Form STATE OF COLORADO For Office Use OnlyNoGWS

OFFICE OF THE STATE ENGINEER RECEIVt18 DIVISION OF WATER RESOURCES5 00 818 Centennial Bldg 1313 Sherman St Denver CO 80203

303 866 Fax 866 JUN 2 U 23581 303 3588

W5TAit GIPAL HNOTICE OF WELL COMPLETIONFor well permits issued pursuant to C R S 37 90 137 4

Insert the Well Permit Number o So zY3F

Well honer Information

NAME S A rAlc K A E EHe e

Mailing Address Z 6 Caw eEc L r

City St Zip Co eo9Za VS yo

Phone 71 1 sq 3 866 i

WELL LOCATION County Ee A4JG Owner s Well

Designations 1SIO 1 4 of thekJ 1 4 SeciTwp 0 N or aS Range 4 X I E or LW S P Mf fDistance from Section Lines s8ea Ft From LJ N or S 90o Ft From E or l V1 Line

Subdivision Name SM w A4 r Nsrarcr Lot e Block Filing Unit

Date ofwell completion 6 Dec F

Name of the Well Construction Contractor Fe e7 c YeA 7 r G c w c 5 e

License Number 79 7

I we claim and say that I we are the owner s of the well described above and that construction of this wellwas completed lawfully under the well permit on the date indicated and the statements made herein are true tomy our knowledge This notice is filed in accordance with Section 37 90 137 3 a 11 C R S

Please print the Signer s Name Title Slgnatur Date

INSTRUCTIONS

This notice is required for wells constructed under permits issued pursuant to the provisions of Colorado RevisedStatutes 37 90 137 4 and must be filed with the Division of Water Resources prior to expiration of the well permitas required by the Statewide Nontributary Ground Water Rule 7A Please type or print neatly in black ink Thisform may be reproduced by photocopy or word processing means

For Office Use Only

FORM NO

rI rise9d

WELL CONSTRUCTION AND TEST REPORTSTATE DF COLORADO OFFICE OF THE STATE ENGINEER

For Office Use only

RECEIVED

JAN 2 0 2000INAirHHr UsrA ttN61WEi

1 WELL PERMIT NUMBER 050243F

2 OWNER NAME S Patrick A Kelleher

Mailing Address 7720 Conifer DrCity St Zip Colo Spgs CO 80920 4540Phone 719 593 8669

3 WELL LOCATION AS DRILLED SW 1 4 NW 114 Sec 9 Twp 11S Range 65 W

DISTANCES FROM SEC LINES1580 ft from North Sec line and 900 ft from West Sec line OR

north orsouth east or

SUBDIVISION Shiloh Ranch Estates LOT BLOCK FILING UNIT 1

STREET ADDRESS AT WELL LOCATION 19260 Shiloh Ranch Dr

4 GROUND SURFACE ELEVATION ft DRILLING METHOD Air Rotary

DATE COMPLETED 12118 99 TOTAL DEPTH 300 ft DEPTH COMPLETED 300 ft

5 GEOLOGIC LOGDepth Description of Material Type else Color Water Location

It

0 1 Top soil

6 HOLE DIAM in From ft To ft9 0 39

6T39 300

1 16 Sand gravel w s tan clay

7 PLAIN CASINGOD in Kind Wall Size From ft To ft

6 Steel 188 1 39

4 PVC 200 12L12201

PERF CASING Screen Slot Size4 PVC 032 220 300

16 35 Loose sand gravel

m 7 81 Sand gravelm w tan brown clay

81 132 Semi loose sand ravel w scan clay

132 222 Sand gravel m w tan brown clay

222 295 Loose to semi loose sand gravel295 300 Tight sand gravel

8 FILTER PACK

Material Quartz

Size 8 12Interval 220 300

9 PACKER PLACEMENT

Type

Depth

10 GROUTING RECORD

Material Amount Density Interval PlacementCement 4Sacks 24 0 39 Pumped

CementREMARKS

11 DISINFECTION Type HTH POWDER Amt Used 2 CUPS

12 WELL TEST DATA Check box if Test Data Is submitted on Supplemental FormTESTING METHOD BLOWNBYAIRStatic Level 80 ft Date Time measured 12 18 99 Production Rate 15 gpm

Pumping level 230 ft Date Time measured 12 17 99 Test length hrs 4

Remarks

1 3 1 have reed the statements made herein and know the contents thereof and that they are true to my knowledge Pursuant to section 24 4 104 18 a C R S the makingof alas statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor

CONTRACTOR Fletcher Drilling Inc Phone 719 481 3589 Lie No 797

Mailing Address 797 Hwy 105 Palmer Lake CO 80133

Name Title Please type or print

Thomas Fletcher President

Signature Date

12118 99

Form No OFFICE OF THE STATE ENGINEERGws12s CiOLORADO DIVISION OF WATER RESOURCES

818 Centennial Bldg 1313 Sherman St Denver Colorado 80203r 303 866 3581

APPLICANT

PATRICK A KELLEHER7720 CONIFER DRCOLORADO SPRING CO

719 593 8669

PERMIT TO CONSTRUCT A WELL

LIC

WELL PERMrr NUMBER 050243 FDIV 1 CNTY 21 WD 1 DES BASIN MD

Lot 6 Block Filing 1 Subdiv SHILCH RANCH ESTATES

80920 4540

APPROVED WELL LOCATION

EL PASO COUNTY

SW 1 4 NW 1 4 Section 9

Twp 11 S RANGE 65 W 6th P M

DISTANCES FROM SECTION LINES

1580 Ft from North Section Line

CONDI110NS OF APPROVAL

900 Ft from West Section Line

1 This well shall be used in such a way as to cause no material injury to existing water rights The issuance of the permit doesnot assure the applicant that no injury will occur to another vested water right or preclude another owner of a vested water rightfrom 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 inaccordance with Rule 18

3 Approved pursuant to CRS 37 90 137 4 and the decree granted In case no 96CW125 Division 1 Water Court case no96CW060 Division 2 Water Court The operation of this well is subject to the terms and conditions of said decrees

4 The uses of ground water withdrawn from this well Is limited to In house use inside one single family dwelling the watering ofup to 5 large noncommercial domestic animals horses and Irrigation of not more than 3 000 square feet of turf grass asspecified in Case no 96CW060 Division 2 Water Court

5 The maximum pumping rate shall not exceed 15 GPM6 The allowed average annual amount of ground water to be withdrawn through this well Is 0 46 acre foot

7 The allowed average annual amount of ground water to be withdrawn through this well In combination with all other wellscompleted in the Dawson aquifer subject tothe decree entered in case no 96CW060 Division 2 Water Court Is 19 54 acre feet

8 The total depth of this well shall not exceed 1085 feet which corresponds to the base of the Dawson aquifer

9 The geophysical logging requirement has been waived

10 The owner shall mark the well In a conspicuous place with well permit numbers s name of the aquifer and court case

numbers s as appropriate The owner shall take necessary means and precautions to preserve these markings

11 The return flow from the use ofthiswell must be through an individual waste water disposal system of the non evaporative typewhere the water is returned to the same stream system In which the well is located

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

13 This well Is subject to administration by the Division Engineer In accordance with applicable decrees statutes rules andregulations

Note To Insure a maximum productive life of this well perforated casing should be set through the entire producing interval ofapproved zone or aquifer indicated above

Note The ability of this well to withdraw Its authorized amount of water from this non renewable aqufer may be lessthan the 100 years upon which the amount of water in the aquifer is allocated due to anticipated water level

declines 0 1 SEE NEXT PAGE

APPROVED ft

KWM

Bate Engineer

JUL p 1998 EXPIRATION DATE J U L l 0 1999Receipt No 0430901 DATE ISSUED J UV 11

SEE NEXT FADE

3 Approved pursuant to CRS 37 90 137 4 on the condition that this well is operated inaccordance with the Gary L Erickson Et Al plan for augmentation approved by the Divsion2 Water Court in case no 96 CW 060 Division 1 watercourt case no 96CW126 if the

well is not operated in accordance with the terms of said decree it will be subject toadministmation including orders to cease pumping

KRW T Fa IRATlON DATE EXTENDED To O O

COLORADO DIVISION OF WATER RESOURCESDIRPARtMENT OF NATURAL RESOURCES1313 SHERMAN ST RM 818 DENVER CO 0203phone info 303 866 3587 main 303 866 3581

RECEIVED

lJUN 011996

rh n SLAJHCF SSTATE ENGINEER

Wt o

RESIDENTIAL fE Note You may also use this form to apply for pmluokwmeadng Water Well Permit ApplicationR ow Instructions rior to commletina form Must be complated in blade ink or typed

1 APPLICANT INFORMATION 6 USE OF WELL check appropriate entry orex M pplle iN

Patrick A Kelleher

Sea instructions to latsmtina uses for which you may quasfy

A Ordinary household use in one single family dwellingLoubme use

B Ordinary household use in 1 to 3 single familydwellings

Number of dwellings 1

Home gardenAawn irrigation not to exceed 1 acre

area irrigated 3000 sq ft acre

0 Domestic animal watering non commercial

C Livestock watering on farm ranchlran e eature

era Aaar

7720 Conifer Drive

City area Be arm

Colorado Springs CO 80920 4540

N aw co a ea0

719 593 766 92 TYPE OF APPLICATION check applicable box esflit Construct new well 0 Use existing well

Replace existing well Change Increase Use

0 Change source aquifer Reapplicatiors apked p miN

0 Other

7 WELL DATAnoon pumping new

15 gpm

An w eawwaeoh

acre feet

rpweeNn

feet

Agdhr

D3 REFER TO if applicablewater court rat r

96CW060 96CW126

Permit If 8 TYPE OF RESIDENTIAL SEWAGE SYSTEMM Septic tank absorption leach field

Central systemDistrict name

Vault

Location sewage to be hauled to

Other attach copy of croneering design

Verbal rVE

Monitoring halo acknowl6domenr IfMH

Wen name or f

4 LOCATION OF WELLcounty

El Paso

Quarter Quarter

SW

Quarter

NW

9 PROPOSED WELL DRILLER optionalN ueu e nnw

Winn

9

Towmhin N or a

11

Range E or W r rplan Aralaah

6th 10 SIGNATURE of applicants or authorized agent

Distance of well from station lines

1580 R from M N s 900 ft from E N w

The making of false statements herein constitutes perjuryin the second degree which is punishable as a class 1 mis

demeanor pursuant to C R S 24 4 104 13 a 1 have read

the statements herein know the contents thereof and state

that they are tive to my knowledge

wIlmwupnaerrerr a different r 0pArraaddneeofapphahiel

19260 Shiloh Ranch Drive

r r w p lrwn a aiy bleu mronlpn am aa dl ro are w r

feet direction G45 TRACT ON WHICH WELL WILL BE LOCATED

A You must check arise of tha following Die instructions

H Subdivision Name Shiloh Ranch EstatesLot no 6 Block no Filing Untt 1

County exemption attach copy of county approval surveyName no Tract no

I3 Mining Claim attach copy of dead or suretyName no

Title

Property Owner

car

Z Zlvr 99OPTIONAL INFORMATION

s p DWI

V4309DI 0 l U

Office use Only TIN OF HATER RESOURCES 4DIV

COO

WO

BA

USE MD

Dow attach hail description to appacalion

B STATE PARCEL

ID laptmailC a sereir less

9 53

D Ara yarn er owner of etas property

1 OYES NO 1f no sae detailed ante

E Will this be the only web on this tractBYES NO of other wets art onthis treat seal detailed inst

Form GWS 44 11 95

EXEMPT WELL DATA SHEET DENVER BASIN COLORAD

APPLICANT KELLEHER RECEIPT NO 430901

LOCATION SW1 4 OF NW1 4 OF SEC 9 T 11S R 65W 1580 NSL 900 WSL

PROPOSED AQUIFER

SURFACE ELEVATION 7440 NUMBER OF ACRES IN TRACT 9 53

IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S B S CONSENT MAPS N

IF SUBDIVISION IS UNDER AUGMENTATION PLAN CASE NO IS

IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH

INFORMATION ON SUBDIVISION OR TRACT OF LAND SPECIAL RESTRICTIONS

note E indicates location is at aquifer boundary and values may be mindicates the proposed aquifer

All values are interpolated from the S B 5 data base assembled in Nove

ELEVATION DEPTH TO ANNUALNET APPROP STAT

AQUIFER HOT TOP SAND BOT TOP A F

UPPER DAWSON 6353 7273 460 1087 167 8 768 NNT

LOWER DAWSON

DENVER 5457 6304 405 1983 1136 6 545 NT

UPPER ARAPAHOE 4894 5419 272 2546 2021 4 390 NT

LOWER ARAPAHOE

LARAMIE FOX HILLS 4267 4529 192 3173 2911 2 745 NT

note E indicates location is at aquifer boundary and values may be mindicates the proposed aquifer

All values are interpolated from the S B 5 data base assembled in Nove

STATE OF COLORADOOFFICE OF THE 5TATE ENGINEERDivision of Water ResourcesDepartment of Natural Resources

1313 Sherman Street Room 818Denver Colorado 80203Phone 303 866 3581FAH 303 8663589

hop water state m us defauIt htm

March 30 1999

Patrick Kelleher7720 Conifer Dr

Co Springs Co 80920 4500

Re Well Permit No 50243 F

Mr Kelleher

iF op

w

re7c

Bill OwensGovernorGreg E W JcherExecutive Uirector

Hal D Simpyun P EState Engineer

It has come to my attention that the condition of approval no 3 on the referenced permit is incorrectEnclosed is a copy of your revised permit with condition of approval no 3 corrected on page 2 Theterms and conditions of your permit are not changed The new condition of approval no 3 referencesthe augmentation plan and corrects the court case number All other conditions remain unchanged

Please replace the your current copy of the referenced permit with the enclosed copy Also pleaseforward the copy to the new owners if you have sold the property associated with the permit

I have also enclosed a change of ownership form for any new owners to complete

Contact me at 303 866 3581 ifyou have any questions regarding this matter

R icFiard A Nie lsen

Water Resource Specialist

RECEIVED

JUL 0 6 1999LtCol Patrick A Kelleher USMC

rL 6NE6p 7720 Conifer DriveCOLO

Colorado Springs CO 80920 4540

1 July 1999

Office of the State Engineer

Division ofWater Resources

Department of Natural Resources1313 Sherman Street Room 818

Denver CO 80203

Sir

Per a recent telephone conversa i on with our office I am requesting a one yearextension for my well permi ave enclosed a check for 60 00

Please feel free to contact me at either work 719 554 5963 or home

719 593 8669 if you have any questions

Sinc

Patrick A Kelleher

CHECKS TR 447382 070699 60 00N OF WATER RESOURCES

Best C Available

Office of the State EngineerDivision of Water Resources

Department of Natural Resources1313 Sherman Street Room 818Denver CO 80203

Sir

LtCol Patrick A Kelleher USMC7720 Conifer Drive

Colorado Springs CO 80920 45401 July 1999

Per a recent telephone conversation with your office I am requesting a one yearextension for my well permit number 50243F I Oave enclosed a check for 60 00

Please feel free to contact me at either work 719 554 5963 or home719 593 8669 if you have any questions

Sinc

Patrick A Kelleher

WAIT R u Ri vu

JUL 15 99 12 2BPh1 J3V5 ADMIN 554 5937 P 1

HQ USSPACECOM J33YSPECIAL TECHNICAL OPERATIONS

FAX COVER SHEET

13ECEIVEDCLASSIFICATION 6 n c LAS P i ieJ JUL r

I999TRANSMITTAL DATE

TOTAL PAGES I COVER

FROM HQUSSPACECOWJ33Y 4 eoc P SareLe NE4

TO Ss ud e COPY

3r r J rrr rQ r Q 8TO r e ro pzr COPY

TO COPY

TO COPY

CMROL NUMBER

RECEIPT REQUESTED YES

SIGNATURE PRINTED

DATE

REMARKS

SUBJECT DATE

At1eec rre rr i Yl T s 99

NO a

JUL 15 99 12 29PM J3V5 RDMIN 554 5937

Office of the State Engineer

Division ofWater ResourcesAttn SandyDepartment of Natural Resources1313 Sherman Street Room 818Denver CO 80203

Sandy

LtCol Patrick A Kelleher USMC7720 Conifer DriveColorado Springs CO 80920 454015 July 1999

AEctry Fa

JUL 151999MVAIEH9TAT4 ENO xEaCOLO NEB

P 2

Per a recent telephone conversation that you had with my wife regarding the reasonthat we have not yet drilled the well the following information is provided We are still inthe planning stages for our future house We have not yet finalized the location of thehouse and until we have accomplished that we cannot determine a specific location forthe associated well I apologize for not providing you with this information sooner but Iaryl an active duty Marine and it has been a quite hectic month

If you have any further questions please feel free to contact me at either work 719554 5983 or home 719 693 8889

Sinceel

Patrick A Kelleher

OFFICE OF THE STATE ENGINEERDivision of Water Resources

Department of Natural Resources

1313 Sherman Street Room 818Denver Colorado 80203

Phone 303 866 3581

FAX 303 866 3589

http water state co us defauIt htm

Patrick Kelleher7720 Conifer Dr

Colorado Spgs CO 80920 4540

RE Well Permit No 50243 F

Dear Mr Kelleher

STATE OF COLORADO

July 16 1999

Your request for an extension oftime to complete the referenced well has been received andreviewed

PRw

x x

M X

reas

Bill OwensGovernorGreg E WalcherExecutive Director

Hal D Simpson P EState Engineer

You are hereby given notice that the State Engineer pursuant to C RS 37 90 137 3 a 1I hasapproved an extension of one year to July 10 2000 A copy ofthe amended well permit isenclosed

Once the well is completed the well owner must tale a Notice of Well Completion prior to the

expiration date ofthe permit The contractor must submit well completion and pump installationreports including well and permanent pumptest data to this office After water from the wellhas been putto beneficial use the well owner must submit Notice ofCommencement of

Beneficial Use to this office within 30 days

Pursuant to the Statewide Nontributary Ground Water Rules if the name and license number ofthe licensed water well contractor who will drill the well was not known atthe time the permitapplication was submitted or the listed licensed water well contractor is cfianged prior to

construction the permitee shall notify the State Engineer in writing of the name and licensenumber ofthe new water well contractor ten days prior to the commencement ofconstruction of

the well Also if any of the information inthe application changes the permittee shall informtheState Engineer within 30 days

If you have any questions please contact this office

Sincerely

Sandy JohnsPhysical Scienc eering Assistant

SMJ smj