DWR_GWS_44 Copy of Original Well Permit Application.pdf

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WELL PERMIT NUMBER 22197-- A

Division of Water Resources tJr+a RECEIPT NUMBER 10028833

Department of Natural Resources

ORIGINAL PERMIT APPLICANT(S) APPROVED WELL LOCATION

USA RIO GRANDE NATIONAL FOREST Water Division: 3 Water District: 20

Designated Basin: N/ A

Management District: N/ A

County: RIO GRANDE

Parcel Name: N/ A

AUTHORIZED AGENT Physical Address: 1243 CR 20 SOUTH FORK, CO 81154

ANDREW KEHLER NE 1/ 4 SE 1/ 4 Section 9 Township 39.0 N Range 3. 0 E New Mexico P. M.

UTM COORDINATES ( Meters. Zone: 13, NAD83)

Easting: 353519. 0 Northing: 4166906. 0

PERMIT TO REPLACE EXISTING WELL

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 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 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 37u92. 602( 3)( c) for the relocation of an existing well, permit no. 22197-A, on a residential site described as a Tract of Land in the NE1/ 4 of the SE 1/ 4 of Section 9, Township 39 North, Range 3 East, N. M. P. M., Rio Grande

County. The old well must be plugged in accordance with Rule 16 of the Water Well Construction Rules within ninety-one( 91) days of completion of the new well. A Well Abandonment Report form must be completed and submitted to affirm that the old well was plugged.

4} The use of ground water from this well is limited to ordinary household purposes inside two single family dwellings and the watering of domestic animals.

5) The maximum pumping rate of this well shall not exceed 15 GPM.

6) 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.

7) This well shall be constructed not more than 200 feet from the location specified on this permit.

NOTE: This permit will expire on the expiration date unless the well is constructed by that date. A Well Construction and Yield Estimate Report ( GWS- 31) must be submitted to the Division of Water Resources to verify the well has been constructed. An extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension request form ( GW5. 64) available at: dwr.colorado. gov

NOTICE: You are hereby notified that you have the right to appeal the issuance of this permit, by filing a written request with this office within sixty( 60) days of the date of issuance, pursuant to the State Administrative Procedures Act. ( See Section 24- 4- 104 through 106, C. R. S.)

Date Issued: 9/ 15/ 2023 r

Issued By DARIN SCHEPP Expiration Date: 9/ 15/ 2025

Printed 09- 15- 2023 For questions about this permit call 303 866. 3581 or go to https:/ ldwr.colorado. gov Page 1 of 1

COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-44( 01/ 2020)

DEPARTMENT OF NATURAL RESOURCES

1313 SHERMAN ST., Ste 821, DENVER, CO 80203 Main: 303' 866-3581 4•,gu limit„ 44liR- i,e,, M C, ,. RECEIVED RESIDENTIAL Note: Also use this form to apply for livestock watering 04/28/2023

Water Well Permit Application WATER RESOURCES

Review form Instructions prior to completing form, STATE ENGINEER Hand completed forms must be completed In black or blue Ink or typed. COLO l 1. Applicant Information Name(s) 6. Use Of Well (check applicable boxes)

United States of America ( Rio Grande National Forest) See instructions to determine use( s) for which you may qualify

0 A. Ordinary household use in one single-family dwelling Mailing address no outside use)

1055 9th St.

B. Ordinary household use in 1 to 3 single- family dwellings:

City State Zip code

Del Norte CO 81132 Number of dwellings: 2

Telephone( wiar•ea code) E- mail}"' 0 Home garden/ lawn irrigation, not to exceed one acre:

719-657- 3321 margaret.sullivan(+'usda.gov area irrigated C sq. ft. ID acre

2. Type Of Application (check applicable boxes) Domestic animal watering—( non-commercial)

Construct new well Change source( aquifer) 0 C. Livestock watering( on farm/ ranch/ range/pasture) Replace existing well 0 Reapplication( expired permit) Use existing well 0 Rooftop precip, collection 7. Well Data (proposed) Cha we or increase use 0 Other: Maximum pumping rate Annual amount to be withdrawn

3. Refer To ( if applicable) 15 gpm , 3 acre- feet

Total depth Aquifer Well permit# Water Court case tt feet'. ''! -' ' a l r 120 unconfined

Basin Deterrnin ion# u Well name or# 8. Water Supplier _.

v ^

Is this parcel within boundaries of a water service area? IO YES 1 NO

4. Location Of Proposed Well ( Important! See Instructions) If yes, provide name of supplier:

County 9. Type Of Sewage System

Rio Grande 1 ' .,,. 1 4 of the 5' 1i4

Secfipn Township N or S Range E or W Principal Meridian Septic tank/ absorption leach field

9 39 IF 1 3 ER l NM 0 Central system: District name, Distance of well from section lines( section lines are typically not property lines) 0 Vault Location sewage to be hauled to:

Ft, hona N r-S Ft, fromr7,E „.."W

0 Other( explain), For replacement wells only« distance and direction from old well to new well a.....- ........._ m._._•... . w- --- ----

180 ,... feet west Direction. ., 10. Proposed

Name

Well Driller License#( optional):

Well location address( Include City, State. Zip) 1 . SignorE

Check if well address is same as: n item 1 Applicant(s) or Authorized Agent

The making of false statements herein constitutes perjury in the second 1243 County Rd 20, South Fork, CO 81154 degree, which is punishable as a class 1 misdemeanor pursuant to C. R.S.

Optional: GPS well location information in UTM format. GPS unit settings are as follows;

24-4- 104( 13)( a), ( have read the statements herein, know the contents thereof and state that theyare truemyto Format must bin UTM knowledge,_

Sign or enter names) of person( s) submitting application Date( mrnrddtyyyy) Zone 12 be M

Zone 13 Eashng 353 / Digitally signed by ANDREW

Units Meters ANDREW KELHER KELNER Datum must be NAD83 Northing` 41i 6465 04 Date: 2023.04. 28 07: 35: 16- 06'00'.

If signing print name and titia Unit must be set to We north Remember to set Datum to NAD83 Was GPS unit checked for above? YES Andrew Kelher, Acting Forest Supervisor

5. Parcel On Which Well Will Be Located Office Use Only

You must attach a current deed for the subject parcel) USGS map name i

DWR map no_ Surface inlay.

A, You must check and complete one of the following:

Subdivision: Name NA- US Government

Receipt area only Lot Block Filing/ Unit

County exemption( attach copy of county approval& survey) 10028833 Name/# Lot#

V

Parcel less than 35 acres, not in a subdivision attach a deed with metes bounds description recorded prior to June 1, 1972, and current deed

Mining claim( attach copy of deed or survey) Name/#:

Square 40 acre parcel as described in Item 4 Parcel of 35 or more acres( attach metes& bounds description or survey)

A©uAMAP

Other:( attach metes& bounds description or survey) WE

B.# of acres in parcel C. Are you the owner of this parcel? WR j YES No_________ m

A .., CWCB

D. Will this be the only well on this parcel? f YEsln No( if no i list other wells)

TOPO

E„ State Parcel ION( optional).

MYLAR

5B5 DIV WO BA MD

MAR 4, Ena s c/ fohm E((RAH' 5„ 0 ti.

17s43, STATE OF COLORADO

DIVISION OF WATER RESOURCES EIt,1TaIndexN°....."..{g..q ...%. OFFICE OF THE STATE ENGINEER J I° WIQ GROUND WATER SECTION tr OV 17 1964u: e.._

GROUND WATER SECT.Registered. ..-/ 7` ra V LOG AND HISTORY OF WELL COLORADO For State Engineer's Use)

PERMIT NO 22197 STATE ENGINEER

WELL LOCATION

Driller 14 &-it" G L)rj11 tng &. Svvpply lic. No. 2$

Owner_ Usk Forest ,service Rio Grande County

R

Street City Monte Vista, Colo. NE . . Y4 of 5 t of Sect,_,., 9 . ., Tenant w _ Twp. 39N •, age. Net . .

PM

Use of Water DniiieAfifc

No.

On or By Acre% North description of site or lend) f"'

Date Started- Cat• 19 i

Date Completer _ 1 I9 fret iir" - -- - -- rages--- -

Yleiri 1 (2 GPM or CFS i

WELL DESCRIPTION: vim' ' Ear x °

Depth to Water ft. Total Depth 38 . ft. 1 measured from ground surface) from n ft. to 9 ft., 12" in.

Hole i i

Diameter from-_ .,9 . it. to.. 38, ,,,_._.ft,, 7tt in. i from ft. to ft., -.,, in.

stash

TEST DATA:

ABOVE DIAGRAM REPRESENTS ONE FULL SEC.

How Tasted. Pump or_ Balled

TION, LOCATE WELL ACCURATELY IN SMALL

Date Tested 19 Lengths.,,. hrs. SQUARE REPRESENTING 40 ACRES.

Rate_ GPM Drawn Down . . ft. or

PUMP DATA: If the above is not applicable fill in:

Pump Type... . Outlet Size in.

No. Street

Driven by HP_

City or Town

CASING RECORD:

Plain Casing or

Size Kind n . m, Ww tfrom . 0 ft. to. 9_. ft. Lot Block_

Size 7" , Kind_-.____ from 9 ft. to_ 31 ft, bdivision include filing or number)

Size Kind. from_. W ... " ft. to . ft.

Perforated Casing TO BE MADE OUT IN QUADRUPLICATE:

7il Original Blue and Duplicate Green CopySize Kind from 33 ft. to 38 _. ft. must be filed with the State Engineer within 30 days after well is completed. WhiteSI7A — , Kind . _.. „_ from ft, to ft, copy is for the Owner and Yellow copy for

Size Kind from_.__.__._t, to ft, the Driller. SIGN BLUE COPY s,.

j' r>:is b i "";'` i l ."

v ,« ^ ..`'• tl" i» ` ° i"' ,,,, 5. a. t k r a, ' °" 4` r,+,; SSE' yJ, f

WELL LOG

a

GroundElevation__ f known) How Orillixt_ ,° " w. ._...

mamas fit004 TO

WI

P OF TEAL Illii , Shvt off. 411.f.

y w ., a. wo-.

wxiw x ,. w w. s_. a wxmmxwwmww.al.r.,_ ...__+.+,_ iwwxw.+ uwmm

2 et/ Bouldersd x

Boulders ti e t m, _ e.,.. .. w m s xv+'* ""'

4.

m t- I:

o-w _ w „.-m++ fummwn w w , w. . . w.

a mwa++" no-..

aw.,»« .,« - ... mmH. ....+ w:uw........... ..:

m ,. w. m _ uv..+ n s. .....,.....,,..: re, A s ,.

ast rswuwxWuvww... w+ x. wxx ..... ..<« x+n,..... x...,_,... w. m,. ,'

S -.

u- u... ... mes, o. w .. , u........, « m=umm:mm.«. c.nxm. w...., ... w.

w..,..., x, n.+.»...

rrweanmemniw.

n,..., ,..« .... i v xw„.**' _ .+. w,.... ....« r...... x a. n:..:. u..,, m.n^°,,,,.i., r.., w+. nm,,,—,. s.. e . — w. a .

w.«.. ro_ n ... a. m....„. r wxwnnent m.. .., y.

w, wn. m,. . a:mmm m. .. <.,.,. vwm x- rxwx n numm.. ., w+ mmxxna.

au- ' wmwq p. mmmm« w<w n'

w. n,... wnixwwr..

iiwwo-... .., .,,...,.+ wmri, m-._ w. sw. e w„ w.:,.w nx era a m.xmm,,. r .. nww..x.,.. v.,m v , w«, a-, «.

m....ra m+d. _,:.,., w a.. m. w i. rw""" " d.

az . ..... , t*.....,•, o ww..+,, o . ...,., ai, ...,., a... ., , „„„ w,:... ." w' w. -.,..,« w,,:».... a.,. x.,w, a.,r'/.:

n ,,,.,,..,, tea, >„ ..~,. nx:r ,. .,•<. x .:.,. w+ w t ,. „' spettAFFFI4H4i11b

Witt hiThi4 W. 11. w & KO under my sopetvision and the above information is tare end correct to the best of my knowledge rwd fief.

4-1„/ _:$ 4".''.41_ 1 ''''' '

Vq- IR_ grD

COLORADO DIVISION OF WATER RESOURCIES FEB r F 19$ 1

PRJNT IN SLACK INK

E GA

818 Centennial Bldg., 1313 Sherman St. Ell W. J#: GES

COPY OF ACCEPTED Denver, Colorado 80203 4 Nut - NGR4EES

STATEMENT MAILED MA

ON REQUEST STATE OF COLORADO I t

AFFIDAVIT

COUNTY OF Rio Grande SS. f

RECEIVED

xx STATEMENT OF BENEFICIAL USE OF GROUND ATER

FEB a 01981

AMENDMENT OF EXISTING RECORD

Own moms" F.

LATE REGISTRATION

PERMIT NUMBER 22197

LOCATION OF WELL

THE AFF1ANT( S) U. S. D. A. Forest Service county

Rio Grande whose mailing 11177 W. 8th Avenue address is P. O. Box 251.27 _ „ , ,_ ._ NE y, D the SE sect., , 9

City Lakewood Colorado 80225 mm Twp, 39 N Rng. 3 E NM P I

4l, A. e) 171p) IM Oa 5i IF OR WI being duly sworn upon oath, deposes and says that he ( they) is ( are) the owner( s) of the well described hereon, the well I located as described above, at distances of

m. 14©g feet from the Sari h section line and 300 feel fr, m yh

Imp., r• v' i? Ii' w 1 bird East ,, section line; voter om this well was First applied to a beneficial use for the purpose( s) d cribed herein t e b•3 day of 4eldilr 19 8© ;

theme maxi sustained pumping rate of the well is -, ' gallons per minute, the pumpin rate claimed hereby isi. . gall nnss per minute; the total depth of the well is 1© 1 feet; the overage annual amour of water to be diverted is . ._, acre- feet; for which claim is hereby mode for Domestic purpose( s); the legal description of the land on which the water from this well s used c

NE 1 SE , Sec. 9,, T. 39 N.! R. 3E. ,. NMPM of whir acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed i compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; I.

they) has ( have) read the statements made hereon; knows the content thereof, and that the some ore true of his ( their) knowledg

OMPLETE REVERSE SIDE OF THIS FORM)

4419.tuce(s-) ^

5ub,scrrbed artc.r, t rirrn FOR OFFICE USE ONLY tc‘ before tne, orj i g= day of 19 ik Court Case No

My 49mmilsiop ' res April 299 1982 My eitr

6(. 6( tsr., t Prior, Mo, .

V Div. Cty. 5-3

ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO

PURSUANT TO THE FOLLOWING CONDITIONS: 4, 4

Well Use _ 1

Div, 20 Refill Men ©. s

DATE STATE ENGINEER BY

Well drilled by Burk Drilling and Irrigation Inc.

Lic. No.

752 t

Permanent Burk Drillingand Irrigation7g2Pump installed by Inc. Lic, No.

Meter Serial No. N/ A El Flow Meter Date Installed N/k

Owner of land on which water is being used U. S. D. A. Forest Service

THE LOCATION OF; THE WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS- HATCHED ON THE DIAGRAM BELOW, This diagram represents nine( 9) sections, Use the CENTER SQUARE one section) to indicate the location of the well, if possible.

1 I 1 I F t l . } I i f . 1 f NORTH SECTION i_ I IE

I

NORTH

N z +

Ak GIl m

1 g r m r-" ku

SOUiH SECTION LIRE

THE SCALE OF T E DIAGRAM IS TWO INCHES E DUALS ONE- MILE

1- --- + --- 1,-, , WATER EQUIVALENTS TABLE ( Rounded Figures)

An ocre• foot covers 1 acre of land 1 foot deep.

1 cubic foot per second ( cfs) . 449 gallons per minute ( gpm).

1 acre- foot . . . 43, 560 cubic feet . , , 325, 900 gallons.

1, 000 gpm pumped continuously for one day produces 4. 42 acre- feet.

100 gpm pumped continuously for one year produces 160 acre• feet.

WHITE AND PINK COPY TO BE FILED WITH THE STATE ENGINEER

PINK COPY WILL BE RETURNED TO OWNER)

7 s

COLORADO DIVISION OF WATER RESOURCES

THIS FORM MUST BE SUBMITTED 1313 Sherman Street - Room 818 RECEIVEDWITHIN 60 DAYS OF COMPLETION

Denver, Colorado 80203 OF THE WORK OESCF1IBED HERE- DEC 1 51980ON,? VP>t DR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT

PATER RESOURCESPERMIT NUMBER .. /} - 7 /9 STATE ENGINEER

COtO

WELL OWNER U1 . I).4. /

rr o r't's. / ] + C rv s'_ e. I E z of ttie E . Y, of Sec.., ADDRESS 1 7 Th 2$72 17 T. 3 9' /f' , R. 3 4 P.M a fv eaZ2J

DATE COMPLETED_.. . - 9--- .Z 2 19 eta HOLE DIAMETER

WELL LOG

7 in. from . e) to ,_" a d ft.

Water From To Type and Color of Material Loc. _

1 in. from cj4 0 _ to T ft.

O. _ ...... in, from 4/ to i/ ft.a l Ta , DRILLING METHOD ANY Rvf!µI 10 /

2 ekokiki C/a/ CASING RECORD: Plain Casing le

V 5 kind £ CC 1' from © to qr. ft,Size t , & kind . we, from Lir, to . -6 ft. l8' r fd Size .,. .. & kind from to ft. 3. -

36 5 . ©L1. v eia7. Perforated CasingJ/ un /' frbve./ Size kind _ el"C from if6' to 9/ it. 7 .

h d Size

X _ & kind 5c•+- from 9 to l / ft. Size. _, . & kind from to ft. GROUTING

RECORD Material

COh c Ire* )4.

C, Intervals .

d 2 C7 Placement

Method/ k V GRAVEL

PACK: Size Interval .... ... ._ . . , TEST

DATA Dater

Tested-. .. .2 2... 19 C S1ai

Yatez Level Prior to Test , . . 4/ 2- ft. Type of Teat PumpS errgUa of rest h r-f

Sustairted Yield (Metered) I o P TOTAL DEPTH , f!Use additional pages necessaryto complete log, Final Pumping Water Level q.

PUMP INSTALLATION REPORT 1. ''.

ti

Pump Make yi A•/ d 1 , _

Type S. i i An t r- 5 4 , d 1e L# J ,••;,•, k\.

Powered by _ Lt f ' f 2. 1.. HP . L.r, •P.

vv

Pump Serial No. ri JJ r.

wATER

Motor Serial IVo, 14 O ( r'.., . _ ib j _ w L+ TABLE a WF Date I nstal lap - Z Z — m 1-

Pump

Remarks t r.. 2' ,^ r r r a.

t"fir f t

WELL TEST DATA WITH PERMANENT PUMP a I

N Q

Date Tested 2 I- I s CONE © F

0- a DEPRESSION

Static Water Level Prior to Test ._._. V 2- 0 = • t.

Length of Test Hours 5`""°

Sustained yield ( Metered) '_ .,_. / GPM

Pumping Water Level i

Remarks _

T

CONTRACTORS STATEMENT

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 same is true of his o n knowled e.

Signature am License No. 2_5_ 4 a ._

J SSState of Colorado, County of . ,! /

Subscribed and sworn to betore we this'//: day of 19f.

My Commission astpirl:w Mardi 15, t98`

My Commission e ires:

y ... , 4.,Notary Public L

FORM TO GE MADE OUT IN QUADRUPLICATE: WHITE FORM must be en original copy on both sides end signed.

WHITE AND GREEN copes must be filed with the State Engineer, PINK COPY is for the Owner end YELLOW COPY is for the Orilla

Y

RJ. Rer 76

COLORADO DIVISION OF WATER RESOURCES

818 Centennial Bldg., 1313 Sherman St., Denver, Colgr dq/ emED I Of 2

PERMIT APPLICATION FORM A 0 4 198t Application must be complete where A PERMIT TO USE GROUND WATEIMA'T applicable. Type or C A PERMIT TO CONSTRUCT A WELL print in BLACK FOR: ( A PERMIT TQ INSTALL A PUMP

INK. No overstrikes C..-or erasures unless REPLACEMENT FOR NO. _ 22197 initialed. 1 OTHER

WATER COURT CASE NO. .

1) APPLICANT • mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN

3 i C.5825

NAME

U. S. D A. Forest Service Receipt No.

STREET 11177 W. 8eh. Ave..,. P-i). Rox 25127 ' Basin Dist .

Lakewood Col©. 80225, CITY

Issarej ZIP) CONDITIONS OF APPROVAL

TELEPHONE NO 234- 557Qy This well shall be used in such a way as to cause no material injury to existing water rights The

2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant

RIO GRANDE NF - Del Norte RD that no injury will occur to another vested water right or preclude another owner of a vested water

County Rio Grande right from seeking relief in a civil court action.

NE 14 © t the . SE Section 9 APPROVED AS A REPLACEMENT OF WELL A-

W7 Twp._• 39 N , Rng.. _ 3. Ili P. M. THE EXISTING WELL MUST BE PLUGGED AND N ED vcss, ie, w, ACCORDING TO THE REVISED AND AMENDED RULES AND

3) WATER USE AND WELL DATA

REGULATIONS FOR WATER WELLANU PUMP INSTALLATION

ONTRACTORS. THE ENCLOSED AFFIDAVIT MUST BE •

SUBMITTED WITHIN SIXTY( fit)) DAYS AFTER THE

Proposed maximum pumping rate ( gprnl 15 ONSTRUCTION OE THE NEW WELL, AFFIRMING THAT i

Average annual amount of ground water 1 WELL N©"// 7 Was PLUGGED AN© ANLQNE@.

to be appropriated ( acre-feet):

Number of acres to be irrigated: 1

Proposed total depth ( feet); 100 rBR MUNICIPAL OR COUNTY GOVERNMENT

SHALL BE CONSULTED WHEN LOCATING

Aquifer ground water is to be obtained from: THIS WELL, AM) THEIR REGULATIONS

Sand & Gravel

SHALL BE COMPLIED WITH.

Owner' s well designation_ South Fork Guard Station

AROUND WATER TO BE USED FOR:

I HOUSEHOLD USE ONLY • no irrigation( 9)

XI DOMESTIC ( 1) INDUSTRIAL ( 5)

LIVESTOCK ( 21 IRRIGATION ( 6)

I COMMERCIAL ( 4) MUNICIPAL ( 81

OTHER ( 9) APPLICATION APPROVED

DETAIL THE USE ON BACK 1N ( 11)

02 / 97

PERMIT NUMBER

4) DRILLER

DATE ISSUED S E P 191980

Name Burk Drilling EXPIRA © ATE S E P 191 8 ee

Street 0I28 Weer Rd. 3 North.

City Monte Vista, Co 81144 STATE GI ER isiare) awl

852- 2752 752 BY. w--

Telephone No. . Lic. No.

I. D. 3 - zo COUNTY

5) THE LOCATION OF THE PROPOSED WELL and the area on ( 6) THE WELL MUST BE LOCATED ELOIN' which the water will be used must be indicated on the diagram below, by distances from section lines.

Use the CENTER SECTION ( 1 section, 640 acres) for the well location.

s2c, line

4"- . 4- — ± --- + — - 1- 1400 it. from South or south)

I 4—• '1 MII,.E. 5280 FEET - • 1r 1 I 3©© s ft. from East sec, line least or west) f' -+ I T

L© T..,........'',. BLOCK FILING •

I I 1 1 v i NORTH SECTION LINE 1:

SUBDIVISION

I

7) TRACT QN WHICH WELL WILL BE

I LOCATED owner USDA, Forest Service NORTH Im""

Z T

T — H + No, of acres 4d Will thi3 be

I I I m I the only well on this tract? Yes n4-w

I 5 8) PROPOSED CASING PROGRAM

r- t r I Plain Casing la k I-- X -- = — — a +

I" 6.- 5/ 8 in, from _ ©

Tftfl..

to ft.

I I in, from. t© ft.

4- — + - 1 Perforated casing

SouTt4 E TI© LINE so

I 1 s

in. from 9©

ft. to ft.

4- rt 4 I i-- in, from ft. to t.

j I ( 9) FOR REPLACEMENT WELLSgivedistance ancjdirection from old welland plans for plugging+ —

4. ^ , _'.. — T I it:

The scale of 1he diagram is 2 inches= 1 m; le 25 t ealtth of old well.

Each small square represents 40 acres. Old well to be plugged according WATER EQUIVALENTS TABLE ( Rounded Figures)

An acre•foot covers I acre of lend 1 foot deep to ,reF><ulations. _ 1 cub c foot pet second Icfsl . 449 gallons per minvre Ygpm) A family of 5 WI require epprot metely 1 acre•toot 01 water per year.

1 ecre"fool . ,. 43,560 cubic feel . , . 325,900 gallons.

1. 000 gem pumped continuously for one day produces 4, 42 acre- feet.

10) AND N WHICH R UND WATER WI E

Owners):

USDR1, Forest Service No, at acres' 40

Legal description' NE1/4SE1/4, Section 9,, T. 39 N,,.. R. 3 E.,. N. M,, P, M,

11) QE• , EQ-D R+P.T#ON-af the use of yruatttf water:• HcsUteffold use oral domestic wells must indicate type of disposal system to be used. Ground water will be used as the potable water supply for" occupants of the South Fork Guard Station durin& the summer. Septic tank and leach field approximately ,3fl0_ , WC$ t of well. . .

12) , ER WAT,ER RIrh1sTused 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 :TO THE iEST OF HIS KNOWLEDGE.

0";

t

0 fsIGNA rU+tE 4!>> f tY$J ,• ,. tr'" 0 Ir i r ti I Tr - Wil

Fn ' t` S u P Q>5, vilrr4 1' i k, io G rm., Z Ala- i. F..,k

Use additional sheets of paper if more space is required.

1.313B s r RN. 818 n C© MI A1R3 03

1 fTFt 1̀11CA

WELL ABANDONMENT AFFIDAV IT* ' FE$ 0 6 798iA'

STATE Qf COLORADO AVER rE Resound xUiN4. iR COUNTY OF Rio Grande

S. pDt° s f f I ( we) George W. Whitlo1 Jr.

A being first duly sworn upon oath, despose and say:

That an old well , located in the NI 1/ 4 of the SE 1/ 4, Section 9 , Township 39 N ,, Range - , 3 _ E NM P. M., was replaced for the following reason( s) : The water coming from the well did not meet the standards for potable water as required by the State. of Colorado.

That the old well , which was replaced by a new well drilled under permit number 22197- A was plugged and abandoned according to the rules and regulations of the State Board of Examiners of Water Well and Pump

Installation Contractors by Burk Drilling and Irrigation Inc.

persons) or company) on July 22 19 80 .

That the old well was plugged with the following materials placed at the indicated intervals :

Neat Cement Grout from 38. 5' feet to 34. 5' feet

Gravel from 34, S` feet to 12. 0` feet

Neat Cement rut from feet to 0. 0' feet Signature of alants je / dr

Subscribed and sworn to before me this m day of tart\ AiA1j f. 1931.

My. Commission expir©s April 29, W My Commission expires:

ary Pub lc

It is the owner' s responsibility pursuant to the conditions of approval to see that the affidavit is returned.

Bee rrsverect side far Abandonment Regulations) ltrItInThan b Rev. STATE OF COLORADO 9-( 12J10M 0

A PERMIT TO USE GROUND WATER W/ .10 1964

APPLICATION FOR:

A PERMIT TO CONSTRUCT A WELL GROUND wimp W.

Applicant V. 0, raiders Mtn" LOCATION OF WELL COLORADO County_ iiiiiiii STATE ENWINER

P. O. Address jiimpli VW/As Cola.' Quantity applied for iQ gpm or 4 i' of .* of Sect, 9 , Twp., V, No

AF Storage w Rge. 1 1 ,__.(, P. M. 22 Used for 0 Purposes ti • on/ at lil w Street Address or Lot & Block No.

jiiegalMillers ptlon o t site)

Town or Subdivision

Total acreage irrfgated and other rts. 2 = o

ESTIMATED DATA OF WELL N

Hole size: fn. to ft.

x t

in. tolgg ft. 1 P a 1

Casing Plain _in. from ® totft. q u r

I - Locate

in. from toft. I well in

Open or Perf. I in. from toft. m` 40 acre

in. from to ft. 4 co I

E ( small)

PUMP Outlet AI" r gi square

DATA: Type) j. . HPJ$ize f as near as possible.

Use initiation date ilims 1 19 itiS 174 1 Large square

Use Supplemental pages for additional data.)

0 S

1 is one section.

25. 00 fee required for uses other

THIS APPLICATION APPROVED than Domestic or Livestock.

PERMIT NO. Applicant A $, Awn' ISSUED: Agent or

DATE 19 Driller timistwiiiii No. $

Address Awn Meat l

NOTE — SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION

RECEIVED

S ' p 419802of2 PTO

HATE pmaws.

as

The United States of America, by and through the United States Forest Service, Department of Agriculture, and solely for the purpose of notification to the Office of the Colorado State Engineer, submits herewith a Well Drilling Permit Application for the South Fork Guard Station replacement well.

The filing of this form is not, nor should it be construed as, acknowledgment of any right or power of the Colorado State Engineer or of the State of Colorado to limit or in any manner determine the rights of the United States to develop and uti-lize fully the ground water resources located on its property.

Additionally, the filing of this form is not, nor should it be construed as, a waiver of any rights of the United States.

Also, the processing fee of 5 is paid under protest.

Porrti E Rev. STATE OF COLORADO 71AMEOWED9- 62/ L0M A PERMIT TO USE GROUND WATE APPLICATION FOR: El A PERMIT TO CONSTRUCT A WELL 0

GROUND WAIER SST.

Applicant U. S. FoRE3T SERVICE LOCATION OF WELIWLO

County Rio GRANDE _- STATE NICINEER P. O. Address Mean VISTAS COLORADO Quantity applied or 10 gpm or NE ,, of SC t of Sect. 9 , Twp. IL

AF Storage

W Rge. 3_ E ,, N1M, P. M. OR

Used for DOMB31Ic Purposes R on/ at Sa iN FoRIc Cigailik gTATI aril. Street Address or Lot & Block NO.

legal description of land site) a Townor Subdivision Total acreage irrigated and other rts. 2 0

ESTIMATED DATA OF WELL N

Hole size: in. to ft. I I

in. tolib

Casing Plain 10 in. from to ft. R I T

I Locate

7 in. ( romp to ft. I well in

Open or Perf in, from ,to ft. , 44 E 40 acre

in. from to, ft. 2 . I small)

PUMP Outlet alb x square

DATA: Type Su5M[ Rs IOM, . HP 1 Size 2 as near as possible.

Use initiation date MAY I 19, 65 . t r Large square Use Supplemental pages for additional data) "4 6 1 is one section.

A S

25. 00 fee required for uses other

THIS APPLICATION APPROVED than Domestic or Livestock.

PERMIT NO. 22197 Applicant U. S. FOREST S_ ERV ICE

ISSUED: Agent or

DATE , NOV 10 1964 19 Driller M& G DR I LL1 NG NO. 28

Address MONTE V IsTA_I CoL©RAod

NOTE — SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION

COLORADO

Division of Water Resources

PPR RECEIPTDepartment of Natural Res urceS

1313 SHERMAN S ', STE 821

DENVER, CO, 80203

Date: 4/28/2023 1 ?: : 21 AM Cashier: 66357

Order Number: 28034

Transaction Number: 35340

MARGARET SULLIVAN

1055 9TH STREET

DEL NORTE, CO. 81132

Application/ Receipt Quantity Description Price Discount Extended Price

10028833 1 Exempt Replacement Well Permit 60,00 60,00 0,00

Application- Outside DesB( Legacy Code:

15)

Subtotal: 0.00

Total: 0,00

Cash) Tendered: 0.00

Change: 0.00

Exempt Replacement Well Please allow 4-6 weeks for the processing of your application. Check the status of your Permit Application- Outside application using the Application/ Receipt number( not order number) at:

DesB( Legacy Code: 15) https://dwr.state,co,us/tools/WellPermits cazo

1313 Sherman Street, Room 821, Denver, CO 80203 P 303.866 3581 www.coloredo.govlwater Jared S. Pots, Governor I Dan Gibbs, Executive Director I Kevin G. Rein, State Engineer/Director