steamboat Springs
or the nearest Division of Water Resources Field Office located in Greeley
Alamosa
970 879 0272
719 589 6683
Montrose 970 249 6622
Glenwood Springs 970
or Durango 970 247 1845
DETAILED INSTRUCTIONS ARE AVAILABLE UPON REQUEST
COLORADO DIVISION OF WATER RESOURCES 1313 SHERMAN STREET PHONE 303 888 3587
Information
303 866 3581
Main
303 866 3447
Well
ROOM 821
DENVER
Water Rights Recordsl
CO 80203
303 866 3589
Fax
y
EXEMPT WELL
APPLICANT
LABODA
LOCATION
NW1
PROPOSED AQUIFER SURFACE
RECEIPT
4 OF
SW1
UPPER
ELEVATION
NO
18
DENVER
BASIN
COLORAD
T
10S
R
65W
2580
SSL
450
WSL
DAWSON
7140
NUMBER
PROPERTY
IF
SUBDIVISION
IS UNDER AUGMENTATION
IF
SUBDIVISION
WAS
ON
SHEET
444226
SEC
IS
INFORMATION
WITHIN
4 OF
DATA
SERVICE BOUNDARIES
RECOMMENDED
SUBDIVISION
OR
FOR
OF
OF ACRES
CASE
OF LAND
NO
S
B
S
CONSENT
MAPS
THE
WATER
MANAGEMENT
BRANCH
RESTRICTIONS
DEPTH TO
ANNUAL
NET
APPROP
SAND
N
IS
SPECIAL
ELEVATION
42
TRACT
MUNICIPALITY
PLAN
APPROVAL BY
TRACT
IN
BOT
TOP
STAT
AQUIFER
BOT
TOP
A F
UPPER
DAWSON
6336
7001
333
804
139
27
888
LOWER
DAWSON
6210
6390
160
930
750
13
440
DENVER
5282
6167
330
1858
973
23
491
NT
UPPER ARAPAHOE
4687
5227
328
2453
1913
23
348
NT
3975
4270
192
3165
2870
12
096
NT
NNT E
NT
LOWER ARAPAHOE LARAMIE
FOX
note
HILLS
E indicates location is at aquifer boundary and values may be m indicates
All
values
are
the
proposed
interpolated
from
aquifer the
S
B
5
data
base
assembled
in Nove
4IL
Lilg2NECEIVED
EXHIBIT A CROWFOOT SPRINGS RANCH
APR 151999 WATER STATEE WEE
LEGAL DESCRFrMI
TRACT 4
A TRACT OF LAND BEING A PORTION OF SECTION 18 TOWNSHIP 10 SOUTH RANGE 66 WEST OF THE SIXTH PRINCIPAL MERIDIAN COUNTY OF DOUGLAS STATE OF COLORADO BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS BASIS OF BEARINGS
THE SOUTH LINE OF THE SOUTHWEST QUARTER OF SECTION 18 TOWNSHIP 10 SOUTH RANGE 65 WEST OF THE SIXTH PRINCIPAL MERIDIAN BEING MONUMENTED AT THE SOUTHWEST SECTION CORNER BY A NO 6 REBAR AND 3 1 4 ALUMINUM SURVEYOR S CAP
STAMPED JR ENG LTD RLS 10377 1994 AND AT THE SOUTH QUARTER CORNER BY A NO 6 REBAR AND 3 1 4
ALUMINUM SURVEYOR S CAP STAMPED
RLS 10377 1994
JR ENG LTD
IS ASSUMED TO BEAR S89 25 44 E
A DISTANCE OF 2617 01 FEET
COMMENCING AT THE WEST QUARTER CORNER OF SAID SECTION 18 SAID POINT BEING THE POINT OF BEGINNING THENCE NOO 14 2TW ON THE WEST LINE OF THE NORTHWEST QUARTER OF SAID SECTION 18 A DISTANCE OF 1305 02 FEET TO A POINT ON THE EAST WEST FENCE LINE THENCE S89 12 00 E ALONG SAID FENCE LINE A
DISTANCE OF 1607 55 FEET ftHENCE S10 00 00 W A DISTANCE OF 560 92 FEET TO A POINT ON CURVE THENCE ON THE ARC OF A CURVE TO THE LEFT WHOSE CENTER BEARS S10 00 00 W HAVING A OELTA OF 121 10 00 A RADIUS OF 500 00 FEET A DISTANCE OF 1057 38 FEET TO A POINT OF TANGENT THENCE S21 10 OOfE A
DISTANCE OF 70 00 FEET TO A POINT OF CURVE THENCE ON THE ARC OF A CURVE TO THE RIGHT HAVING A DELTA OF 22 30 00 A RADIUS OF 600 00 FEET A DISTANCE OF 235 62 FEET TO A POINT ON CURVE THENCE N88 40 00 W A DISTANCE OF 1016 40 FEET TO A POINT ON THE WEST LINE OF THE SOUTHWEST QUARTER OF SAID SECTION 18 THENCE NOO 14 10 W ON THE WEST LINE OF THE SOUTHWEST QUARTER OF SAID SECTION 18 A DISTANCE OF 215 02 FEET TO THE POINT OF BEGINNING CONTAINING A CALCULATED AREA OF 42 033 ACRES
TOGETHER WITH AND SUBJECT TO EASEMENTS DESCRIBED IN BOOK 1357 AT PAGE 1750 RECORDS OF DOUGLAS COUNTY COLORADO AND SUBJECT TO EASEMENTS DESCRIBED
IN BOOK 1362 AT PAGE 164 RECORDS OF DOUGLAS COUNTY COLORADO
F 5
