Free DBB-003, Administrative Reporting - Meter Information - Colorado

DBB-003 (03/2004) This form must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed.

COLORADO GROUND WATER COMMISSION Room 818 Centennial Building, 1313 Sherman Street Denver, CO 80203

For Office Use Only

Administrative Reporting-Meter Information
Instructions: Submit this form for all wells which require measurement of water withdrawals. Fill out one form for each well. Submit changes within 30 days. The individual providing the information herein must sign and date this form in item 9 and complete the address and phone information in item 9 if different from those listed in items 4 and 5.

(1) PERMIT NO.

................................................... Expanded Acres Commingling N or Other................................................... S, Range......... E or W ..........P.M.

(2) ADMINISTRATION FOR:

(3) WELL LOCATION ......... 1/4......... 1/4, Sec......... Twp......... (4) WELL OWNER
Name Mailing Address City, St. Zip Phone ............................................................................................... ............................................................................................... ............................................................................................... ...............................................................................................

(7) POWER METER DATA
Power Utility Co. Serial No. Account No. Units of Measurement Multiplier ...................................................................................... ....................................................................................... ....................................................................................... ....................................................................................... ....................................................................................... .......................................................................................

(5) WELL USER (if different from the owner)
Name Mailing Address City, St. Zip Phone ............................................................................................... ............................................................................................... ............................................................................................... ...............................................................................................

Power Coefficient Electric Meter Factors: CT Factor PT Factor Kh Factor

....................................................................................... ....................................................................................... .......................................................................................

(6) FLOW METER DATA
Manufacturer Model No. Serial No. Meter Size Volumetric Units Multiplier Installation Information: Installation Date Flow Meter Reading Power Meter Reading Calibration Information: Last Calibration Date Internal Diameter (I.D.) Outside Diameter (O.D.)

Primary Meter

Backup Meter

(8) WELL TEST DATA
Well Test Date Power Meter Reading Static Water Level Yield Pumping Water Level Pressure Head Total Head ....................................................................................... ....................................................................kWh or cfm .....................................................................................ft ............................................................................... gpm ...................................................................................ft .................................................................................. psi .....................................................................................ft ......................................................................................

...................................../....................................... ....................................../....................................... ....................................../....................................... ...................................in/....................................in ...................................../....................................... ....................................../.......................................

....................................../....................................... ..................................../....................................... ..................................../.......................................

Measured Input Hp Test performed by: Name Mailing Address

....................................................................................... ....................................................................................... ....................................................................................... ....................................................................................... Attach copies of field data and worksheets

..................................../....................................... ...................................in/....................................in ...................................in/....................................in

City, St. Zip Phone

For Office Use Only

(9) FLOW METER INSTALLATION
and label all fixtures (valves, check valves, elbows, etc.) and changes of pipe diameters within 25 pipe diameters upstream and 5 pipe diameters downstream of the meter installation. Note the type of fixture, the distances to these fixtures, internal and external diameters of straight pipe, and the schedule nos. of straight pipe. Space is provided below for this diagram. You may use a separate sheet if necessary. Use the diagram which most closely matches the type of flow meter.

1 2 3 4

The numbers 1 through 4 below correspond to the numbers in the diagrams above. Length of straight, unobstructed pipe downstream of meter drop pipe centerline = Length of straight, unobstructed pipe upstream of meter drop pipe centerline = Length of straight, unobstructed pipe upstream of meter propeller = Length of meter drop pipe =

........... ft. .......... in. ........... ft. .......... in. ........... ft. .......... in. ........... ft. .......... in.

Are valves, changes in pipe diameter or any other flow restrictions located within 25 pipe diameters upstream or 5 pipe diameters downstream of the flow meter? Yes No If yes, how far? Upstream ........... ft. ........... in. Downstream ........... ft. ........... in. Are straightening vanes included in this flow meter installation? Yes No

(10) I (WE) HEREBY AFFIRM THAT I(WE) HAVE READ AND UNDERSTAND THE ABOVE FORM AND THAT THE INFORMATION I(WE) HAVE PROVIDED IS TRUE AND CORRECT.

Signature

...............................................................................................

Mailing Address ................................................................................................ City, St. Zip Phone ................................................................................................ ................................................................................................

Name (print) ............................................................................................... Date ...............................................................................................

FLOW METER INSTALLATION GUIDELINES 1) All valves should be located downstream of the flow meter (excepting check valves). 2) The manufacturers installation instructions must be followed to assure meter measurement accuracy within five (5) percent. Installations using straightening vanes due to space limitations may have to be field verified and/or calibrated. Additionally, the requirements outlined in the Commission Policy Memorandum 95-3, concerning the use of flow meters and power meters, must be met. 3) The following minimum unobstructed straight pipeline requirements are provided as a general guideline only. Refer to the manufacturers instructions for meter specific installation instructions. Pipe diameters are internal diameters. · · · 10 pipe diameters upstream of propeller without vanes, 5 pipe diameters upstream with vanes 1 pipe diameter downstream of meter 20 pipe diameters upstream to exaggerated flow restrictions or jetting(may be caused by pressure regulator valves, check valves, changes in pipe diameter, etc.) without vanes, 10 pipe diameters with vanes

Other Meters · 10 pipe diameters upstream of meter · 5 pipe diameters downstream of meter · 20 pipe diameters upstream to exaggerated flow restrictions or jetting (may be caused by pressure regulator valves, check valves, changes in pipe diameter, etc.)