DWR_1382657.pdf

r1 AL CP

COLORADO DIVISION OF WATER RESOURCES

1313 Sherman Street. Room 818 Denver, Colorado 80203

WJH. 2!ii .?~ 7

T".''' FORM MUST BE SUBMITTED

WI'THIN so OA YS OF COMPLETION

OF THE WORK DESCRIBED HERE.

ON. TYPE OR PRINT IN BLACK

INK,

2/ 11' lei I

WELL COMPLETION AND PUMP INSTALLATION REPORT

PERMIT NUMBER 61869~ A

WELL OWNER Lawrence L. Lowery S W N W of Sec.of the

ADDRESS PO Box 346 Julesburq Co 80737 T.....l.L... _B..._, R, 46

19.2Q HOLE DIAMETERDATE COMPLETED Ang. 22

WELL LOG

Water

From To Type and Color of Material Loc.

0 2 Top soil

2 5 Sand & Gravel

5 181 Brule

181 19J Course Sand

190 210 Brule

TOTAL DEPTH 210'

Use additional pages necessary to complete log.

W

JLl.L4in. from 0 to 210 ft.

in. from ft.to

in. from to ft.

DRILLING METHOD Rot~rl__ CASING RECORD: Plain Casing

Size ... 5-"-- & kind --8.tee 1 from 0

I

Ii

2"9

P. M.

Size ..A.\i.."... & kind J?VC from 20

Size _____ & kind ___,~~ from

Perforated Casing to 20ft.

to J..AO_ ft, to __ ft.

Size ..J.i"._ & kind __...l'~ from _ 140 to 210ft.

Size ___ & kind .____ from ~_ to __~ ft.

Size ___ & kind __, from

GROUTING RECORD

Material Ceonen.t

Intervals __ From O_.! o 24' to __ ft.

Placement Method Mixed & Poured

GRAVEL PACK: Size _ Jlu'~ksho.~

Interval Form 0 to 24 '

TEST DATA

Date Tested __ Aug. 22

Static Water Level Prior to Test 100'

19~ ft.

Type of Test Pump Bailed

Length of Test .1!!, hours

Sustained Yield ( Metered) 15 qpm

Final Pumping Water Level 140'

PUMP INSTALLATION REPORT

Pump Make Did not install pump

Type

Powered by HP ~___

Pump Serial No, Motor Serial No.

Date I nstalleo

Pump Intake Depth_

LLJ ,

I \x l-ll.

LLJ 0

Q I-

J Z

0..

0 1IJ

l- e:>

Remarks

WELL TEST DATA WITH PERMANENT PUMP

Date Tested ~

Static Water Level Prior to Test __

Length of Test Hours

Sustained yield ( Metered)_____~ GPM

Pumping Water Level

Remarks __._____~_.__

1' --:..

n:n,..,< ~'-" i.' Lfl.J ;.~."}'::h) f .......... .................- "

I.... , l~ i~: :i,-i: .~;

1.4 .~~<;~ i~ . ,.., r" .'9

J.t' t...... ,~ r

IL CONt. OF

DEPRESSION

M'

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 own knowledge.

rJ) .e-J'1.1:LW~--: U 1-0..41Signature

State of Colorado, County of ___,__~ QSIan

Subscribed and sworn to betore me this 1..L day of Feb

My Commission expires: May 2 , 19.'ll...

E ., gPf.~-U/J-dL__.Notary Public l((~

License No. ~_

SS

19~.

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 filed with the State Engineer. PINK COPY is for the Owner and YELLOW COPY is for the Driller.

Fo-\ TH'Ilo.

GWS- 2,-

OFFICE OF THE STATE ENGINEER

COLORADO DIVISION OF WATER RESOURCES

818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203

303) 866.3581

APPLICANT

WELL PERMIT NUMBER

DIV.!...... CNTY. 58 WD 64 DES, BASIN ~

6/ ftCf Ii

MD~

LAWRENCE L LOWERY

POBOX 346

JULESBURG, CO 80737

APPROVED WELL LOCATION

COUNTY, SEDGWICK ___~__

SW 1/ 4 NW 1/ 4 Section ~__

Twpll N , Range46 W__ ~__ P. M.

DISTANCES FROM SECTION LINES

1934_ Ft. from North Section Line

144 Ft. lrom West Section Line

PERMIT TO CONSTRUCT A WELL

ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT

CONOmONS OF APPROVAL

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

Approved pursuant to CRS 37 -92-602( 3)(c) for the relocation of an existing well, permit no. 61869. The old well must be plugged and abandoned according to the Water Well Construction and Pump Installation Rules within ninety (90) days of completion of the new well. The enclosed well abandonment report form must be completed affirming that the old well was plugged and abandoned.

The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS

37-92-602(1) ( c) , for a commercial business, a gas station/restaurant. Water from this well shall not be used for lawn or landscape irrigation or for any other purpose outside the business building structure.

The maximum pumping rate shall not exceed 15 GPM.

The maximum annual of ground water to be diverted by this well shall not exceed 1 acre-foot.

The return 110w from the use of the well must be returned to the same stream system in which the well is located.

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

m. m ;2-'/-"/

APPROVED:

MAM

a. ;rJ~

Receipt No. 032075~ tate Engl ~..; rf:ftiii;

DATE ISSUEDFEB 0 4 \ 99\

7/1- II- ~~

PIRATION DATE fEB 04 1991 pr:-:f~r~ti' t"Dl- WRJ. 5. Rev. 76 COLORADO DIVISION OF WATER RESOURCES

818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 nEe 2 !{. '90

Application must be complete where applicable. Type or print in BLACK IN K. No overstrikes or erasures unless initialed.

PERMIT APPLICATION FORI\'!

A PERMIT TO USE GROUND WATER

I A PERMIT TO CONSTRUCT A WELL

FOR: I ) A PERMIT TO INSTALL A PUMP

X) REPLACEMENT FOR NO. n 1 Rnq

OTHER

WATER COURT CASE NO.

WATER RESOURCES

ST/\ TE ENGINEER

COLO

l"S:l r..>;;:1

C',.!

g L~ J i r c.)

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

NAME -L..aurpnl' P- 1.. T. o>lery II Receipt No. \.. 9'<l.2 n l-f /{ n /

STREET P. O. Box 346 Basin Dist.

CITY ] 111Q~"hllr~. f':()lorndO 80737 CONDITIONS OF APPROVALState) ( Zip)

TELEPHONE NO. ( 303) 474- 3374 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 that no injury will occur to another vested water right or preclude another owner of a vested water

County Sedq,,ri ek right from seeking relief in a civil court action.

SW % of the NW %, Section 29

Twp. 11 _, Rng. 46 6th P. M.

N, S) ( E, W) ,.

3) WATER USE AND WELL DATA

Proposed maximum pumping rate (gpm) 15 C-

Average annual amount of ground water _.

r--

7to be appropriated ( acre-feet): Nonp. G

Number of acres to be irrigated: None

Proposed total depth ( feet): 200

Aquifer ground water is to be obtained from:

Ogallala

Owner' s well designation Hill Top Conoeo

GROUND WATER TO BE USED FOR:

I HOUSEHOLD USE ONLY. no irrigation ( 0)

XX) DOMESTIC ( 1) ( ) INDUSTRIAL ( 51

I LIVESTOCK ( 2) ( ) IRRIGATION 16)

XXi CDMMERCIAL 141 ( ) MUNICIPAL 18)

I ) OTHER 19) APPLICATION APPROVED

DETAIL THE USE ON BACK IN ( 11)

PERMIT NUM8ER

4) DRILLER

DATE ISSUED

Name St-P..Wnrt Drill i n'J Com.,. EXPIRATION DATE

Street 18897 Hwy 6

City Sterlino. Co. 80751 ( STATE ENGINEER) State) ( Zip)

Telephone No. ( 303 ( 522 - 14 5L4c. No. 66

BY

575' - folf_I.D, COUNTY

5:1

S;I

r. ,

5) THE LOCATION OF THE PROPOSED WELL acd the area on which the water will be used must be indicated on the diagram below.

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

I..

I t-

I t I

I-

I

NORTH +

I i-f

I

I

I 1--

I MILE, 5280 FEET I

t

I

I

I

NORTH SECTION LINE

I

I I w - + - - - + - - m l> Il

1 I .... Il

I m n

T :!

I

I z

I- - + - - -+ z m

I I I I

J

Z o w Il

I- Il W

SOUTH SECTION LINE

I swlo of the NWlo t I

I

I t

I t

I

IiSec. 29- 111- 46

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 gpm pumped continuously for one day produces 4.42 acre-feet.

6) THE WELL MUST BE LOCATED BELOW

by distances from section lines.

lq~4 ft. from _~ orth sec. line north or south)

144 West east or west) sec. lineft. from

LOT BLOCK FILING #

SUBDIVISION

7) TRACT ON WHICH WELL WILL BE

LOCATED Owner:

4No. of acres

T. T.. T. o'tl1P- ry TT

Will this be the only well on this tract? VP.f::.

8) PROPOSED CASING PROGRAM

Plain Casing

41, o ft. to 140in. from ft.

in. from Perforated casing

4~ _ in. from

ft. to ft.

140 ft. to 200 ft.

in. from ft. to ft.

9) FOR REPLACEMENT WELLS give distance and direction from old well and plans for plugging it:

Replacement well is 548 ft.

South of the old well. Old well will be filled with qravel with a 5 ft. cement cap.

10) LAND ON WHICH GROUND WATER WILL BE USED:

Owner( s): Lawrence L. LOwery II No. of acres:

4. 0 acres'

Legal description: swlo of NWlo 29 - 11 - 46

11) DETAILED DESCRIPTION of the use of ground waler: Household use and domestic wells must indicate type of disposal system to be used. .

Well for bus1ness at Hilltop ConoeD. Disposal system consists of two( 2) septic tanks and leach field.

12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers.

Type or right

None

Used for (purpose) Description of land on which used

13) THE APPLlCANT( S) STATE( S) THAT THE INFORMATION SET FORTH HEREON IS

TR~~~;:

ZZ:

L:;

SIGNA rURE 0 APPLlCANT(Si '.

Use additional sheets of paper if more space is required.