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Home My WebLink About20130083WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit t: SP -0400180 Sec/Twn/Rng: 20 04 64 Owner: THE HAROLD PEPPLER FAMILY TRUST Applicant: PEPPLER GWYN Permit Type: RNEW C=Commercial, R=Residential + NEW, REPair, VauLT Parcel #: 1053-20-0-00-009 Location: 24125 CR 42 Legal Description: 8892 NW4 20 4 64 EXC �OG&M (4R) Installer: ce C &KrgOaItvo Status: ISSUED Applied: 05/20/2004 Issued: 06/01/2004 Finaled: Description: HOUSE Commercial: N Residential: Y Acres: 9.26 # of Persons: 4 Basement Plumbing: Y # of Bedrooms: 4 Bathrooms - Full: 3 3/4: 1 1/2: 0 Water Public: N Water Source: Water Private: Y Cistern: N Well: Y Well Permit t: 249110 Percolation Rate: 8.5 Limiting Zone: 7 ft 6 in Description: WEATHERED BEDROC % Ground Slope: 2 Dir: W Soil Suitable: (Y/N) Y Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N Minimum Installation . Chambers Septic Tank: 1250 gallons Absorption Trench: 696 square feet or Absorption Bed: 948 square feet Actual Installation Septic Tank: gallons Absorption Trench Absorption Bed: Design Type: c,. A. I testa square feet square feet 35 NOTICE The issuance of this permit does not imply compliance with other state, county or local regulatory or building requirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit pursuant to CRS 1973 25-10-111 (2). This permit is non transferable and non refundable. The Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the Final inspection of the completed system by the Weld Count' Department?f Public Health and Environment. x 44/7 2L Environmental Health Specialist Fnrm-. S_FINAL Z-2 /cg Date WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 WEBSITE: WWW.CO.WELD.CO.US Permit Number: SP -0400180 05-20-2004 Amount: $400.00 Payment Method: Check Owner Name: THE HAROLD PEPPLER FAMILY TRUST Applicant Name: PEPPLER GWYN Parcel Number. 105320000009 Location: TBD CORNER OF WCR 49 & 42 Account Code 256041400-4221-4203 2560-41400-4221-4203 2560414004221-4203 256041400-4221-4203 Description: HOUSE Commercial: (Y/N) N Number of Persons: 4 Number of Bedrooms: 4 Water Public: (Y/N) N Water Private: (Y/N) Y Description New Septic Permit Repair Septic Permit Vault Permit Variance Request Residential: (Y/N) Y Acres: Basement Plumbing: (Y/N) Y Bathrooms: Full - 3 3/4: 1 Water Supply: Cistern: (Y/N) N 9.26 1/2: 0 Well: (Y/N) Y APPLICATION / RECEIPT Initials: SC Receipt Number. HAP -04181 Notation: 6129 Amount $400.00 $0.00 $0.00 $0.00 Well Permit Number: 249110 TERMS AND CONDITIONS A permit fee, as set by separate ordinance of the Board of Weld County Commissioners, shall be required of applicants for new individual sewage disposal systems (ISDS), payable at time of application. Permit fees are nonrefundable; permit applications are non -transferable. If both a building permit and an 1SDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit, the ISDS permit shall expire at the same time as the building permit. If an ISDS permit is issued for a property that does not require a building permit, the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent. Expired permits can be renewed by payment of the permit fee only if A.There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B. The surrounding land, its use or zoning has not changed so -as -to cause the original application not to be acceptable under these regulations. NOTICE The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of Public Health and Environment (WCDPHE). The issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10 title 25, CRS as amended. The applicant certifies that the proposed system will not be located within 400 feet of a community sewage system. The undersigned certifies that all statements made, information and reports submitted herewith are, or will be, represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein. Applicant further understands that falsification or misrepresentation may result in the denial of the cation or revocation of any permit granted, and in legal action of perjury as provided by law. -L— Owner/A Form: RT HAPP �-2D-off/ Date WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, COLORADO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Permit #: Owner: Applicant: Permit Type: Parcel #: Location: Legal Desc: SP-O4OO18O Sec/Twn/Rng: 20 04 64 THE HAROLD PEPPLER FAMILY TRUST PEPPLER GWYN RNEW C=Commercial, R=Residential + NEW, REPair, VauLT 1053-20-0-00-009 TBD CORNER OF WCR 49 & 42 8892 NW4 20 4 64 EXC OG&M (4R) PERMIT Applied: 05/20/2004 Description: HOUSE Commercial: N Residential:Y # of Persons: 4 Basement Plumbing: Y # of Bedrooms 4-1), Bathrooms - Full: 3 3/4: 1 1/2: 0 Acres: 9.26 Water Public: N Water Source: Water Private: Y Cistern: N Well: Y 1 Well Permit Number: 249110 447 Percolation Rate 7J° Limiting Zone 1� ft (0 in Description��)� �" l (d fO�� % Ground Slope _1 Direction (/c) Soil Suitable (YIN) Engineer Design Required (Y/N) In 100 Year Flood Plain (Y/N) IAA) From the application information supplied and the on -site soil percolation data the following minimum installation specifications are required: l�f^n Chambers Septic Tank ' gallons, Absorption Trench (kC( lL square feet 23 -_ or Absorption Bed (c1443 square feet 3t In addition, this permit is subject to the following dditional terms and conditions: a uv)A0� uz ut tin -,fie , YY�i�s� (t It )01-(_) 11(1.14 NOTICE This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet any term or condition imposed thereon during temporary or final approval. The issuance of this permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage disposal system. This permit is non transferable and non refundable. Before issuing final approval of this permit the Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is contingent upon the final inspection of the completed system by the Weld County Department of Public Health and Environment. Form: SPERMITN Li (y,-( Environmental Health Specialist Date WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 NOTICE his individual sewage. disposal system has been inspected and appears to have een installed in accoriance with the regulations regarding individual sewage isposal systems in Weld County, Colorado. s. Approved ate 7/2 Z ( D y Permit No.: SP 6RoD i Owner: Pei? leiL ocation: 2 17 C (a Environmental Health Specialist i Permit #: Owner: Applicant: Permit Type: Parcel #: Location: Legal Description: 8892 NW4 20 4 64 EXC OG&M (4R) Installer: %OSC- CCU -4-t vv WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 NORTH 17TH AVENUE GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 SP-O4OO18O Sec/Twn/Rng: 20 04 64 THE HAROLD PEPPLER FAMILY TRUST PEPPLER GWYN RNEW C=Commercial, R=Residential + NEW, REPair, VauLT 1053-20-0-00-009 24125 CR 42 Finaled Status: LSSu ED Applied: 05/20/2004 Issued: 06/71/20 _94 Finaled: 7adJ Description: HOUSE Commercial: N Residential: Y Acres: 9.26 # of Persons: 4 Basement Plumbing: Y # of Bedrooms: 4 Bathrooms - Full: 3 3/4: 1 1/2: 0 Water Public: N Water Source: Water Private: Y Cistern: N Well: Y Well Permit #: 249110 Percolation Rate: 8.5 Limiting Zone: 7 ft 6 in Description: WEATHERED BEDROC % Ground Slope: 2 Dir: W Soil Suitable: (Y/N) Y Engineer Design Required: (YIN) N In 100 Year Flood Plain: (Y/N) N Minimum Installation Septic Tank: 1250 gallons Absorption Trench: 696 square feet or Absorption Bed: 948 square feet Actual Installation Septic Tank: ISCZ> gallons Design Type: 67.A. Absorption Trench: square feet Absorption Bed: /O9a square feet Chambers 35 NOTICE The issuance of this permit does not imply compliance with other state, county or local regulatory or building requirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). This permit is non transferable and non refundable. The Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the final inspection of the completed system by the Weld Co>nt -Djpartment o f ublic Health and Environment. X Form: SFINAL Mz/ay Environmerital Health Specialist Date "I I; s i FOAM NU GWS 2. 5/2003 PUMP INSTALLATION AND TEST REPORT OF THE STATE ENGINEER For OHmo Use only r -r a "` L° STATE OF COLORADO, OFFICE 1. WELL PERMIT NUMBER 249110 2. OWNER Mailing City, Phone NAME(S) Peppler Farms,. Address 1/043 CU kTY 394 St. Zip LaSalle CO 80645" (970 ) 301-1947 3. 4. WELL LOCATION AS DRILLED: SW 1/4 SW 1/4, Sec. 19 Twp. 4 N 64 W ,Range DISTANCES FROM SEC. LINES: 50C ft, tram South Secline. and 50C ft. from West Sec. line. FIUNG(UNIT) SUBDIVISION: STREET T�(east or wag LOT BLOCK ADDRESS AT WELL LOCATION: PUMP DATA: Type Submersible Installation Completed 10/27/04 Pump Design Pump ADDITIONAL Manufacturer Uou I d Pump Model No. 10G507 GPM 15 at RPM variable HP 1-1/2 ,Volts 230 ,Full Load Amps 5.9 Intake Depth 240 Feet, Drop/Column Pipe Size 1-1/4 Inches, Kind PVC INFORMATION FOR PUMPS GREATER THAT 50 GPM: TURBINE Design DRIVER TYPE: Electric ❑ Engine ❑ Other Head feet, Number of Stages , Shaft size inches. 5. OTHER EQUIPMENT: ft. . Monitor Tube Installed Depth ft. Airline Flow Meter Meter Installed Yes ❑ No, Orifice Depth ❑ Yes ❑ No Mfg. Meter Serial No. Readout ❑ Gallons, Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading 6. TEST is submitted on Supplemental Form. 10/27/04 DATA: Check box if Test data Total Well Static Date Measured Date Depth 252 Time 2 Hrs Level 165 Rate (GPM) 15 10/2/104 PumpingLA 220 7. DISINFECTION: Type NTH Dry Powder Amt. Used 1/4 Cup 8. Water No Quality analysis available ❑Yes X a Remarks 10. I have (Pursuant degree CONTRACTOR Mailing Address read the statements made herein and know the contents thereof, and that they are true to my knowledge to Section 244-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the secon and is punishable as a class 1 misdemeanor.] Canfield Drilling Co Phone ( 970) 867-2943 Lic. No. 7 P 0 BOX 519 Ft Morgan, CO 80701 Name/Title (Please type or print) Jeffrey K. Canfield/Pump Installer Signatur ( 1/��, i 4 Date 11/19/04 FORM N° mew WELL CONSTRUCTION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1313 Sherman St.. Rm 818. Denver. CO 80203 For Office Use only � ir 1rn 4"r \.. 6 1. WELL PERMIT NUMBER 24511u 2 OWNER Mailing City, Phone( NAME(S) Peppier Farms Address 17043 CO RD 394 St Zip LaSalle CO 80645 970) 301-1947 3. WELL LOCATION AS DRILLED: SW 1/4 SW 1/4,Sec. 19 _Twp. 4 N ,Range 64 W DISTANCES FROM SEC. LINES: 500 ft. from South Sec. line. and 500 ft. from West Sec. line. OR FIUNG(UNIT) SUBDIVISION: STREET (norm or cum/ loan[ or WOS1] LOT BLOCK ADDRESS AT WELL LOCATION: 4. GROUND DATE SURFACE ELEVATION ft DRIWNG METHOD Rotary COMPLETED 7/29/04 . TOTAL DEPTH 252 ft DEPTH COMPLETED 252 ft, 5. GEOLOGIC LOG: Depth Description S Material (Type. Size, Color, Water Location) 0 - 2 Top 6. HOLE DIAM. (n.) From (ft) To (ft) 11 0 117-1/2 6-1/2 117-1/2 252 2 - 7 Sand 7 - 12 Clay & Sand 7. PLAIN CASING OD(in) find Wall Size From(ft) To(tt) 7" Steel .188 +1 119 12 - 20 Clay Trace of Sand 20 - 40 Clay 40 - 50 Clay turning to Shale 50 - 116 Blue Shale 4" PVC .248 -7 170 116 - 140 Shale Some Coal 340 - 162 Shale 162 - 181 Shale Some Coal 4PERF.CASING:ScreenSlotSize: 248 Oil 181 - 186 Shale Some Sand tiU 251 186 - 205 Shale 705 - 215 Shale More Sand 215 - 751 Shale & Sand 251 - 252 Shale Very Little Sand 8. FILTER PACK: Material Silica Sand 9. PACKER Type Depth PLACEMENT: Size 8/12 Interval 119 to 252 10. GROUTING RECORD: Material Amount Density Interval Placement Cement 33 Sacks 6#/gal 10' to 119 REMARKS: 11. DISINFECTION: Type 13TH Dry Powder Amt Used 2. WELL TEST DATA ❑ Check box if Test Data is submitted on Form No. GWS 39 Supplemental . Well Test. 15 gpm. TESTING Static Pumping Remarks METHOD Bailed Level 165. ft Date/Ttme measured 7 /29/04 , Production Rate level 220 ft. DaterTme measured 7/29/04 , Test length (hrs.) 2 13. I have read C.AS., CONTRACTOR MailingAddress the statements made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section 24-4-104 (13) (e) the making of false statements herein constitutes perjury in the second degree and is punishable es a class 1 misdemeanor.) Canfield Drilling Co Phone(970) 867-2943 Lic.No. 765 P 0 Box 519 Ft Morgan, CO 80701 Name/Title L. Catypnfield eldt) L. George Canfield Signature SA..-1,/ �f% ativ Date 11/17/04 Hello