HomeMy WebLinkAbout20132519.tiffGWS 1
03/2005
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
DIVISION OF WATER RESOURCES
1313 Sherman St. Room 821
Denver, CO 80203
(303) 866-3581 Fax (303) 866-3589
NONTRIBUTARY GROUND WATER LANDOWNERSHIP STATEMENT
I(We) c ii a> X 5 —jilt' 11
(Name(s))
on -
claim and say that I (we) am (are) the owner(s) of the following described property consisting of
�� acres in the County of Ztje '/
State of Colorado:
(Insert the property legal description)
ZJt d Cc_ Vic. 9 /ow/2shIsp
64 w�s-t--
N
and, that the ground water sought to be withdrawn from the
aquifer underlying the above -described land has not been conveyed or reserved to another, nor has
consent been given to its withdrawal by another.
Further, I (we) claim and say that I (we) have read the statements made herein; know the contents
hereof; and that the same are true to my (our) knowledge.
X
Signature
72 tea,
Date
Signature Date
INSTRUCTIONS:
Please type or print neatly in black or blue ink. This form may be reproduced by photocopy or word
processing means. See additional information on the reverse side.
LANDOWNERSHIP STATEMENT INSTRUCTIONS
The landownership statement must be submitted with well permit applications or applications for
determinations of water rights in all cases where the well permit applicant believes or claims that water
to be withdrawn is nontributary ground water or any ground water from the Dawson, Denver, Arapahoe
or Laramie -Fox Hills aquifers. The statement must be signed by the landowner(s).
The legal description and the number of acres of overlying land must be indicated. In areas of
the state that are not surveyed, the State Engineer will accept an alternate description of the location of
the overlying land sufficient to identify and locate the land. For legal descriptions of irregularly shaped
parcels (where the boundaries do not follow or parallel section lines) or where there are exclusions of
land within the total parcel, the applicant must submit a map having a scale of 1:24,000 or larger (e.g.,
1:10,000) which accurately depicts the overlying land.
If the legal description is too lengthy for the space provided on the statement, please indicate
"See attached legal description" in the space provided on the statement and attach the complete legal
description. The legal descriptions and maps provided must be complete and legible.
The aquifer from which ground water is to be withdrawn must be indicated on the space
provided. Where applications for more than one aquifer are submitted at one time, the applicant shall
provide a separate statement for each aquifer. Production from a well is limited to one aquifer only.
Form No.
GWS-43
Rev. 9/96
OFFICE OF THE STATE ENGINEER
818 Centennial Bldg.
1313 Sherman St., Denver, Colorado 80203
(303) 886-3581
NONTRIBUTARY LANDOWNERSHIP OR CONSENT VERIFICATION OF NOTICE
(We) ,Kitve
i kV h
(Nalne of Well Permit Applicant)
claim and say that I (we) have given notice pursuant to CRS 37-90-137(4)(b.5) of the application for
a well permit by registered or certified mail, return receipt requested, no less than ten days prior to
making of the application for the permit, to every record owner of the overlying land and to every
person who has a lien or mortgage upon, or a deed of trust to, the overlying land recorded in the
county in which the overlying land is located.
The names of the persons given notice are listed below:
NA
Further, I (we) claim and say that I (we) have read the statements made herein; know the contents
hereof; and that the same are true to my lour) own knowledge.
/ Mt - D (c4)/Al/ Co -0 ak )
(Signature) (Date)
(Signature) (Date)
INSTRUCTIONS
PLEASE TYPE OR PRINT NEATLY IN BLACK INK. THIS FORM MAY BE REPRODUCED BY
PHOTOCOPY OR WORD PROCESSING MEANS. SEE ADDITIONAL INSTRUCTIONS ON BACK.
9/26/96
INSTRUCTIONS
NONTRIBUTARY LANDOWNERSHIP OR CONSENT VERIFICATION OF NOTICE
This form must be provided by the applicant seeking a well permit in all cases (except exempt
wells) where the applicant believes or claims that water to be withdrawn is nontributary ground
water or any ground water from the Dawson, Denver, Arapahoe or Laramie -Fox Hills aquifers.
Except that it is not required when the right to such ground water has been determined by a valid
decree or is being claimed by a municipal water supplier pursuant to C.R.S. 37-90-137(8).
The record owner, or persons holding a lien or mortgage upon, or deed of trust to the
overlying land must be notified by registered or certified mail, return receipt requested, no less than
ten days prior to making the application for a well permit. The applicant is to list the persons who
have been thus notified as required. This statement must be signed by the well permit applicant.
For the purposes of satisfying the provisions of CRS 37-90-137(4)(b.5)(Iq, a "person" means
ally' ;riclviduai, partnership, association, or corporation authorized to do business in the State of
Colorado, or any political subdivision or public agency thereof, or any agenpy of the United States.
ij 002/002
04/06/2010 ii::] FAX
t —
Form No-
OWS-25
APPLICANT
;1FFICE OF THE STATE ENGINEER
18CentennialDIVISION OFrWATERoRESOURCES
373) 866-3581
698
WELL PERMIT NUMBER 2756:x1
DIV. 1 WD2 DES. BASIN MI )
WELT FARGO FINANCIAL CO INC
0/0 .: E MARTINEZ
1200 PECOS ST STE 160
WES MINSTER, CO 80234-
(303) 550-1800
PERMIT TO '_'ONSTRUQT A WELL
1)
LAC A Block: Fling: Subdh". 1309.81 -RE -2a21
APPROVED WELL LOCs tIION
WELD COUNTY
SE 114 SE 1/4 Section 8
Township 2 N Range 61W Sixth P.M.
DISTANCES F., t(JA_j Tom! LINES
129 Ft. from South Section Line
748 Ft. from East Section Line
UTM COORDI NAT gays pters,2one:13 NAD_B3)
Easting: 517527 Jorthing: 4443938
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIG iT
CQNDITIONS OE APPROVAL
This well t alt be used in Such a way as to cause no malarial injury to existing water right*. The suuanc:i of this permit does not ensure that
no Injury i I occur to another vested wstiw right or preclude another owner of. vested water right from sinking elle( Ina chill court action.
2) The cons 'I talon of this well shall be In cxunpharrce with the Water Wee Construction Rules 2 OCR 4024, wiles approval of a variance has
been gra u id by the State Board at Examiners of Water Weil Conetniclion and Pump Installation Contra tors s socerdance were Rule 16.
3) Approver pursuant to CRS 37.92.602(3)(b)(I) and policy of the State Engineer under the following And1t ono, fo a 10,22 tiara parcel known
at Lot A, :flcorded Exemption 13094.4 -RE -2921, more particularly deathbed on the leeched Exhibit A.
4) The use f ground water from this heels invited to ordinary household purposes inbldo two (2) single far Illy Owe rings, the watering of
domestic plena, and the Irdgadon Of not Moro than 33,400 square foet of home gardens and levant
s) Predudk from this well is restricted to tie Laramie Fox -Hills aquifer, which corresponds to the interval three 350 feet and 600 het
below Its c round surface. Plate casing shell la installed end grouted to prevent production from other zones.
6) The depl o the lop of the Laramle-Fox lies aquifer Is approximate- To ensure the exclusion of poor qt elity wit .er from zones
immedia d r above the aquifer. plain casing sic grout shall extend through the lowermost coal andlor ca bonacr ous shale that evedles the
Lerernle end podlon of the .puller.
The pun tug rate of this well shaft not eaosed 15 GPM,
The tnni a withdrawal of ground water from this well Shall not exceed 2.32 aCM-feet
The well rnsbudad under permit no. 211015 must be plugged in accordance with Rule 16 of t e Watei Well C )nstructlof Rules wihln
ninety (9 ) days of =notation of the new wee. The enclosed well Abandonment Report form must be Amite 1 to affirm that the old wet
was plug td.
10) The sou ice et thle permit hereby cancels permit no. 211015.
11) The reto i flow from the use of this well mutt be through en individual waste water disposal syttefn of d.l type
One total amount of weer withdrawn Is returned to the traffic stream system in with the well is focaled.
12) This weal i tin be constructed not more Ilan 200 feet from the location specified on ttds permit.
NOTICE 1 his pnrmk has been approves subject to the following changes: The distances from eel:Pan t rtes we a calculated from UIM
coordina s values provided with the pemra application. You are hereby notified that you have the right ti appal the issuance of this
pelmll, t lung a written request with Ihts cfflcs whim sixty (60) days of the date of bsuanre, pursuant a the S ate Administrative
Procedu i ;Act. (See Section 24-4-104 through 106. C_R.SJ-8,D, 41. t.o/N/07
7)
s)
9)
APPROVE
BDH
o that not less Man 2% of
9 e_
For Stara rpintrgr EKPIF IO 4 OATatt.10-11-2009
ReCeiBt NO 1622096 DATE ISSUED 10-11-2007 '�
I
FINDINGS Lm: 1HE''TATE ENGINEER
IN THE MATTER OF AN APPLICATION FOR A PERMIT TO USE AN EXISTING WELL IN
WATER DIVISION NO. 1, WELD COUNTY, COLORADO
APPLICANT : LOUIS D GOLDSBY
AQUIFER: LARAMIE-FOX HILLS
PERMIT NO.: 74473-F
In compliance with C.R.S. 37-90-137(1) and the Statewide Nontributary Ground Water
Rules, Louis D Goldsby, (hereinafter "applicant") submitted an application to use an existing
well. Based on information provided by the applicant and records of the Division of Water
Resources, the State Engineer finds as follows:
1. The application was received complete by the State Engineer on September 8, 2010.
2. The existing well is located in the SE1/4 of the SE1/4 of Section 8, Township 2 North,
Range 66 West, 6th Principal Meridian.
3. The existing well is located outside the boundaries of a designated ground water basin.
4. The applicant proposes to apply the water withdrawn from the well to the following beneficial
uses: domestic and commercial.
5. The proposed maximum pumping rate of the well is 15 gallons per minute, and the
requested average annual amount of ground water to be withdrawn is 2.32 acre-feet.
6. The applicant is the owner of the land on which the well is located.
7. The existing well withdraws ground water from the Laramie -Fox Hills Aquifer (hereinafter
"aquifer'), which, according to site -specific information, is located 335 feet to 605 feet below
land surface at the location of the proposed well.
8. The location of the existing well is more than 600 feet from any existing well completed in
the aquifer, excluding those wells under permit no.'s 71225 and 56867-F, whose owners
signed a 600 foot well spacing statement, waiving any objection to the issuance of this well
permit.
9. According to a sworn statement, the applicant owns, or has consent to withdraw ground
water underlying 10.2 acres of land as further described in said statement, which is attached
hereto as Exhibit A.
10. Withdrawal of ground water from the aquifer underlying the land claimed by the applicant will
not, within one hundred years, deplete the flow of a natural stream at an annual rate greater
Applicant: Louis D. GoldsbyLouis D Goldsby
Aquifer: Laramie -Fox Hills
Permit no.: 74473-F
Page 2
than one -tenth of one percent of the annual rate of withdrawal and therefore the ground
water is nontributary ground water as defined in C.R.S. 37-90-103(10.5).
11. In considering whether the requested permit shall be approved the provisions of C.R.S.
37-90-137(4) and the Denver Basin Rules shall apply. Withdrawals shall be allowed on the
basis of an aquifer's life of 100 years, C.R.S. 37-90-137(4)(b)(I).
12. The quantity of water in the aquifer, exclusive of artificial recharge, underlying the 10.2 acres
of land described in Exhibit A is 230 acre-feet. This determination was based on the
following as specified in the Denver Basin Rules:
a. The average specific yield of the saturated aquifer materials underlying the land under
consideration is 15 percent.
b. The average thickness of the saturated aquifer materials underlying the land under
consideration is 150 feet.
13. A review of the records in the State Engineer's office has not disclosed that there are any
existing wells or other water rights claiming or diverting ground water from the aquifer
underlying the land claimed by the applicant.
Based on the above, the State Engineer finds that there is water available for withdrawal by
the existing well and no material injury to vested water rights would result from the issuance of the
requested permit subject to the following conditions:
a. The allowed average annual amount of water to be withdrawn from the aquifer by the
well shall not exceed 2.3 acre-feet (the quantity of water which is considered available
divided by the 100 year aquifer life).
b. The well shall be located no more than 200 feet from the location specified on the permit
application.
c. The applicant shall submit geophysical and lithologic logs after the construction of the
well. The geophysical logs shall be obtained from the hole before the casings are installed.
d. The maximum pumping rate of the well shall not exceed 15 gallons per minute.
e. A totalizing flow meter must be installed on the well and maintained in good working
order. Permanent records of all diversions must be maintained by the well owner (recorded
at least annually) and submitted to the Division Engineer upon request.
f. Production is limited to the Laramie -Fox Hills Aquifer. The well must be constructed
with plain, non -perforated casing properly grouted so as to prevent intermingling of water
between aquifers.
g. Pursuant to C.R.S. 37-90-137(9)(b) and the Denver Basin Rules, no more than 98% of
the nontributary ground water withdrawn annually shall be consumed and the applicant
Applicant: Louis D. GoldsbyLouis D Goldsby
Aquifer: Laramie -Fox Hills
Permit no.: 74473-F
Page 3
shall demonstrate to the reasonable satisfaction of the State Engineer that no more than
98% of the water withdrawn will be consumed.
h. The owner shall mark the well in a conspicuous place with appropriate well permit
numbers, name of the aquifer, and court case numbers. He shall take necessary means
and precautions to preserve these markings.
Dated this 181k day of
Prepared by: JLV
Form:0546(o)
Oc,totoev
,20 10
By:
Dick W
Director/State Engineer
illiams
esource Engineer
oanna
Water
MAR -26-2010 FRI 09:02 AM W C ENVIRONMENTAL HEALTH FAX N0. 970 304 6411 P. 01
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
PHONE (970) 304-6415 FAX 304-6411
(970)
'Permit #: SP -0200450 Sec/Twn/Rng:08 02 66
Owner: MASON CYNTHIA GRINER &JOHN
Applicant: WATERS DOREEN
Permit Type: KNEW C=Commcrcial, R=Residential + NEW, REPair, VauLT
Parcel #: 1309-08-0-00-016
Location: 13831 CR 22
Legal Description;
Installer: 1. J tr \ J
Finaletl
Status: ISSUED
Applied: 10/03/2002
Issued: 11/26/200?
Finaled: '' /�;
Description: MODULAR
Commercial: N Residential:Y
# of Persons:
# of Bedrooms:
2 Basement Plumbing: N
4 Bathrooms - Full: 3 3/4: 0
Water Public: N
Water Private: Y
Acres: 10.8
1/2: 0
Water Source:
Cistern: N Well: Y Well Permit #: 211015
Percolation Rate: 46.3 Limiting Zone: 4 ft 0 in Description: GROUNDWATER
% Ground Slope: 0 Dir: Soil Suitable: (Y/N) N
Engineer Design Required: (Y/N) Y In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1250 gallons Absorption Trench: 0 square feet
or Absorption Bed: 1588 square feet
Actual Installation
Septic Tank: t Goa gallons
Design Type: c, . A ,
Absorption Trench: square feet
Absorption Bed: t 7I /v square feet
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 County Department of Public Health and
Environment.
Form: SPINAL
E viro ntal Health Specialist Date
Tiffane Johnson
From: Specialgrading@aol.com
Sent: Thursday, April 18, 2013 9:15 AM
To: Tiffane Johnson
Subject: Re: GOLDSBY SITE PLAN -PLEASE RESPOOND TO TIFFANE NOT BETHANY
Attachments: image001.jpg; image001.jpg
Rather than go through a re permitting process, which I do not understand as only 2 people part time would use the home
restroom, we would propose porta pottty.
Scott
In a message dated 4/18/2013 7:55:18 A.M. Mountain Standard Time, tvlohnson@co.weld.co.us writes:
As 1 indicated to Terry, if employees use the bathroom in the house then the well must be re -permitted to a
commercial well as outlined by the Environmental I lcalth Department or you can propose porta polies Please let
me know.
Tiffane Johnson
Planner 1
Weld County Dept. of Planning Services
1555 N. 17th Avenue
Greeley, CO. 80631
Office: 970-353-6100, ext 3527
!Ht.)
CC-N'Y
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is
addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in
error, please immediately notify sender by return c -mail and destroy the communication. Any disclosure, copying. distribution or the taking of any action
concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Specialgrading@aol.com [mailto:Specialgrading@ao[.coml
Sent: Thursday, April 18, 2013 8:52 AM
To: Tiffane Johnson
Subject: Re: GOLDSBY SITE PLAN -PLEASE RESPOOND TO TIFFANE NOT BETHANY
Tiffane Johnson
From: Specialgrading@aol.com
Sent: Thursday, April 18, 2013 8:52 AM
To: Tiffane Johnson
Subject: Re: GOLDSBY SITE PLAN -PLEASE RESPOOND TO TIFFANE NOT BETHANY
Attachments: image001.jpg
Tiffane,
The 4 include myself and my son. Terry is in 2 or 3 times a week to deliver or pick up paper work, there is a lady who
works part time, usually 2 times a week for a few hours at a time on book keeping. Terry and the accountant use the rest
room in the house if needed, so a total of 4 people maximum use the home. The 2 drivers come in and get trucks and
leave.
Please let me know of any other questions.
Scott Carr
In a message dated 4/16/2013 1:36:24 P.M. Mountain Standard Time, tjloyd@comcast.net writes:
Please send any questions to special gradinq@AOL.com
Thanks
Terry
Sent from my Verizon Wireless 4G LTE DROID
Tiffane Johnson <tviohnson@co.weld.co.us> wrote:
Terry I am reviewing the submittal and 1 can't seem to find an explanation of how the applicants will
provide restroom facilities for their employees. Are they planning on using the house or are they going
to provide porta- potties? If they are going to use the house they will need to repermit their well to
include the business.
Also it states four employees and I am not sure if that includes Scott and his son or if it is four
employees plus Scoot and his son. Can you Please Clarify.
Tiffane Johnson
Planner 1
Weld County Dept. of Planning Services
1555 N. 17th Avenue
Greeley, CO. 80631
Office: 970-353-6100, ext 3527
1
Form No.
GWS-25
OFFICE OF THE STATE ENGINEER
COLORADO DIVISION OF WATER RESOURCES
APPLICANT
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303) 866-3581
698
WELL PERMIT NUMBER 275571
DIV. 1 WD2 DES. BASIN MD
Lot
WELLS FARGO FINANCIAL CO INC
CIO JOE MARTINEZ
12OOO PECOS ST STE 160
WESTMINSTER, CO 80234-
(303) 550-1800
PERMIT TO CONSTRUCT A WELL
A Block: Filing: Subdiv: 1309.84 -RE -2921
APPROVED WELL LOCATION
WELD COUNTY
SE 1/4 SE 1/4 Section 8
Township 2 N Range 66 W Sixth P.M.
DISTANCES FROM SECTION LINES
129 Ft. from South Section Line
748 Ft. from East Section Line
UTM COORDINATES (Meters,Zone:13,NAD83)
Easting: 517527 Northing: 4443938
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit does not ensure that
no injury will occur to another vested water right or preclude another owner of a vested water right from seeking relief in a civil cowl action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval of a variance has
been granted by the State Board of Examiners of Water Well Construction and Pump Installation Contractors in accordance with Rule 18.
3) Approved pursuant to CRS 37.92.602(3)(b)(I) and policy of the State Engineer under the following conditions, for a 10.22 acre parcel known
at Lot A. Recorded Exemption 1309 -8 -4 -RE -2921, more particularly described on the attached Exhibit A.
4) The use of ground water from this well is limited to ordinary household purposes inside two (2) single family dwellings, the watering of
domestic animals, and the irrigation of not more than 33.400 square feet of home gardens and lawns.
5) Production from this well is restricted to the Laramie Fox -Hills aquifer, which corresponds to the interval between 350 feet and 600 feet
below the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The depth to the top of the Laramie -Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from zones
immediately above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous shale that overlies the
Laramie sand portion of the aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual withdrawal of ground water from this well shall not exceed 2.32 acre-feet.
9) The well constructed under permit no. 211015 must be plugged in accordance with Rule 16 of the Water Well Construction Rules within
ninety (90) days of completion of the new well. The enclosed Well Abandonment Report form must be submitted to affirm that the old well
was plugged.
10) The issuance of this permit hereby cancels permit no. 211015.
11) The return flow from the use of this well must be through an individual waste water disposal system of the type so that not less than 2% of
the total amount of water withdrawn is returned to the same stream system in which the well is located.
12) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTICE: This permit has been approved subject to the following changes: The distances from section lines were calculated from UTM
coordinate values provided with the permit application. You are hereby notified that you have the right to appeal the issuance of this
permit, by filing a written request with this office within sixty (60) days of the date of issuance. pursuant to the State Administrative
Procedures Act. (See Section 24-4-104 through 106, C.R.S.)-B,D 4J, on O7
Well permit cancelled on October 18, 2010. See permit no. 74473-F. - SRB 05/20/2013
APPROVED
BDH
For State Engineer
(Receipt No. 3622O95 DATE ISSUED
Hello