Wyo. Code R. 037-0004-4
Effective Date: 03/05/1974 to Current
Rule Type: Current Rules & Regulations
Reference Number: 037.0004.4.03051974
CHAPTER IV.
The following chapter shows sample formats of all the forms dealing with obtaining a ground water right with the State Engineer's Office. All formats shown have been explained in detail in previous chapters.
NOTE: Do not fold this form. Use type-writer or print neatly with black ink.
OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT TO APPROPRIATE GROUND WATER
FILING FEE $2.00
Temporary Filing No. U.W. ____
FOR OFFICE USE ONLY
| PERMIT NO. U.W. |
|---|
| WATER DIVISION NO. DISTRICT |
| U.W. DISTRICT |
NAME AND NUMBER OF WELL
Black Watch No. 1
1. Name of applicant(s) Black Watch Ranch Company Phone: 234-7087
2. Address of applicant(s) P. O. Box 6, Farson, Wyoming Zip: 82932
3. Name & address of agent to receive correspondence and notices John S. Hankins Black Watch Ranch Company, P. O. Box 6, Farson, Wyoming 82932
4. Use to which the water will be applied: Irrigation [X] Municipal [ ] Industrial [ ] Domestic [ ] Stock Watering [X] Miscellaneous (Describe completely and accurately) Water will be used to sell to drilling companies for exploratory drilling.
5. Location of the well: Sweetwater County, SW, N, SW, % of Sec. 23, T. 26, N., R. 107, W., or Lot _, Block of the _ Subdivision (or Add'n) of , N, _, % of Sec. , T. _, N., R. , W., of the 6th P.M. (or W.R.M.), Wyoming. NOTE: Quarter-quarter (40-acre subdivision) must be shown. Example: SEWNW¼ of Sec. 12, Township 14 North, Range 68 West.
6. Estimated depth of the well is 400 feet.
7. MAXIMUM quantity of water to be developed and beneficially used: 900 gallons per minute. NOTE: If for domestic or stock use, this application will be processed for a maximum of 25 gallons per minute. SPRINGS: Only springs flowing 25 gallons per minute or less, where the proposed use is domestic or stock-watering, will be considered as ground water appropriations. After approval of this application, some type of artificial diversion must be constructed to qualify for a water right.
8. If for irrigation use, [X] Land will be irrigated from this well only. [X] Land is irrigated from existing water right(s) with water from this well to be additional supply. Describe existing water right(s) under REMARKS.
9. If for irrigation use, describe MAXIMUM acreage to be irrigated. The number of acres to be irrigated in each 40-acre subdivision MUST be shown in the tabulation below.
| Township | Range | Sec. | NE¼ | NW¼ | SW¼ | SE¼ | TOTALS | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | ||||
| 26N | 107W | 23 | 40 | 40 | 80 | ||||||||||||||
| Lands described above have surface rights from Long Creek, Trib. of | |||||||||||||||||||
| Sweetwater River through the Jones Ditch, Permit 30765, Proof 22179, | |||||||||||||||||||
| O.H. 26, Pg. 472, C.H. 79, Pg. 386 with an additional supply from the | |||||||||||||||||||
| Black Watch No. 1 Well. | |||||||||||||||||||
| 26N | 107W | 26 | 40 | 40 | 40 | 40 | 160 | ||||||||||||
| The lands described above will have original supply from the Black | |||||||||||||||||||
| Watch No. 1 Well | |||||||||||||||||||
| 26N | 107W | 20 | XX | XX | XX | XX | Points of use for water sold for drilling TOTAL ACREAGE | 240 |
10. If the water is to be utilized for some purpose other than irrigation, the area(s) or point(s) of use MUST be shown in the above tabulation.
11. If for irrigation use, describe method of irrigation, i.e. center pivot sprinkler, flood, etc. flood and center pivot sprinkler system
12. The well is to be constructed on lands owned by Black Watch Ranch Co. (The granting of a permit does not constitute the granting of right of way. If any easement or right of way is necessary in connection with this application, it should be understood that the responsibility is the applicant's. A copy of the agreement should accompany this application, if the land is privately owned and the owner is on a co-applicant.)
13. The water is to be used on lands owned by Black Watch Ranch Co. (If landowner is not the applicant, a copy of the agreement relating to usage of appropriated water on the land should be submitted to this office. If the landowner is included as a co-applicant on the application, this procedure need not be followed.)
REMARKS
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true, correct and complete.
BY: John A. Harkins Signature of Applicant or Authorized Agent Black Watch Ranch Co. Date March 30 19 73
THE STATE OF WYOMING ) ) ss. STATE ENGINEER'S OFFICE )
This instrument was received and filed for record on the __ day of _, A. D. 19_, at __ o'clock __ M.
Permit No. U. S.
for State Engineer
THIS IS TO CERTIFY that I have examined the foregoing application and do hereby grant the same subject to the following limitations and conditions:
This application is approved subject to the condition that the proposed use shall not interfere with any existing rights to ground water from the same source of supply and is subject to regulation and correlation with surface water rights, if the ground and surface waters are interconnected. The use of water hereunder is subject to the further provisions of Chapter 169, Session Laws of Wyoming, 1957, and any subsequent amendments thereto.
Granting of a permit does not guarantee the right to have the water level or artesian pressure in the well maintained at any specific level. The well should be constructed to a depth adequate to allow for the maximum development and beneficial use of ground water in the source of supply.
If the well is a flowing artesian well, it shall be so constructed and equipped that the flow may be shut off when not in use, without loss of water into surface formations or at the surface.
The right to temporary industrial use for selling of water for drilling purposes as granted by this permit will extend for a period of five years from the date of approval, or until ______. At that time the miscellaneous use will be automatically deleted unless a request for extension of time for such use is approved by the State Engineer. No final Proof of Appropriation will be required under this permit.
Approval of this application may be considered as authorization to proceed with construction of the proposed well.
Construction of well will begin within one (1) year from date of approval. A Statement of Completion will be filed within thirty (30) days of completion of construction, including pump installation.
Completion of construction and completion of the beneficial use of water for the purposes specified in Item 4 of this application will be made by December 31, 19____.
The amount of appropriation shall be limited to the quantity to which permittee is entitled as determined at time of proof of application of water to beneficial use.
Witness my hand this __ day of _, A. D. 19_.
State Engineer
SUBMIT THIS FORM WHEN CONSTRUCTION OF THE WELL BEGINS
GROUND WATER
NOTICE OF COMMENCEMENT OF WORK
Parson, Wyoming, April 17 19 73
State Engineer
State Office Bldg., Cheyenne, Wyoming 82001
I hereby notify you that work on the Black Watch No. 1 Well began on the 15th day of April, 19 73.
BLACK WATCH RANCH CO. Signature: BY: John S. Hawkins Manager Applicant
PLEASE NOTE: The STATEMENT OF COMPLETION form must be submitted to the State Engineer within 30 days of well completion (with pump).
NOTE: Do not fold this form. Use typewriter or print neatly with black ink.
IF WELL IS TO BE ABANDONED, SEE ITEM 15, PAGE 4
OFFICE OF THE STATE ENGINEER
STATEMENT OF COMPLETION AND DESCRIPTION OF WELL
(For wells used only for stock or domestic purposes, use Form U.W. 7)
NAME OF WELL. Black Watch No. 1
1. NAME OF OWNER Black Watch Ranch Company
2. ADDRESS P. O. Box 6 Farson, Wyoming Zip Code 82932
3. USE OF WATER: Domestic ☐ Stock Watering ☒ Irrigation ☒ Municipal ☐ Industrial ☐ Miscellaneous ☒ Water will be used to sell to drilling companies
4. LOCATION OF WELL: SW ¼ SW ¼ of Section 23 T 26 N., R. 107 W., of the 6th P.M. (or W.R.M.), Wyoming, being specifically N 10° 3' East, 500 feet (Bearing and Distance) or ft. North and ft. East from the SW corner of Section 23 T 26 N., R. 107 W. (Strike out words not needed).
5. TYPE OF CONSTRUCTION: Drilled ☒ rotary (Type of Rig) Dug ☐ Drives ☐ Jetted ☐ Other
6. CONSTRUCTION: Total Depth 360 ft. Depth to Water Level 90 ft.
a. Casing Schedule New ☒ Used ☐ 16" diameter from + 1½ ft. to 113 ft. Material Gage diameter from ft. to ft. Material Gage diameter from ft. to ft. Material Gage
b. Perforations: Type of perforator used None Size of perforations inches by inches. Number of perforations and depths where perforated: perforations from ft. to feet. perforations from ft. to feet.
c. Was well screen installed? Yes ☐ No ☒ Diameter: slot size: set from feet to feet. Diameter: slot size: set from feet to feet.
d. Was well gravel packed? Yes ☐ No ☐ Size of gravel e. Was surface casing used Yes ☒ No ☐ Was it cemented in place? Yes ☒ No ☐
7. NAME & ADDRESS OF DRILLER Sam Cable, Rock Springs, Wyoming
8. DATE OF COMPLETION OF WELL (including pump installation) May 2, 1973
9. PUMP INFORMATION: Manufacturer Western Land Roller Type Turbine Source of power electric Horsepower 40 Depth of Pump Setting 120 Amount of Water Being Pumped 850 Gallons Per Minute.
10. PUMP TEST: Was a pump test made? Yes ☐ No ☐
If so, by whom Sam Cable Address Rock Springs, Wyoming
Yield: 850 gal./min. with 10 foot drawdown after 24 hours.
Yield: _ gal./min. with _ foot drawdown after ____ hours.
11. FLOWING WELL (Owner is responsible for control of flowing well). WELL DOES NOT FLOW
If well yields artesian flow, yield is _ gal./min. Surface pressure is _ lb./sq. inch, or ____ feet of water.
The flow is controlled by: valve ☐ cap ☐ plug ☐
Does well leak around casing? Yes ☐ No ☐
12. LOG OF WELL: Total depth drilled 360 feet.
Depth of completed well 360 feet. Diameter of well 16 inches.
Depth to first water bearing formation 75 feet.
Depth to principal water bearing formation Top 300 feet to Bottom 360 feet.
Ground Elevation, if known ____
| From Feet | To Feet | Material Type, Texture, Color | REMARKS (Cementing, Shutoff, Packing, etc.) | Indicate Water Bearing Formation | Indicate Perforated Casing Location |
|---|---|---|---|---|---|
| 0 | 15 | Soil and surface sand | Cased from 1½" above | ||
| 15 | 35 | blue clay | ground surface to 113' | ||
| 35 | 75 | coal | some water | ||
| 75 | 103 | gray shale, some sand | |||
| 103 | 165 | blue shale | |||
| 165 | 220 | coal | |||
| 220 | 280 | gray shale | |||
| 280 | 300 | blue shale | |||
| 300 | 360 | gray sand | principle water |
QUALITY OF WATER INFORMATION:
Was a chemical analysis made? Yes ☐ No ☑
If so, please include a copy of the analysis with this form.
If not, do you consider the water as: Good ☐ Acceptable ☑ Poor ☐ Unusable ☐
a. If for irrigation, the land proposed to be irrigated should be described in the following tabulation. Describe in the "Remarks" section, under Item 14, the means of conveying the water to the lands and the method of irrigation.
(Give irrigable acreage in each legal subdivision. If proposed use is for supplemental supply for lands with a right from another source, indicate in the tabulation the priority or permit number, the source of supply and the name of the ditch or other well.)
b. If not used for irrigation, show the area and point(s) of use and location of well in the tabulation below. Also describe the method of conveyance in the "Remarks" section under Item 14.
| Township | Range | Sec. | NE¼ | NW¼ | SW¼ | SE¼ | TOTALS | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | ||||
| 26N | 107W | 23 | 35 | 28 | 63 A.S. | ||||||||||||||
| 26N | 107W | 26 | 35.5 | 35.5 | 35.5 | 35.5 | 142.0 O.S. | ||||||||||||
| 26N | 107W | 23 | |||||||||||||||||
| X Point of Use for Stockwatering |
TOTAL NUMBER OF ACRES TO BE IRRIGATED 205
Original Supply 142.0 acres
Supplemental Supply 63.0 acres
a. If the well is to be used for irrigation, industrial, miscellaneous or municipal use, show the location of the well on the plat below. For such uses, a plat certified by a licensed engineer or land surveyor is required to be submitted at the time the Proof of Appropriation and Beneficial Use of Ground Water is submitted. b. For other uses, accurately show the well location, point of use or uses and describe method of conveyance of water to points of use on plat and in "Remarks" section below. Make certain location on plat agrees with written description. c. A separate map may be submitted if the information required cannot be shown on this plat.
Flood irrigated; surface rights from Jones Ditch. Additional supply from Black Watch No. 1 Well.
Original supply from Black Watch No. 1 Well. 13-tower "Valley" sprinkler system.
REMARKS. Miscellaneous use for sale of water to drilling companies for exploratory drilling. Water sold at the well site and hauled to drilling sites in trucks.
15. IF WELL IS TO BE ABANDONED, complete Items 1 through 8, Item 12 (Log of Well) and state reason for abandonment below.
It is the responsibility of the owner to properly plug or fill in the well in order to prevent contamination of ground water and to cover or cap the well at ground level.
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is true, correct and complete.
BY:
Manager Black Watch Ranch Company
May 3 19 73
Date of Receipt____, 19__
Date of Priority_ April 5_, 19 73
Date of Approval____, 19__
for State Engineer
NOTE: Do not fold this form. Use typewriter or print neatly with black ink.
OFFICE OF THE STATE ENGINEER
The owner is responsible for submitting Parts I and II of this form. Part III will be prepared by a State Engineer Representative at time of inspection.
| WATER DIVISION 4 (6) | U.W. DISTRICT Sweetwater County |
|---|---|
| STATEMENT OF CLAIM | DATE OF PRIORITY April 5, 1973 |
| PERMIT NO. U.W. 22000 | LOCATION SW % SW % of Section 23 |
| WELL REGISTRATION | T. 26 N. R. 107 W. |
| NAME OF WELL Black Watch No. 1 |
1. Name of Claimant(s) Black Watch Ranch Company
2. Address P. O. Box 6 Farson, Wyoming Zip Code 82932
3. For What Purpose(s) is Water Used? Use: Irrigation Date First Used May 12, 19 73 Use: Miscellaneous Date First Used: June 1, 19 73 Use: Stock Date First Used May 12, 19 73 If use is for irrigation, give date irrigation was completed on all lands under this Permit: June 6, 1973
For Irrigation, Industrial, Municipal and Miscellaneous Wells
A plat which has been certified by a licensed professional engineer or land surveyor shall be submitted to accompany this form. The plat shall be in accordance with Sec. 33-366 Wyoming Statutes (1957 Supp.) or see Chapter V and VI, Manual of Regulations and Instructions issued by the State Engineer's Office. (Minimum scale shall be 2" = 1 mile.) The map shall be prepared with waterproof black ink on tracing linen or an acceptable equivalent and shall show on a suitable scale the legal subdivisions, the accurate location of the well or wells, storage facilities, if any, main canals, streams, highways and other important cultural features. Land ownership will be shown, if there is more than one owner under the permit.
IRRIGATION WELLS
Acreage irrigated under terms of this permit will be clearly shown with a distinctive pattern and a distinction clearly made between lands having an original supply and those provided a supplemental supply. Where use is for supplemental supply for lands with a right from another source, indicate the priority or permit number of the source, the source of supply and the name of the ditch, pipe line or other well. Conveyance system will be shown and described. Indicate method of irrigation being used.
INDUSTRIAL WELLS
In addition to the information outlined above, industrial users will locate and describe conveyance facilities to the point(s) of use, giving as accurately as possible the location of points of use. Permits for other sources of water must be identified.
MUNICIPAL WELLS
The plat will show the area of use and show and describe the means of conveyance of the water from the well to the connection with the distribution system for a municipal water system.
MISCELLANEOUS WELLS
(1) The linen plat for wells where the use is described as miscellaneous and where the yield flow of the well exceeds twenty-five (25) gallons per minute must show the area of use and describe and show the means of conveyance from the well to the distribution system and/or points of use. (2) The plat for wells where the use is described as miscellaneous and where the yield or flow is twenty-five (25) gallons per minute or less may be a 7% minute United States Geological Survey Quadrangle map in lieu of a linen tracing provided the U.S. Geological Survey Quadrangle map is in compliance with the following conditions: (a) The entire United State Geological Survey quadrangle map must be submitted to the State Engineer's Office. (b) The scale on said quadrangle map must be one to twenty-four thousand. (c) An identified section corner or quarter corner must be shown on said quadrangle map along with Section, Township and Range. (d) The section in which the well is located and the section(s) where the area(s) or point(s) of use are located must be subdivided into forty (40) acre tracts and the well location and area(s) or point(s) of use clearly labeled and described. (e) Said quadrangle map showing the well location and area(s) or point(s) of use must be certified by a professional engineer or land surveyor licensed to practice within the State of Wyoming.
Proof Number U.W.
C.R. U.W. Pg.
Order Record Pg.
WATER DIVISION 4 DIST 6
STATEMENT OF CLAIM NO. U.W.
WELL REGISTRATION NO. U.W.
NAME OF WELL Black Watch Ranch Company
U.W. DISTRICT Sweetwater County
DATE OF PRIORITY April 5, 1973
LOCATION SW 1/4 SW 1/4 of Section 23 T. 26 N. R. 107 W.
Name of Claimant Black Watch Ranch Company
Post Office P. O. Box 6 Farson State Wyoming Zip Code 82932
Field Inspection made on 18th day of August 19 73
Size of surface casing Flowing Well? NO Use IRRIGATION - MISCELLANEOUS - STOCK
DESCRIPTION OF PUMP: Make Western Land Roller Type Turbine I.D. No. C7089
Rated H.P. 40 Type of Power Electric Make General Electric I.D. No. BEJ22661
Discharge Pressure Unknown psi Static Water Level 90 ft. Pumping Level 100 ft.
Size of Discharge Line 8" O.D. Amount of Water Produced 850 G.P.M.
How was production determined? Pitot tube, manometer and open discharge
Is well described accurately on Statement of Completion? ☑ Yes ☐ No. If not, describe difference
Other wells in the same distribution system? ☐ Yes ☑ No. If yes, describe
Description of Conveyance of Water From an 8 inch buried pipeline extending approximately 1,600
feet southeast from the well to the pivot located in the center of the NW 1/4 of Section 26.
SPRINKLER SYSTEMS: Type Center Pivot Length 1,580 ft. Make Valley
I.D. No. None Nozzle size & spacing Variable # No. of Towers 13
Mainline Size 5 1/4" I.D. in. Lateral Lines --- in. End Gm. Yes
System Pressure 76 psi Where measured First nozzle past pivot
Any existing Surface Water Sources? ☑ Yes ☐ No. If yes, describe Surface rights from Long
Creek, Trib. of Sweetwater River, through the Jones Ditch, Permit No. 30765.
Does irrigated acreage, points of use, etc. agree with Map submitted? ☑ Yes ☐ No. If not, describe difference
Are all ditches, pipelines, etc. shown and properly labeled? ☑ Yes ☐ No. If not, describe difference
Does construction comply with State Engineer's Standards? ☑ Yes ☐ No. If not, Why?
A "CERTIFICATE OF OWNERSHIP" FROM THE COUNTY CLERK'S OFFICE SHOWING OWNERSHIP OR CONTROL OF LAND(S) INVOLVED MUST ACCOMPANY THIS FORM.
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is true, correct and complete.
BY:
John L. Harkins, Manager, June 10, 19 73 Black Watch Ranch Company
Date of Receipt: ___, 19___
AVERAGE TABULATION AND/OR POINTS OF USE
| Two | Range | Sec. | NE¼ | NW¼ | SW¼ | SE¼ | TOTAL | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | |||||
| 26N | 107W | 23 | 35 | 28 | 93 A.S. | |||||||||||||||
| Lands described above have surface rights from the Long Creek, Trib. of Sweetwater River, through the Jones Ditch, Permit 30765, Proof 22179, O. R. 26, Pg. 472, C. R. 79, Pg. 386 with an additional supply from the Black Watch No. 1 Well. | ||||||||||||||||||||
| 26N | 107W | 26 | 35 | 35 | 35 | 35 | 140 O.S. | |||||||||||||
| The lands described above will have original supply from the Black Watch No. 1 Well. | ||||||||||||||||||||
| 26N | 107W | 20 | XX | XX | XX | XX | Points of Use for water sold for drilling | |||||||||||||
| 26N | 107W | 23 | X | Point of Use for Stockwatering |
Does above tabulation agree with Map submitted? ☑ Yes ☐ No. If not, Why?
Does claimant own all lands shown in the above tabulation? ☑ Yes ☐ No.
Claimants:
Supporting Documents: Certificate of Ownership
Do you recommend approval? ☑ Yes ☐ No
OFFICE OF THE STATE ENGINEER
WATER DIVISION NO. 4 DISTRICT 6
U.W. DISTRICT Sweetwater County
NAME AND NUMBER OF WELL
Black Watch No. 1
STATEMENT OF CLAIM
WELL REGISTRATION
DATE OF PRIORITY April 5, 1973
LOCATION SW ¼ SW ¼ of Section 23
T 26 N. R. 107 W.
I, Richard G. Stockdale, being an authorized representative of the State Engineer, have this 18th day of August 19 73 conducted a field inspection of the above well and accompanying facilities to determine Proof of Appropriation and Beneficial Use of Ground Water. I have found everything in agreement with Permit No. U. W. 22000, required notices and the certified map filed in conjunction with Proof of Appropriation and Beneficial Use, Form U.W. 8; subject to the following exceptions:
DATE 8-18-73
I, John S. Hankins, Manager do depose and say that I have read the Proof of Appropriation and Beneficial Use of Ground Water and am witness to the field inspection conducted this 18th day of August 19 73. I agree with the findings of said inspection and exceptions as noted above. I further agree to the amendment of existing records to reflect the findings of this inspection.
John S. Hankins DATE 8-18-73
| THE STATE OF WYOMING Certificate of Appropriation of Ground Water Proof No. U.W. 300 Certificate Record No. U.W. 40, Page 60 |
|---|
| WHEREAS, Black Watch Ranch Company has presented to the Board of Control of the State of Wyoming proof of the appropriation of ground water from the Black Watch Ranch No. 1 Well located in the SW1SW of Section 23 T. 26 N. R. 107 W., under Permit No. U.W. 22000, for Miscellaneous (selling of water for drilling) Stock 6 irrigation of the lands herein described, lying and being in Sweetwater County, Wyoming. NOW KNOW YE, That the State Board of Control, under the provisions of the Statutes of Wyoming, has, by an order duly made and entered on the 10th day of November, A. D. 1973, in Order Record No. 300, Page 651, determined and established the priority and amount of such appropriation as follows: Name of Appropriator Black Watch Ranch Company; Mailing Address P. O. Box 6 Farson, Wyoming; Date of Appropriation April 5, 1973; Total Acreage 203; Amount of Appropriation 850 gallons per minute; Description of land to be irrigated and for which this appropriation is determined and established: |
| TWP. |
| NE¼ |
| 26N |
| 26N |
| 26N |
The right to water hereby confirmed and established is limited to irrigation Miscellaneous (selling of water for exploratory drilling) Stock and the use is restricted to the place where acquired and to the purpose for which acquired and shall not exceed the amount of the appropriation stated above.
IN TESTIMONY WHEREOF, I, FLOYD A. SISROP, President of the State Board of Control, have hereunto set my hand this 10th day of November, A. D. 1973, and caused the seal of said Board to be hereunto affixed. Attest: [Signature] Ex-officio Secretary. [Signature] President.
NOTE: Do not fold this form. For type writer or print neatly with black ink.
OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT TO APPROPRIATE GROUND WATER
FILING FEE $2.00
Temporary Filing No. U.W.
FOR OFFICE USE ONLY
| PERMIT NO. U.W. |
|---|
| WATER DIVISION NO. DISTRICT |
| U.W. DISTRICT |
NAME AND NUMBER OF WELL
Summer Spring No. 1
1. Name of applicant(s) John Flower Phone:
2. Address of applicant(s) 1794 Rosebud, Sundance, Wyoming Zip: 82729
3. Name & address of agent to receive correspondence and notices Same
4. Use to which the water will be applied: Irrigation [ ] Municipal [ ] Industrial [ ] Domestic [☑] Stock Watering [ ] Miscellaneous (Describe completely and accurately)
5. Location of the well: Crook County, NE, NE, % of Sec. 10, T. 51, N., R. 63, W., or Lot _, Block of the _ Subdivision (or Add'n) of , _, , % of Sec. _, T. , N., R. ____, W., of the 6th P.M. (or W.R.M.), Wyoming. NOTE: Quarter-quarter (40-acre subdivision) must be shown. Example: SE¼NW¼ of Sec. 12, Township 14 North, Range 68 West.
6. Estimated depth of the well is 12 feet.
7. MAXIMUM quantity of water to be developed and beneficially used: 15 gallons per minute. NOTE: If for domestic or stock use, this application will be processed for a maximum of 25 gallons per minute. SPRINGS: Only springs flowing 25 gallons per minute or less, where the proposed use is domestic or stockwatering, will be considered as ground water appropriations. After approval of this application, some type of artificial diversion must be constructed to qualify for a water right.
8. If for irrigation use, [ ] Land will be irrigated from this well only. [ ] Land is irrigated from existing water right(s) with water from this well to be additional supply. Describe existing water right(s) under REMARKS.
9. If for irrigation use, describe MAXIMUM average to be irrigated. The number of acres to be irrigated in each 40-acre subdivision MUST be shown in the tabulation below.
| Tensile Ship | Range | Sec. | NE¼ | NW¼ | SW¼ | SE¼ | TOTALS | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | ||||
| 51N | 63W | 10 | X | Point of Use of Well | |||||||||||||||
10. If the water is to be utilized for some purpose other than irrigation, the area(s) or point(s) of use MUST be shown in the above tabulation.
11. If for irrigation use, describe method of irrigation. i.e. center pivot sprinkler, flood, etc.
12. The well is to be constructed on lands owned by applicant. (The granting of a permit does not constitute the granting of right of way. If any easement or right of way is necessary in connection with this application, it should be understood that the responsibility is the applicant's. A copy of the agreement should accompany this application, if the land is privately owned and the owner is to a coapplicant.)
13. The water is to be used on lands owned by applicant. (If landowner is not the applicant, a copy of the agreement relating to usage of appropriated water on the land should be submitted to this office. If the landowner is included as a coapplicant on the application, this procedure need not be followed.)
REMARKS: This spring will be dug out to approximately 10 feet and a collection box made of cement will be installed. Water will then be piped 150 feet to a cabin for domestic use. Said point of use is located in the NE&NE¼ Section 10, Township 51 North, Range 63 West.
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true, correct and complete.
John F. Johnson
THE STATE OF WYOMING )
) ss.
STATE ENGINEER'S OFFICE )
This instrument was received and filed for record on the day of A. D.
19___, at ___ o'clock ___ M.
for State Engineer
THIS IS TO CERTIFY that I have examined the foregoing application and do hereby grant the same subject to the following limitations and conditions:
This application is approved subject to the condition that the proposed use shall not interfere with any existing rights to ground water from the same source of supply and is subject to regulation and correlation with surface water rights, if the ground and surface waters are interconnected. The use of water hereunder is subject to the further provisions of Chapter 169, Session Laws of Wyoming, 1957, and any subsequent amendments thereto.
Granting of a permit does not guarantee the right to have the water level or artesian pressure in the well maintained at any specific level. The well should be constructed to a depth adequate to allow for the maximum development and beneficial use of ground water in the source of supply.
If the well is a flowing artesian well, it shall be so constructed and equipped that the flow may be shut off when not in use, without loss of water into surface formations or at the surface.
Approval of this application may be considered as authorization to proceed with construction of the proposed well.
Construction of well will begin within one (1) year from date of approval. A Statement of Completion will be filed within thirty (30) days of completion of construction, including pump installation.
Completion of construction and completion of the beneficial use of water for the purposes specified in Item 3 of this application will be made by December 31, 19__.
The amount of appropriation shall be limited to the quantity to which permittive is entitled as determined at time of proof of application of water to beneficial use.
Witness my hand this day of A. D. 19__.
State Engineer
NOTE. Do not fold this form. Use type-writer or print neatly with black ink.
OFFICE OF THE STATE ENGINEER
APPLICATION FOR PERMIT TO APPROPRIATE GROUND WATER
FILING FEE $2.00
Temporary Filing No. U.W.
FOR OFFICE USE ONLY
| PERMIT NO. U.W. |
|---|
| WATER DIVISION NO. DISTRICT |
| U.W. DISTRICT |
NAME AND NUMBER OF WELL
Maddy No. 12
1. Name of applicant(s) KERR-MC GEE Phone: 235-6600
2. Address of applicant(s) P. O. Box 800 Casper, Wyoming Zip: 82601
3. Name & address of agent to receive correspondence and notices Joe James
P. O. Box 800 Casper, Wyoming 82601
4. Use to which the water will be applied: Irrigation [ ] Municipal [ ] Industrial [X] Domestic [ ] Stock Watering [ ] Miscellaneous (Describe completely and accurately)
Secondary Recovery Operation
5. Location of the well: Campbell County, NE ¼, NW ¼ of Sec. 27, T. 47 N., R. 71 W., or Lot _, Block of the _ Subdivision (or Add'n) of , _ ¼ of Sec. , T. _ N., R. W., of the 6th P.M. (or W.R.M.), Wyoming. NOTE: Quarter-quarter (40-acre subdivision) must be shown. Example: SE¼NW¼ of Sec. 12, Township 14 North, Range 68 West.
6. Estimated depth of the well is ____ feet. THIS IS AN OIL WELL SEPARATOR
7. MAXIMUM quantity of water to be developed and beneficially used: 200 gallons per minute. NOTE: If for domestic or stock use, this application will be processed for a maximum of 25 gallons per minute. SPRINGS: Only springs flowing 25 gallons per minute or less, where the proposed use is domestic or stockwatering, will be considered as ground water appropriations. After approval of this application, some type of artificial diversion must be constructed to qualify for a water right.
8. If for irrigation use, [ ] Land will be irrigated from this well only. [ ] Land is irrigated from existing water right(s) with water from this well to be additional supply. Describe existing water right(s) under REMARKS.
9. If for irrigation use, describe MAXIMUM acreage to be irrigated. The number of acres to be irrigated in each 40-acre subdivision MUST be shown in the tabulation below.
| Square Shore | Range | Sec. | NE¼ | NW¼ | SW¼ | SE¼ | TOTALS | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | NE¼ | NW¼ | SW¼ | SE¼ | ||||
| 47N | 71W | 27 | X | X | X | ||||||||||||||
10. If the water is to be utilized for some purpose other than irrigation, the area(s) or point(s) of use MUST be shown in the above tabulation.
11. If for irrigation use, describe method of irrigation, i.e. center pivot sprinkler, flood, etc.
12. The well is to be constructed on lands owned by Federal Government (BLM) (The granting of a permit does not constitute the granting of right of way. If any easement or right of way is necessary in connection with this application, it should be understood that the responsibility is the applicant's. A copy of the agreement should accompany this application, if the land is privately owned and the owner is no a co-applicant.)
13. The water is to be used on lands owned by Federal Government (BLM) (If landowner is not the applicant, a copy of the agreement relating to usage of appropriated water on the land should be submitted to this office. If the landowner is included as a co-applicant on the application, this procedure need not be followed.)
REMARKS: There are 10 oil wells tied to this well and they are producing from the Muddy Formation.
THE LEGALLY REQUIRED FILING FEE MUST ACCOMPANY THIS APPLICATION
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true, correct and complete.
Joe James, Production Signature of Applicant or Authorized Agent Superintendent Sept 12, 1972
THIS SECTION IS NOT TO BE FILLED IN BY APPLICANT
THE STATE OF WYOMING ) ) ss.
STATE ENGINEER'S OFFICE )
This instrument was received and filed for record on the __ day of _, A. D. 19_, at __ o'clock ____ M.
for State Engineer
THIS IS TO CERTIFY that I have examined the foregoing application and do hereby grant the same subject to the following limitations and conditions:
This application is approved subject to the condition that the proposed use shall not interfere with any existing rights to ground water from the same source of supply and is subject to regulation and correlation with surface water rights, if the ground and surface waters are interconnected. The use of water hereunder is subject to the further provisions of Chapter 169, Session Laws of Wyoming, 1957, and any subsequent amendments thereto.
Granting of a permit does not guarantee the right to have the water level or artesian pressure in the well maintained at any specific level. The well should be constructed to a depth adequate to allow for the maximum development and beneficial use of ground water in the source of supply.
If the well is a flowing artesian well, it shall be so constructed and equipped that the flow may be shut off when not in use, without loss of water into surface formations or at the surface.
Approval of this application may be considered as authorization to proceed with construction of the proposed well.
Construction of well will begin within one (1) year from date of approval. A Statement of Completion will be filed within thirty (30) days of completion of construction, including pump installation.
Completion of construction and completion of the beneficial use of water for the purposes specified in Item 4 of this application will be made by December 31, 19____.
The amount of appropriation shall be limited to the quantity to which permittee is entitled as determined at time of proof of application of water to beneficial use.
Witness my hand this __ day of _, A. D. 19_.
State Engineer
Form U.W. 7
IF WELL IS TO BE
ABANDONED, SEE ITEM 20
NOTE: Do not fold this form. Use typewriter or print neatly with black ink.
OFFICE OF THE STATE ENGINEER
for Domestic or Stock Watering Use Only
A preferred water right is given to such use when the yield or flow does not exceed .066 cubic feet per second or 25 gallons per minute. Domestic use refers to household use and the watering of lawns and gardens for family use, not to exceed one acre.
Water Division No.
U.W. District
Temporary Filing No.
Completed Prior to May 24, 1969
☐
NAME OF WELL Mark No. 1
1. Owner Andrew W. Wallace
2. Address Box 841 Buffalo, Wyoming 82834
3. Agent to receive correspondence Same
4. Name & address of driller C. T. Reid 400 E. Mt. Evans Road, Sheridan, Wyoming 82801
5. Well is constructed on lands owned by applicant (Obtaining of easement or right of way is the responsibility of the applicant's. Include copy if land is privately owned and owner is not a co-applicant.)
6. Type of construction: Dug ☐ Drilled ☒ x rotary Type of Rig Driven ☐ Jet ☒ Other
7. Use of Water—Domestic ☒ X Stock ☐
8. Means of conveyance, distance and direction to point of use Water is conveyed to dwelling S.E. by 1½" pipe 20 feet
9. Date started 8-17 19 41
10. Date completed 8-19 19 41 (including pump)
11. Date after completion when water was used 8-19 19 41
12. WELL DESCRIPTION Total Depth 182' Depth to Water Level 22 ft.
13. TEST DATA Yield 8 gal. How Tested Bail Drawdown 140' Length of Test 1 hour
14. PUMP DATA Type Sub. Power Source Elec. (Turbine, Centrifugal, etc.) (Elec., Gas, etc.) Horsepower 3/4 Amount of Water Being Used 8 gal. (Gallons per Minute)
15. CASING RECORD
Size 6" Kind Galv. Plain Casing from 0 ft. to 23 ft. Size 4" Kind Galv. from 0 ft. to 132 ft. Size Kind from ft. to ft.
Perforated Casing Size 4" Kind Galv. from 132 ft. to 182 ft. Size Kind from ft. to ft.
WELL LOCATION
Johnson County SW ¼ of NE ¼ of Sec. 18 T. 51 N. R. 82 W.
N
S
Above diagram represents one full section. Locate well accurately in small square representing 40 ac. or fill in the following:
Lot_ & Block_ or Tract____
of the (Subdivision or Addition)
of (City, Town or County)
Section_ T._ N. R.____ W.
For wells constructed after May 24, 1969, Application Form U.W. 5 must be submitted prior to construction.
16. Was surface seal provided? Yes ☑ No ☐ To What Depth 23 Material used: 6" casing Was well gravel packed? Yes ☑ No ☐
17. FLOWING WELL (Owner is responsible for installing control devices on flowing well.) Does well flow? Yes ☐ No ☑ Flow controlled by: Valve ☐ Cap ☐ Ping ☐ Does well leak around casing? Yes ☐ No ☐
18. LOG OF WELL—Clearly indicate first water bearing material and principal water bearing material.
| From Feet | To Feet | Material Type, Texture, Color | REMARKS (Cementing, Shutoff, Packing, etc.) | Indicate Water Bearing Formation | Indicate Perforated Casing Location |
|---|---|---|---|---|---|
| 0 | 5 | Top Soil | |||
| 5 | 19 | Sand & sandy soil | sealed by 6" casing | Surface Water | |
| 19 | 48 | Gray shale | |||
| 48 | 51 | Rock | |||
| 51 | 79 | Sand stone | |||
| 79 | 162 | Blue shale | perf. pipe | ||
| 162 | 181 | Sand | water bearing | perf. pipe | |
| 181 | 182 | Blue shale | end of well |
19. QUALITY OF WATER INFORMATION
Was a chemical analysis made? Yes ☐ No ☑
If so, please include a copy of the analysis with this form.
If not, do you consider the water as: Good ☑ Acceptable ☐ Poor ☐ Unusable ☐
Was a bacteriological analysis made? Yes ☐ No ☑
If a domestic well, was the well disinfected by the driller? Yes ☐ No ☑
20. IF WELL IS TO BE ABANDONED, complete only Items 1 through 6, Item 10 and Item 18 (Log of Well) and state reason for abandonment below.
It is the responsibility of the owner to properly plug or fill in the well in order to prevent contamination of ground water and to cover or cap the well at ground level.
REMARKS:
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is true, correct and complete.
Andrew W. Wallace Signature of Owner or Authorized Agent
Aug. 12 19 23 Date
Date of Receipt: ____, 19 Date of Priority: ____, 19
Date of Approval: ____, 19__
for State Engineer
Use typewriter or BLACK ink
NOTE: This form may be used for all types of wells, but only when the quantity of water to be developed will not exceed the appropriative right and the use of the water will not be increased or otherwise changed. This form is not to be used if the well is to be relocated. A STATEMENT OF COMPLETION (Form U. W. 7 for domestic and/or stock wells, or Form U. W. 6 for all other wells) MUST BE SUBMITTED TO THE STATE ENGINEER'S OFFICE WITHIN THIRTY (30) DAYS AFTER COMPLETION OF THE WELL.
Well Registration _ Permit No. U. W. _ Statement of Claim ____
LOCATION: __ & _ & Sec.___,
Township __ N., Range ____ W.
Name of Well ____
1. Name of applicant: _ Tel. No. _
2. Address of applicant: _ Zip Code _
City State
3. Present depth of well ____ ft.
4. Proposed depth when deepening is completed: ____ ft.
5. Amount of water presently being appropriated: ____ gallons per minute.
6. Use to which water is presently applied: ☐ Irrigation ☐ Municipal ☐ ☐ Stock Watering ☐ Industrial ☐ Miscellaneous
NOTE: If the amount of water to be appropriated exceeds the amount applied for on the original permit, or if an additional use is to be made of the water, an application for change or addition of use, or increase in the amount of water being appropriated should be submitted on Form U. W. 5, indicating the proposed new use, the increase in the appropriation request, and a description of where and how the water will be used.
7. Reason for deepening well: ____
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true, correct and complete.
Signature of Applicant or Authorized Agent _ Date _
This application was received in the State Engineer's Office on the _ day of _, A.D., 19____.
DATE OF APPROVAL _ 19_
Receipt Acknowledged ____
for the State Engineer
"Application to Deepen an Existing Well"
STATE OF WYOMING, ) SS County of Sheridan)
I. (we) Mary S. & Paul N. Johnson, of the City of Sheridan, County of Sheridan , State of Wyoming, being the owner(s) (if not sole owner, state interest in permit), of the Johnson No. 1 Well under Permit No. U.W. 8000 , as recorded in Book No. 63 of Wells on Page No. 187 , in the office of the State Engineer of the State of Wyoming, for and in consideration of the sum of One Dollar ($1.00) and other valuable considerations, the receipt of which is hereby acknowledged, do by these presents hereby transfer and assign all my (our) right, title and interest of whatsoever nature in and to said permit and all works pertaining thereto to Frank N. Smith, of the City of Sheridan, County of Sheridan, State of Wyoming, his (their) heirs, successors or assigns, forever,
Address: 1005 Fox Road Signature City: Sheridan Signed Signature State: Wyoming 82801
STATE OF WYOMING, ) SS County of Laramie
On this 5th day of April, 1973 before me personally appeared Mary S. Johnson and Paul N. Johnson to me known to be the person(s) described in and who executed the foregoing instrument, and acknowledged that (they) executed the same as his (their) free act and deed.
Signature Notary Public
My Commission Expires December 22, 1975
TEMPORARY WATER USE AGREEMENT
1. This form is to be used for Agreements involving adjudicated and valid unadjudicated water rights.
2. All locations required to be given under this Agreement shall be described by legal subdivision, section, township and range.
3. The sketch map furnished should show the location of the ditch, pipeline or reservoir or well, the location of the source of supply of the appropriation involved and the location of the point of diversion, the location of the area of use, and a brief narrative giving a general description of the proposed temporary use.
4. One (1) fully executed Agreement shall be forwarded to the State Engineer's Office. Upon approval by the State Engineer a fully executed copy will be returned to the parties to the Agreement.
5. Required size of sketch map is 8½" x 11", 8½" x 14" or multiples thereof.
6. If applicable, the signatures of both husband and wife are required on the appropriation.
WATER AGREEMENT
For Temporary Use of Water
THIS AGREEMENT, made and entered into this day of __ 19, by and between ______ of ______ hereinafter referred (address) to as the "User" and _______ (water appropriator's name and address) ________ hereinafter referred to as "Appropriator".
WITNESSETH:
1. Upon receiving authority from the State Engineer, State of Wyoming, Appropriator shall deliver to the User a total amount of ________ of water from the following described (number of gallons, acre-feet) appropriation:
(Permit Number)
(Name of Well, Ditch or Reservoir)
(Priority)
(Source of Supply)
(Amount of Appropriation)
(Location of Record Point of Diversion of Ditch or Outlet or Reservoir or Well under this Appropriation)
(portion of this Appropriation held by Water Appropriator)
(Location of User's Point of Diversion)
2. The water to be supplied by Appropriator to the User shall be supplied at a maximum rate of ______ (gallons per minute or cubic feet per second)
With total daily diversion of ______, (acre-feet or gallons per day)
and said water shall be used for ______ (Indicate where and for what purpose
water will be used and describe method and point of withdrawal, etc.)
3. It is understood and agreed by the Appropriator that in order to satisfy the consumptive use-return flow formula set forth in Wyoming law, as it applies to direct flow appropriation, it will be necessary for the Appropriation to forego the use of up to double the amount of water diverted under this Agreement as specified in paragraphs 1 and 2, unless an adjustment is made in this requirement by the State Engineer.
4. Throughout the term of this Agreement the User agrees that day to day water withdrawals hereunder shall be in such nearly even quantities as possible to the end that waste thereof shall not be created either by the User or by the Appropriator.
5. The User agrees to furnish one (1) copy of a sketch map or any other map necessary for transmittal with this Agreement showing the User's proposed point of diversion, general layout of system and the proposed point of use, as well as location of the water right involved. The items to be depicted on said map shall be shown with reasonable accuracy within the proper legal subdivision, section, township and range.
6. For and in consideration of the water to be furnished under the terms of this Agreement, the User agrees that Appropriator shall receive in payment thereof ______ cents per M gallon, the foregoing to be full consideration for this Agreement and paid or performed by the User at its sole cost and expense.
7. This Agreement shall be in existence and binding upon the parties hereto for a term of __ from and after the date of ____ (length of time) approval by the State Engineer or until such time as the total amount of water contracted for has been supplied, whichever occurs first, but in no event shall exceed a period of two years from the date of approval by the State Engineer.
This Agreement is made pursuant to Chapter 193, Session Laws of Wyoming, 1971, authorizing the temporary acquisition of adjudicated or valid unadjudicated water rights for highway, railroad construction or
repair, drilling operations or other temporary purposes by purchase, gift or lease by the User and providing for the method of said acquisition.
USER:
By _______
Title _______
APPROPRIATOR:
APPROVED:
State Engineer of Wyoming
Date
NOTE: Water will be pumped from the Jones No. 1 Well, Permit No. U. W. 4327 located in the SW¼NE¼ of Section 15, T. 20 N., R. 83 W. at a maximum rate of about 450 gallons per minute, with a maximum daily diversion of 40,000 gallons and a total diversion of 1,000,000 gallons. Water will be loaded on tank trucks and hauled to the area of use as shown on this map for mineral exploration.