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Form No. OFFICE OF THE STATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203
(303)866-3581 EXST
WELL PERMIT NUMBER 276224 -
APPLICANT DIV. 1 WD2 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
NE 1/4 NW 1/4 Section 14
KERR MCGEE GATHERING LLC Township 1 N Range 66 W Sixth P.M.
1999 BROADWAY SUITE 3700 DISTANCES FROM SECTION LINES
DENVER, CO 80202- 178 Ft. from North Section Line
1593 Ft. from West Section Line
(720) 929-6000 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO USE AN EXISTING WELL Easting: Northing:
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 court 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 the policy of the State Engineer dated 4/23/86 under the following
conditions.
4) Approved for the use of an existing well constructed under well permit no. 122553. Issuance of this permit hereby cancels
permit no. 122553.
5) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-602(1)(c),
for a commercial business. Water from this well shall not be used for lawn or landscape irrigation or for any other purpose
outside the business building structure.
6) Production from this well is restricted to the Laramie-Fox Hills aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be withdrawn shall not exceed 0.33 acre-feet(108,600 gallons), as applied for.
9) Approved as the only well on a tract of land of 40.24 acre(s)described as a portion of the NW1/4 of Section 14,Township 1
North, Range 66 West,6th P.M.,Weld County, reference attached exhibit"A".
10) 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less than 2%of the total amount of water withdrawn is returned to the same stream system in which the well is located.
11) A totalizing flow meter must be installed on this 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.
12) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE: To ensure a maximum productive life of this well, perforated casing should be set through the entire Aroducing
interval of the approved zone or aquifer indicated above. JtNAi I2J171 O'7
APPROVED /
JMW 4J.ors 'J) /Lida' I
State Engine IA
Receipt No. 3624109 DATE ISSUED 12-17-2007 EXPIRA ION DATE 't A
/
A , PP%CATION F� RIN $I.DU,AL SEWAGE DISPOSAL SYSTEM No. FiI--0,1
L.D COUNTY HEALTH DEPARTMENT New I--
ENVIRONMENTAL HEALTH SERVICES
t 1/010',Hospite l Road, Greeley, CO 80631 Repair _
k " 353-0540 EXT. 270,g BP
'OWNER?`///� �� ,Fd�ra
/h0ir . r'alFA / ADDRESSA41 lY i„7? 4MQAi/old, %'4, .r:a/c,/ PHONE /-59 i2.-L
ADDRESScOF PROPOSED SYSTEM' 4 ' ' ',-, / '2,27/ c53
LEGAL DESCRIPTION OF SITE: PTI&LA .,'• 7-.74, "" ,T /A_, R 4t Icl
SUBDIVISION
LOT BLOCK FILING
•
USE TYPE: RESIDENTIAI c-� , INSTITUTION
COMMERCI'AI OTHER
SERVICES: PERSONS -`- S' 'BATHROOMS / _LOT SIZE -0) fck'rs
' BEDROOMS 7--- BASE ENT PLUMBING WATER SUPPLY %I 7I
TYPE OF SEWAGE DISPOSAL REQUESTED: ' n e d a .--/e4,41
Applicantadknowledges.that thercompleteness of this application is conditional upon further mandatory and addItIonal tests
and reports<as maybe required by'the Weld.County Health Department to be made and furnished by the applicant or by;the
Weld County'Health;Department for purposes of the evaluation of the application;and the Issuance of the permit is subject
to;such terms'and'condltions as•deemed necessary to insure compliance with rules and regulations-adopted under Article 10,
Title 25, CRS 1!973, as"amended:The applicant certifies that the proposed system will not be located within 400 feet of a.com-
munity sew4pesystem. The undersigned hereby certifies that all statements made, information and reports submitted-here-
with and required'to be Submitted by the applicant are, or will be, represented to be true and correct to the best:of my knows-
edge and bellef;and are designed to be retied on by the Weld County Health Department in evaluating the same for:purposes
of Issuing thepermit applied fortterein I further'understand that any falsification or misrepresentation may result In the denial
of°the,applIcatlon or-revocation of any:permit granted baled upo -said-application and In legal action r.perjury as provided bylaw.
Reisd Application tee �/ dr/ ( , -/Y 1"
y Date// S(/ Owner/ gent Signature Date
,A
• Iti ♦ 4'-9 }4tb ♦ ' t*# '! * * R. * * * • M * ♦ • # ♦ 4 • # R • 4 • * * 1 a * a * • • * • * * • R -.R * * .4 4 +i
•
•FOR DEPT. !/ PERCOLATION RATE_ /1/in /5>-n".
WATER TABLE DEPTH >F i
USE ONLY SOIL TYPE SQ/uty p`he y'c1ay J re/Jy gory
PERCENT GROUND SLOPE .2-16—%
REQUIRES ENGINEER DESIGN ( )YES N(No
a * a • -a * • • ♦ ♦ R • • * * * * * * • a * * # ♦ • • • ♦ • # ♦ * R A * * • -• • • • a * a • i • a • • A -•
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
From the application information supplied and the on-site soil percolation data, the following minimum installation spedifi-
cationsare:required:
SEPTIC TANK 1 0� GALLONS, ABSORPTION TRENCH 020 O SO.FT. •
or
ABSORPTION BED ,9fo 0 SQ. FT.
In addition,this Permit is subject to the following additional terms and conditions:
This-Permit.is.granted temporarily to allow construction to commence. This Permit may be revoked or suspended-by the-Weld
County Health Department 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 -failure or a acy of the sewage disposal system.
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Environ intta Specialist Date
This Permit la not transferrable and shall become void If system construction has not commenced within one year of its issuance.
Before Issuing final approval of this Permit the Weld County Health Department 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 in-
spection of the completed system by the Weld County Health Department.
SYSTEM CONTRACTOR • .__ FINAL INSPECTION A//p7-to4-ac 6y cvc rye
SYSTEM ENGINEER 7. 4'- rr(3 . APPROVAL �ictl�y/y/�t�fverd Qtrr�ar/ �•/—z7 2--
Envlronrddntal Speefallst ,e, . Date
The Issuance of this Permit does not Imply compliance with other state, county or local regulatory or ins iremente,
nor shall It act to certify that the subject system will operate In compliance with applicable state, county and local regulations
adopted pursuant to Article 10,Title 25, CRS 1973, as amended,except for the purposes of establishing final approval of an
Installed system for issuance of a local occupancy permit pursuant to CRS 1973 25-10-111 (2).
Original-Applicant; Copy.WCHD WCHD—EHS February, 1981
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