HomeMy WebLinkAbout20121757.tiff WATER SUPPLY INFORMATION SUMMARY
• Section 30.28.133,fd), C.R.S. requires that the applicant submit to the County,"Adequate evidence that a water supply that
is sufficient in terms of quantity, quality and dependability will be available to ensure an adequate supply of water.
1. NAME OF DEVELOPMENT AS PROPOSED
M K fart 5ev ViC e9 IKc,
2. LAND USE ACTION Oe;:,+ 3?�Q] RkVt' )
3. NAME OF EXISTING PARCEL AS RECORDED l Lo l- Tj off<E11015
SUBDIVISION FILING BLOCK LOT
4. TOTAL ACREAGE t .3 5. NUMBER OF LOTS PROPOSED 1 PLAT MAP ENCLOSED O YES
6. PARCEL HISTORY • Please attach copies of deeds, plats or other evidence or documentation.
A. Was parcel recorded with county prior to June 1, 1972? 0 YES 83 NO
B. Has the parcel ever been part of a divisjgp of land action sin June 1, 1172? YES O NO
If yes, describe the previous action Q ct,rile4 rX ernp -t on KV--41015 L. it
7. LOCATION OF PARCEL • Indude a map delineating the project area and tie to a section corner.
yz_ rt - OF L\1 1/4 SECTION '_TOWNSHIP Z t�N O S RANGE CO(' ❑ E -W
PRINCIPAL MERIDIAN: lit 6TH 0 k.M. 0 UTE 0 COSTILLA
8. PLAT • Location of all wells en property must be plotted and permit numbers provided.
Surveyors plat 0 Yes 0 No If not, scaled hand drawn sketch 0 Yes O No
9. ESTIMATED WATER REQUIREMENTS • Gafford per Day er Acre hat per Year 10. WATER SUPPLY SOURCE
❑ EXISTING 0 DEVELOPED
W a NEW WELLS -
ELLS SPRING
?IMPOSED AQUIFERS-pal an
HOUSEHOLD USE P of units GPO AF WELL PERMIT NUMBERS C ALLUVIAL C UPPER AIUPAlct
C WS QAWSON 0 towER ARAPAHOE
COMMERCIAL USE # of S.F. GPO I a AF C UNISONuRAAE FOX roux
❑°emit C claim
{ C ono
IRRIGATION I of acres GPO AF
STOCK WATERING I of head GPO AF 0 MUNICIPAL
O ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER - GPO AF 0 COMPANY
0 DISTRICT
TOTAL GPD r/-3 AF NAME
LETTER OF COMMITMENT FOR
SERVICE 0 YES 0 NO
11. ENGINEER'S WATER SUPPLY REPORT O YES ffi•NO IF YES, PLEASE FORWARD WITH THIS FORM. (This may bo mooing(before our review is campferedi
12. TYPE OF SEWAGE DISPOSAL SYSTEM
]ffi.SEPTIC TANKJLEACH FIELD ❑ CENTRAL SYSTEM • DISTRICT NAME_
O LAGOON 0 VAULT • LOCATION SEWAGE HAULED TO
❑ ENGINEERED SYSTEM (Attach a cosy of engineering Osage) O OTHER
2012-1757
COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(07/2009)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST,RM 818, DENVER,CO 80203
phone—info:(303)866-3587 main:(303)866-3581
fax:(303)866-3589 http://www.water.state.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be completed in black or blue ink or typed.
1.Applicant Information 6. Use Of Well (check applicable boxes)
Name of applican7l,,,,11 sA� Attach a detailed description of uses applied for.
CAM�cdngae,z Vavtc s, flt 11 Industrial ❑DewateringSystem
Mailing address ❑ Municipal
❑Geothermal(❑production or 0 reinjection)
1'D I 'oX (o 11 0 Irrigation
❑Other(describe):
cry 1 . - ll star Zip code g Commercial
t I* "c s\ C-U 1€0b21 7.Well Data (proposed)
Telephone a E-mail(Optional)
;3 7419 _4559 Maximum pumping rate Annual amount to be withdrawn
2.Type Of Application (check applicable boxes) /5 3 acre-feet
Total depth Aquifer
I$Construct new well ❑Change source(aquifer)
❑Replace existing well ❑Reapplication(expired permit) rA boo feet Lola nue- t LA#dt 6
❑Use existing well ❑COGCG well 8. Land On Which Ground Water Will Be Used
❑Change or increase use ❑Other: Legal Description(may be provided as an attachment):
3. Refer To (if applicable) t Q-I• `y��I a �"1 ^'��
Well permit k Water Court case k �`
Designated Basin Determination k Well name or k
4. Location Of Proposed Well(Important! See Instructions)
County r�' (If used for crop irrigation,attach a scaled map that shows irrigated area.)
Weld EL 1/4 of the (1(E 1/4 A. 4Acrres lea Owner
•Section Township N or S Range E or W Pdndpaif tlian t8`3 s St god ft 5u.5 eatus„rnx
y 2 kg.❑ /0/ ❑ti9 GI C. List lany other wellsor water rights used on this land:
Distance of well from section lines(section lines are typically not property lines) 1O ( l0 n C.
Ft from❑N❑S Ft.from❑E❑W 9. Proposed Well Driller License#(optional):
For replacement wells only—distance and direction from old well to new well 10.Signature Of Applicant(s)Or Authorized Agent
feet direction The making of false statements herein constitutes perjury in the second
Well location address(Include City,State.Lp) ❑Check if well address is same as in Item 1. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
24-4-1 r' (13)(a). I have read the statements herein,know the contents
'n tl ,W Iher-% and state that they are t e . my knowledge.
Si .'.(M •t be•,- al--gnatur- Date
Optional: GPS well location information in UTM format You must check GPS unit for v
required settings as follows: Y pJ—)J/
Format must be UTM PrPrint na 8 ti I� /�
❑Zone 12 or O Zone 13 Easting r/ �(��yjr� /al
Units must be Meters /r N� �f r�� • '^r �sstG'�5
Datum must be NA083 Northing Office U Only
Unit must be set to true north USGS map name DWR map no. Surface Nev.
Was GPS unit checked for above? ❑YES Remember to set Datum to NAD83
5. Parcel On Which Well Will Be Located Receipt area only
(YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A. Legal Description(may be provided as an attachment):
50¢, akfaraft.e-d de.el
B. k of acres in parcel C. Owner AOUAMAP
CBI .m god Acts-5troasfiawWE
•D. will this be the only well on this parcel,ElefES ONO(if no-ist other wells) WR
CWCB
E. State Parcel IDk(optional): TOPO
MYLAR
1 50q o-1 100O0(o 555
SB5 DN_ WD BA MD
COLORADO DIVISION OF WATER RESOURCES Form GWS-57(10/2011)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST.,STE 821,DENVER,CO 80203 Application Receipt No.
main:(303)866-3581 httoxr/waterstate.co.us P
fax:(303)866-3589 Online Requests:AskDWR
Applicant's Name:
• COMMERCIAL DRINKING AND SANITARY WELL WORKSHEET
Review instructions on reverse side prior to completing form.
.TThe form must be completed in black or blue ink ortyped. /j 1. Name and Type of Business: /)4 {y/)god rIut-z ayt r e-5);Y�. 0t�- S7cv�IGC-(-OM y
2. Is this application for a new well? ,- ` CJ
is Yes
❑ No If no,is this application for a change of use for an existing well?
❑Yes Permit Number of well(if applicable)
El No For wells used for drinking and sanitary purposes prior to May 8, 1972,a field inspection of the well to
verify historical uses may be required. See form GWS-12 Registration of Existing Well and
form GWS-12A Statement of Historical Use for further information.
3. Is the parcel the well is located on(or will be located on)within the boundaries of a water service area(water district,
municipality,water company,etc.)or is water available{ror�1 nq{her source Ssu h a�5 a welly? I
®Yes If yes,indicate what this other source is Orth�,+1 WeldLou'r�'-tt ia4i✓kc7vid-�1322 Oat 0ppo5t'Iaol(,t{to.,A)
®No (name4f water district/supplier,or well permit numderf
4. Proposed type of disposal system to be used:
IR Septic tank/absorption leach field
❑ Central System(district name:)
❑ Vault(location sewage hauled to:)
o Other(attach copy of engineering design)
5. Water Demand Calculations(for average factors for water demand see below)
Employees
Number of X Number of Gallons X Number of Days Employee = Gallons per Year
Employees per Employee per Day Works per Year
• 8 X IrJ X 260 = /o800O A
Customers
Number of X Number of Gallons X Number of Days Business = Gallons per Year
Customers per Day per Customer is Open per Year
X /5 X 0 _ 7 B
Other Uses(Note: No uses outside of the building would be permitted for this type of well.)
Type of Use X Gallons per Use
per Day X Days per Year = Gallons per Year
X �/ X _ „ex C
Total amount of water required:
= Gallons per Year
(A+B +C)
= /OSj 60O
For wells used for commercial drinking and sanitary purposes on or after May 8, 1972,the total water demand cannot exceed
108,600 gallons(1/3 of an acre-foot)per year.
For wells used for commercial drinking and sanitary purposes prior to May 8, 1972,the total water demand cannot exceed 325,900
gallons(1 acre-foot)per year.
General Guidelines for Water Demand in Gallons per Day
Day Workers at Offices—15 gallons/person/day
Food Service Establishments(with toilet and kitchen wastes)—10 gallons/patron/day
Churches(does not include food service)—5 gallons/seat/day
Overnight Lodging—50 gallons/customer/day
•On-Site Proprietor of Overnight Lodging(i.e.on-site owner of a Bed& Breakfast)—80 gallons/person/day
Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject.
• OWEI
CENTRAL WELD COUNTY WATER DIStHICT
March 13,2012
C&M Rodriguez Services,Inc.
PO Box 677
Fort Lupton CO 80621
RE: Lot B Recorded Exemption No, 1309-07-01 RE-4015 recorded March 22, 2007 at Reception No.
3463669 being a portion of the E%of the NE Y+of Section 7,Township 2 North,Range 68 West
of the C PM., Weld County,Colorado
To Whom It May Concern,
Please review the District's policy in reference to your request to drill a well and have the District sign off
on the Non-Opposition Consent Form provided from the Department of Natural Resources Division of
Water Resources.
SECTION 8
MAIN LINE EXTENSION POLICIES
WATER SERVICE Wit kilN SERVICE AREA OF DISTRICT. On June 5, 1986,the District
adopted its Statement Of Purposes as required by the Special District Act,Section 32-1-208,Colorado
Revised Statutes. As a part of the District's Statement Of Purposes the area to be served by the District
• for water service was identified. Subsequently additional areas have been added to the water service area
of the District;and agreements have been entered into by the District with municipalities within the
District's water service area that allocate the responsibility for provision of water. The designated service
area of the District may change in the figure. The District has stated and hereby reaffirms that the District
is ready,willing and able to serve all requests for water service within all of its designated water service
area under the terms of its Tariffs, Rules and Regulations. In the event that the District is requested to
state its position regarding the installation of any exempt or nonexempt water well on property that is
within the Service Area of the District,the District shall:
1. provide a copy of its Service Area Map and,
2. provide a copy of the District's Main Line Extension Policy including this Policy,and
3. provide,on further request,a statement of the cost estimate for the installation of a water
tap(s)that would serve the applicable property under the Tariffs,Rules and Regulations of the
District.
The District will not approve or disapprove the installation of any water well to serve land within the
Service Area of the District unless there is a direct impact from the drilling of the well on the distribution
of water from the District's water distribution system.
Please submit this letter in lieu of the Non-Opposition Consent Form. If there are any further questions,
please contact the office.
Sincerely,
CENTRAL WELD COUNTY WATER DISTRICT
• JiZaddj '
eneral Manager
JWZ/jr
2235 2nd Avenue • Greeley,Colorado 80631 • Phone(970)352-1284 • Fax(970)353-5865
John W.Zadel,General Manager
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