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ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602)...

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The following file is part of the Arimetco, Inc. Mining Collection ACCESS STATEMENT These digitized collections are accessible for purposes of education and research. We have indicated what we know about copyright and rights of privacy, publicity, or trademark. Due to the nature of archival collections, we are not always able to identify this information. We are eager to hear from any rights owners, so that we may obtain accurate information. Upon request, we will remove material from public view while we address a rights issue. CONSTRAINTS STATEMENT The Arizona Geological Survey does not claim to control all rights for all materials in its collection. These rights include, but are not limited to: copyright, privacy rights, and cultural protection rights. The User hereby assumes all responsibility for obtaining any rights to use the material in excess of “fair use.” The Survey makes no intellectual property claims to the products created by individual authors in the manuscript collections, except when the author deeded those rights to the Survey or when those authors were employed by the State of Arizona and created intellectual products as a function of their official duties. The Survey does maintain property rights to the physical and digital representations of the works. QUALITY STATEMENT The Arizona Geological Survey is not responsible for the accuracy of the records, information, or opinions that may be contained in the files. The Survey collects, catalogs, and archives data on mineral properties regardless of its views of the veracity or accuracy of those data. CONTACT INFORMATION Mining Records Curator Arizona Geological Survey 416 W. Congress St., Suite 100 Tucson, Arizona 85701 602-771-1601 http://www.azgs.az.gov [email protected]
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Page 1: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

The following file is part of the Arimetco, Inc. Mining Collection

ACCESS STATEMENT

These digitized collections are accessible for purposes of education and research. We

have indicated what we know about copyright and rights of privacy, publicity, or

trademark. Due to the nature of archival collections, we are not always able to identify

this information. We are eager to hear from any rights owners, so that we may obtain

accurate information. Upon request, we will remove material from public view while we

address a rights issue.

CONSTRAINTS STATEMENT

The Arizona Geological Survey does not claim to control all rights for all materials in its

collection. These rights include, but are not limited to: copyright, privacy rights, and

cultural protection rights. The User hereby assumes all responsibility for obtaining any

rights to use the material in excess of “fair use.”

The Survey makes no intellectual property claims to the products created by individual

authors in the manuscript collections, except when the author deeded those rights to the

Survey or when those authors were employed by the State of Arizona and created

intellectual products as a function of their official duties. The Survey does maintain

property rights to the physical and digital representations of the works.

QUALITY STATEMENT

The Arizona Geological Survey is not responsible for the accuracy of the records,

information, or opinions that may be contained in the files. The Survey collects, catalogs,

and archives data on mineral properties regardless of its views of the veracity or

accuracy of those data.

CONTACT INFORMATION Mining Records Curator

Arizona Geological Survey 416 W. Congress St., Suite 100

Tucson, Arizona 85701 602-771-1601

http://www.azgs.az.gov [email protected]

Page 2: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

ARIZONA DEPARTMENT OF WATER RESOURCES OPERATIONS DIVISION

15 South 15th Avenue Phoenix, Arizona 85007

NOTE: A.R.S.§45-593.C. requires that the Department be notified of change of weU ownership and that the weU owner is required to keep the Department's Well Registration records current and accurate. WeU data and ownership changes must be submitted within thirty (30) days after changes take place. Therefore, this form may be completed in fuD by either the previous or new owner.

SA VE THIS FORM TO REPORT FUTURE CHANGES IN OWNERSHIP, CHANGES IN ADDRESS, OR CHANGE IN WELL DATA SUCH AS PUMP CAPACITY, CORRECI10N OF LEGAL DESCRIPTION, CHANGE OF WELL DRILLER AND AMENDING INFORMATION PREVIOUSLY FILED.

CHANGE OF WELL INFORM A TION

Well Registration No. 55-__________ _ File No. _________ {If known)

I/We request the following well information be changed: _________________ _

Date: _____ _ Signature of Current Well Owner _______________ _

STATEMENT OF CHANGE OF WELL OWNERSHIP

1,, ____________ , state that I am (no langer) the (new) owner of the well described below:

___ ',4 ',4 ',4; Section ______ Township _______ Range'--____ _ 10 acre 40 acre 160 acre

Well Registration No. 55-_________ _ File No., __________ (If, known)

PRINT Previous Owner's Name PRINT New Owner's Name

Address Address

City State Zip City State Zip

Dated, __________ Signature PreviouslNew Owner ___________ _

DWR-55-71-6193(Rev)

Page 3: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

~.mIlffi/pIEZOCTtR \flL

FILING FEE $10.00 ..

JlRIZrno. [E>JlR1M:Nf (F W\lIR RESQRC 15 SOUTl-l 1511-1 AVENUE

PHOENIX, JlRIZONA 85007 OOTICE (F INIDmOO 10 mILL r.mITffi/PI~

Sectioo §45-596, Arizooa Revised Statutes provide: Prior to drill ing a rmnitor or piezareter 'hell, the ....ell owner or lessee shall file a Notice of Intention to Drill on a form provided by the Department

1. \rll.L/I..N'ID LOCATIOO: 6. Purpose of \I.e 11 dri 11 ed pursuant 9. Coostructioo will start:

/'/-Section

10 Acre Subdivision

/'Iw ~ Nw .t NE .1 4 4 - 4

10 ACRE 40 ACRE 160 ACRE 2. Crunty 'f..AVtOrPAT

3. Applicant: AR:r;I'7l(;rco IrJc..,

Name 6"2 'IS' f, 8;20 AO w,q y -a 3.ro

Address 7Vf...)~ ,42 gS7J1

City State Zip 4. ,4LlGJ 1:;:, frlG'll-S

Name of Contact Person

Phone L60z..) 7'1 S- '8'~F 2-

Agency ________ _

5. Otrer of Well: ,4r?J;rr1 G nlJ :uHC-

City State Zip

to this notice:

fvbnitor . )<

Piezaneter

7. If for Deepening, Well Regist-tration No: 55-

8. Ot.fler of Land:

111 G kJ~;;t4 ~o ~ f7 A,.J t Nam2 2, 2. .$". vy2 A 12,';.-14- S r.

Address ;>teESfc:JTT

City State Zip

00 tm WUTE IN lHIS SPPU (FfHI:REaRD

File No.A (L/- J..{ ) II..(!- fJ Filed 2 -13 - f 3 Byo....!<;2=---_ Input By ---

[JJPLICATE Mailed!- 1 7 - .13 BY~~_' __ Registration 55- 5""~ 7 2- 0 JlMl\/INA -W/S ~----;S"'/"'B ----

.5~"r 10 73 fvbnth Day Year

10. Period 'hell will rana~ use I D fvbnths rs

11. For monitoring ....ells, is PLll1J equipll2nt to be in­stalled? Yes~ No __

(a) If yes, design pump capacity 8' 8P />J

(b) Type of pump: ~r3 rn(h'Z6/ ($ vIE

submersible, turbine, etc

. (c) W1at use will be made of the water p10#' hi""

12. Drilling Finn: t:}te;".,.t;re-O ];/1/(.. ..

Narre ~6t> 6 2 'I S- F; , (J,etfPlP~

Address e#4OH ,4J? ~711

ttY: State Zip

M License No. $"' Irtt JVl'r t?~~

ROC Category

13. Proposed rrethod of abandonrrent of ....ell after proj ect is canp 1 eted : J3 A c. Ie e. II &0 w F/ t1-!

14. Is this 'hell to rmnitor exisitng contamination? ____ Potential contamination X . Please explain:

CDlRPL INSlRlD100s 1. Fill out this form in IlFLIrATE and send WIlH $10.00 FEE to 15 South 15th Avenue, Phoenix, AI 85007. 2. For specific instructions, limitations and conditions, see the reverse side of this form.

I state that Notice is filed in crnpliance with Sectioo §45-596 and is crnplete and arrect to the best of my kOOolled~ and relief and that I urxJe-stand the and' . crth 00 the reverse side of this fonn.

Date . DWR 55-44-7/90 (Rev.)

Signature of Aj)pl1cant~er Ajt;...r: ,<J~i1Jt£f"£~ r,vc, t:J LL e", f5. We' Lot. .s.

Page 4: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

I:,

.. 15. If construction plans have been coordinated vrith Az. Dept. of Environmental Quality, who is

the agency contact? nfl. GO fb"-l'Q

If construction plans have been coordinated with Az. Dept. Water Resources, Hydrology/Water

Quality Division, who is the division contact? ------------------------------16. WELL CONSTRl.(TI ON PLAN

a) Dri 11 i ng rrethod (rrud rotary, hollow-stem auger, etc. ) __ -=-..:re~r::::..:.R._=____....::::I2::....:o::::._!....r A:.....:..-tVj----L-__ _

b) Borehole diarreters: J Z I} 1.- inches fran 0 feet to 20 feet

7 '9B inches fran 20 feet to «/00 feet

c) Casing materials (PVC, steel, stainless steel, etc.):

material $T!?G L

materi a 1 0:>\1 C.

.s:;" diarreter 8 is ~.() inches fran

diarreter "t "£D, inches fran

t' / I feet to 20 I feet

o feet to C; 00 feet

d) f'ilethod of seal ing at reducti ons, ______________________________________ _

e) Annular seal materials (cement, grout, etc.); rrethod of placement (tremied, circulated) material CG", til"-'T diarreter 3 inches fran 0 feet to ',.2u feet

material [JG.wTDN ~1f3 diarreter ,S inches fran ;lo feet to ~ 00 feet

f) Gravel packs (state material and whether natural or artificial): 1/ .,

material /'1' () ('~Jrt;t.., ""fli'()I'2.,4"l- inches fran :2 I '3 feet to V-OlJ' feet

material inches fran feet to feet .-------

g) Perforations (if pre~anufactured, please give specs of perforations or screens:

type .sL.oT~ c, vr j H PJ ~ c~ .. N-j fran .::; 13 feet to y () D feet type fran feet to, ________ feet

h) f'ilethod of \\e 11 deve 1 oprent (bail, air 1 i ft, surge ). ____ ...!.,t;}.::...~=...c/l..=-___'="0L' ·_r-'_T"-','--________ __

i) Will surface or conductor casing extending above grade be used to protect the aquifer fran additional surface contaminants during drill ing and construction? Y~ No __ _

17. Include detailed construction diagram, if available. 18. Is the proposed \\ellsite vrithin 100 feet of a septic tank system, sewage disposal area,

landfill, hazardous waste facility, storage area of hazardous materials or petroleum storage areas and tanks? Yes __ No---fC

CO"lDITIONS I. Construction and abandonrrent standards for all \\ells shall be in accordance vrith

A.A.C. Rules R12-15-811 and R12-15-816. II. Drilling of the \\ell shall be canpleted within one (1) year after the date of Notice.

III. A Well Driller Report, is required within 30 days of canpletion of drilling. A Can­pletion Report, is required to be filed vrith the Departrrent within 30 days after installation of pump equipment for monitor \\ells.

IV. Pump equipment may not be installed on a \\ell drilled for piezaneter purposes. If a monitor \\ell is pumped, pumping is limited to the maximum amount required for monitor purposes, but in no case may exceed 35 gallons per minute and an annual amount of 10 acre feet total.

V. A.A.C. Rule R12-15-811.H.2, requires that: "A monitor \\ell shall be identified as such on the vault cover or at the top of the steel casing. Identification infonnation will include well registration mIlDer."

VI. Special construction standards required pursuant to A.A.C. Rule R12-15-821:

55-44b-7//CXJ

. .

Page 5: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

ARIZONA DEPARTMENT OF WATER RESOURCES 15 South 15th Avcllue. Phoenix, Arizona 85007

Tclephone (602) 542-1581 Fax (602) 256-0506

B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06

6245 E BROADWAY TUCSON AZ 85711 548

Dear Well Dri! ler:

3-31-94 FIFE SYMINGTON Governor

RITA P. PEARSON Director

The Department of Water Resources issued drilling authority six months ago for the well referenced by the file and registration number as indicated on the above label. To date, our records show that this well has not been drilled.

If well has been drilled, Arizona Revised Statute §45-600 requires that the driller furnish a complete and accurate Well Driller Report (log) within thirty (30) days of concluding drilling.

If this well has been drilled, the file needs the above mentioned report to bring the well into compliance with the law, and you should ensure that this is done.

If this letter does not meet your present circumstance, and the well is to be completed on or before the expiration date of the drilling authority, please disregard.

The Department's file numbering system is explained in detail on the reverse side of this letter.

Your immediate assistance is appreciated. If you have any questions, or need further information, please contact Carlane Stephan at (602) 542-1581.

BSD:dl

DWR-55-60B-6/92(Rev.) 6-month letter

Sincerely,

~J.D-Bruce S. Davis Chief, Operations Division

Page 6: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

t ~u

I ~6 ~ 412 11 ~- I', .. 1-1,,1-- D A 1 0 9 10 l~.H:'---- I-I-'-~- ,b ;r,"; ~) 7 ____ 111 11 16 1.'> 14 L1 f-i- \) -I- ~_" * -A(HI14 lIdb ~ / _~ ~ T 5 H ~ 20 21 n'rl. 14 -, C;;--. -; .. it-t-l-H..- )U 2'J 1U n 2~ Ih H r-I~I"::' ~ ..1t-t-+-+-l--~)1)2))}.4 ) ') )L.~ I , I--c d--I 1.11 S4lt River R 4 E I I = ~k 0 12 Il ~ 11 1 4 ~ LI=c.llnc "--.#--J--I--L-'--'-~

-. / c -t D

~ .--

~<-__ JWa:S -----")0>

Figure 1 Figure 2 Figure J

The st.1te is divided into four Quadmtlls by lhe Gila iUld Salt River Da~c1inc and Meridian. TIle Quadrants arc labelled A, D, C Md D in a counlerclockwise ilirecLioll starting at the northeast qUaLlmnt. See Figure 1.

Each QUallmnl is divided into Townships numbered north and south from the Baseline, Md R.11l·ge numbered C.1St Md WCSI of the Meridian. TIlc Township number appc.1fS on a lopogrnphic map on either side margin (eg: T 5 N); lhe fMlle number appear on the lOp or bouom margin (cg: R 4 E). A nonh township and an cast r.Ulge is in Quallrant A. A north Township and west It11lge is in QUaUrMI B. elC.

An intersection of Township 5 North (T 5 N) Md R.11lge 4 East (R 4 E) is also ca.lled a Township. It is enlarged in Figure 2. A Township usually conuun 36 square miles (or Seclions), numbered in a sel]>Cntine pallem beginning in the northc.1St corner.

Section 14 has been enlarged in Figure 3 to show how it is further subdivided into progressively smaller sets of (luadranlS. The smallest quadr.ult represents a 10-acrc parccl of land. Each sel of quadrants is labelled Il, b, c, and d in a counterclockwise direction sl1ll1ing in lhe 110nhc,L~1 comer.

TI1C well number is defined by assembling the QuadfMt, Township, RiUlge, Section Md thc three subsecLion quadrant identifiers. II pin points lhe lO·"cre pan:cl of lUld in which the well is located. If there arc lwo or more wells in the same IO-acre parcel, consecutive numbers, beginning willl I, arc added al llie end.

' .. . A (5·4) 14 "db 2

.

: 1 I

c

Quadrant (Northeast) ---------------

Township (T 5 N) ----::'.-. ---------.------'

RMgc(R4E) -~------------------------~

SecLion (14) -:------------_____ -.J

'A Section, 160 acres (northeast) ---------------J

'A of the IA Section, 40 acres (soullieast) ------------..J

'A of the 'A of the 'A Seclion, lO'acres (northwest) --------_--J 2nd well in lliis 10 acre tract ------------------'1

lllUS well number A (5-4) 14 adb 2 identifies a weU which is the second wcU (2) in the northwest quarter (b) of the southc.1S1quartcr (d) of lhe northea~t quarter (a) of Section 14 in Township 5 North and R.11lge 4 Ens!, which is . located in the northeast Quad.r.ull (A) of lhe SUite.

Page 7: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

ARIZONA DEPARTMENT OF WATER RESOURCES 15 South 15th Avenue

Phoenix, Arizona 85007

WELL DRILLER REPORT

This report should be prepared by the driller in all detail and filed with the Department within 30 days following completion of the well.

1. Owner Name: Address:

Street City State Zip

2. Driller Name: Address:

Street Cily Stale Zip

3. Location: N/S E/W 1/4 1/4 1/4 Township Range Section lO-acre 40-acre 160-acre

4. Well Registration No. 55-____________ (Required)

5. Permit No. ______________ (If issued)

DESCRIPTION OF WELL

6. Total depth of hole ft.

7. Type of casing

8. Diameter and length of casing in. from to ______ in from ___ to __

9. Method of sealing at reduction points

10. Perforated from to , from to ,from to __ _

11. Size of cuts Number of cuts per foot

12. If screen was installed: Length ft. Diam _____ in. Type. ________ _

13. Method of construction

(drilled, dug, driven, bored, jelted, etc)

14. Date started

Month Day Year

15. Date completed

Month Day Year

16. Depth to water ft. (If flowing well, so slate)

17. Describe point from which depth measurements were made, and give sea-level elevation if available

18. If flowing well, state method of flow regulation: ___________________ _

19. Remarks: ____________ _

DWR·SS-SS·7/91 (Rev.)

DO NOT WRITE IN THIS SPACE OFFICE RECORD

Registration No. File No. ___________ _ Received By ______ _ Entered ____ By ______ _

Page 8: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

LOG OF WELL

Indicate depth at which water was first encountered, and the depth and thickness of water bearing beds. If water is artesian, indicate depth at which encounterd, and depth to which it rose in well.

From To Description of formation material (feet) (feet)

-

I hereby certify that this well was drilled by me (or under my supervision), and that each and all statements herein contained are true to the best of my knowledge and belief.

Driller Nnme: -------------------------------

Street

Cll)' Stnlc Zip OllIe

Page 9: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

ARIZONA DEPARTMENT OF WATER RESOURCES 15 South 15th Avenue

Phoenix, Arizona 85007

WELL DRILLER REPORT

This report should be prepared by the driller in all detail and filed with the Department within 30 days following completion of the well.

I. Owner Name: Address:

Street City State Zip

2. Driller Name: Address:

Street City State Zip

3. Location: N/S E/W 1/4 1/4 1/4 Township Range Section lO-acre 40-acre 160-acre

4. Well Registration No. 55-___________ _ (Required)

5. Permit No. _____________ _ (If issued)

DESCRIPTION OF WELL

6. Total depth of hole ft.

7. Type of casing

8. Diameter and length of casing In. from to

9. Method of sealing at reduction points

10. Perforated from to , from to , from

II. Size of cuts Number of cuts per foot

12. If screen was installed: Length ft. Diarn

13. Method of construction

(drilled, dug, driven, bored, jetted, etc)

in from

to

In. Type

to --

14. Date started. _________________________________ _

Month Day Year

15. Date completed. _______________________________ _

Month Day Year

16. Depth to water ft. (If flowing well, so state)

17. Describe point from which depth measurements were made, and give sea-level elevation if available

18. If flowing well, state method of flow regulation: ____________________ _

19. Remarks: ____________ _

DWR-55-55-7/91 (Rev.)

DO NOT WRITE IN THIS SPACE OFFICE RECORD

Registration No. 55-540719

File No. B ( 1 1 4) 1 2cab Received By ______ _ Entered By ______ _

Page 10: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

LOG OF WELL

Indicate depth at which water was first encountered, and the depth and thickness of water bearing beds. If water is artesian, indicate depth at which encounterd, and depth to which it rose in well.

From To Description of formation material (feet) (feet)

I hereby certify that this well was drilled by me (or under my supervision), and that each and all statements herein contained are true to the best of my knowledge and belief.

Driller Name: -----------------------------

Street

City State Zip Date ________________________________ _

Page 11: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

ARIZONA DEPARTMENT OF WATER RESOURCES 15 South 15th Avenue

Phoenix, Arizona 85007 55- 540 7]g Registration No., _________ _

File No. ____________ _

COMPLETION REPORT

1. Per A.R.S. § 45-600, the Completion Report is to be filed with the Departtnent within 30 days after installation of pump equipment by the registered well owner.

2. Drawdown of the water level for a non-flowing well should be measured in feet after not less than 4 hours of continuous operation and while still in operation and for a flowing well the shut-in pressure should be measured in feet above the land or in pounds per square inch at the land surface.

3. The static groundwater level should be measured in feet from the land surface immediately prior to the well capacity test

4. The tested pumping capacity of the well in gallons per minute for a non-flowing well should be determined by measuring the discharge of the pump after continuous operation for at least 4 hours and for a flowing well by measuring the natural flow at the land surface.

LOCA TION OF THE WELL;

N/S E/W 1/4 1/4 1/4 Township Range Secuon to-acre 40-acre 160-acre

EOUIPMENT INSTALLED:

Kindofpump ______________________________________ _

Turbine, centrifugal, etc.

Kind ofpower ____________________ H.P. Rating of Motor ___________ _ Electric, natural gas, gasoline, etc.

Pumping Capacity Date pump installed: ____________ _

Gallons per minute

WELL TEST;

Test pumping capacity __________________ Date Well Tested:, ___________ _

Gallons per minute

Method of Discharge Measurement. ________________________________ _

Weir, orifice, current meter, etc.

Static Groundwater Level. ______________ ft. Drawdown, ________________ ft

Tota~ing Lift. _________________ ft. Drawdown, ________________ lbs.

(Flowing Well)

I HEREBY CERTIFY that the above statements are true to the best of my knowledge and belief.

Print Well Owner's Name _________________ , 19 __ _

Date Signature of Well Owner or Agent

Address

DWR-55-56-7/91 (Rev.) City State Zip

Page 12: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

ARIZONA DEPARTMENT OF WATER RESOURCES 15 South 15th Avenue

Phoenix, Arizona 85007 55- 540719 Registration No. _________ _

File No. ____________ _

COMPLETION REPORT

1. Per A.R.S. § 45·600, the Completion Report is to be filed with the Department within 30 days after installation of pump equipment by the registered well owner.

2. Drawdown of the water level for a non-flowing well should be measured in feet after not less than 4 hours of continuous operation and while still in operation and for a flowing well the shut-in pressure should be measured in feet above the land or in pounds per square inch at the land surface.

3. The static groundwater level should be measured in feet from the land surface immediately prior to the well capacity test

4. The tested pumping capacity of the well in gallons per minute for a non-flowing well should be determined by measuring the discharge of the pump after continuous operation for at least 4 hours and for a flowing well by measuring the natural flow at the land surface.

LOCATION OF THE WELL;

I) @S Townshlp Range

EOUWMENT INST ALLEDj

12 Secuon

N \1-.1 1/4 to-acre

N E 1/4 40-acre

Sw 1/4 160-acre

Kindofpump ______________________________________ _

Turbine, centrifugal, etc.

Kind ofpower ____________________ H.P. Rating of Motor ___________ _

Electric, natural gas, gasoline, etc.

Pumping Capacity _________________ _ Date pump installed: ____________ _

Gallons per minute

WELLTESTj

Test pumping capacity __________________ Date Well Tested: ___________ _

Gallons per minute

Method of Discharge Measurement. ________________________________ _

Weir, orifice, current meter, etc.

Static Groundwater Level ______________ ft. Drawdown, ________________ ft

Total Pumping Lift. _________________ ft. Drawdown ________________ lbs. (Flowing Well)

I HEREBY CERTIFY that the above statements are true to the best of my knowledge and belief.

Print Well Owner's Name _______________ , 19 __ _

Date Signature of Well Owner or Agent

Address

DWR·55·56·7/91 (Rev.) City State Zip

Page 13: ACCESS STATEMENT CONSTRAINTS STATEMENTdocs.azgs.az.gov/SpecColl/2012-01/2012-01-0065.pdfFax (602) 256-0506 B 110 040 12 CAB WR 540719 LOG ARIMETCO INC 06 6245 E BROADWAY TUCSON AZ

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i YAPAVAJ Co.. Az.

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