HomeMy WebLinkAbout20111735.tiff WATER SUPPLY INFORMATION SUMMARY
ip_Section 30.28-i33,(d), 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 n A
2. LAND USE ACTION fl�Yl-Q.f ld-Qd (-45 R 5Z-1
1211 2.3 0000 1ti ; 1211 2 3 0 0 00 3q , ' 1-1123000013
3. NAME OF EXISTING PARCEL AS RECORDED 121 1 2 3 000 0{5 -,12_11z 3 oOOO 13 01
SUBDIVISION n ` FILING ICI BLOCK 11 I f4 LOT n Pr
ult�m�+cly.
4. TOTAL ACREAGE 293 5 ' 5. NUMBER OF LOTS PROPOSED n1 A PLAT MAP ENCLOSED 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? ❑ YES NO
B. Has the parcel ever been part of a division of land action since June 1, 1972? ❑ YES 2(NO
If yes, describe the previous action
7. LOCATION OF PARCEL - Include a map dekreatinq the project area and tie to a section corner.
Sew a fan.44 eci Cunfirwa-n
ron
114 OF 114 SECTION Z 3 TOWNSHIP °3 ' NOS RANGE (-9t o ❑ E W
PRINCIPAL MERIDIAN: 0 6TH 0 N.M. 0 UTE ElCOSTILLA
PLAT Location of all wells on property must be plotted and permit numbers provided. ( ap attest f1,
surveyors plat ❑ Yes Ct No If not, scaled hand drawn sketch ❑ Yes g No
9. ESTIMATED WATER REQUIREMENTS - Woes per Oay or Acn Feet per Yaw 10. WATER SUPPLY SOURCE We IrS
EXISTING ❑ DEVELOPED ❑ NEW WELLS
WELLS SPRING PROPOSED AQUIFERS (cwcs aco
HOUSEHOLD USE # 1 of units 2_00 GPO AF WELL 2-39 C?
NUMBERS o ALLUVIALa P A UPPER MAKE
I 59 0 OPP81 DAWSON 0 LOWER ARAPAHO(
0 LOWER OAWSON 0 tAPAME FOX MIS
COMMERCIAL USE # of S.F. 50 GPD AF 2 L-}--) Li r q ❑DanER C DAKOTA
❑OTHER
Zy 1 y3
IRRIGATION I of acres GPO AF 2 3 I
STOCK WATERING 13 0 of head ZOO GPD AF ❑ MUNICIPAL
❑ ASSOCIATION WATER COURT DECREE CASE NO.'S
OTHER - GPD _ AF 0 COMPANY
I 0 DISTRICT
TOTAL 45 U GPD AF NAME
LETTER OF COMMITMENT FOR
SERVICE ❑ YES ❑ NO
11. ENGINEER'S WATER SUPPLY REPORT 0 YES Ic21 NO IF YES, PLEASE FORWARD WITH THIS FORM. (The may be required beton our review is comeletedj
12. TYPE OF SEWAGE DISPOSAL SYSTEM J-Cpt G
•SEPTIC TANKILEACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME
2011-1735
❑ LAGOON ❑ VAULT - LOCATION SEWAGE HAULED TO
0 ENGINEERED SYSTEM (Attech a copy of anyinaerrno desiya) O OTHER
• Water Supply Information Summary
Question 7 (Continued)
Location of Parcel:
Parcel: 121123000039
Legal Description: E4W2NW4 23 3 66(.23R)
Parcel: 121123000013
Legal Description: W2NE4 23-3-66 (.92R)
Parcel: 121123000015
Legal Description: W2SE4 23-3-66
Parcel: 1123000012
Legal Description: E2NW4 23-3-66 (.92R)
Parcel: 121123000002
Legal Description: PT E2SE4 23-3-66 LOT B REC EXEMPT RE-4640
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Form No. Uri-1Ut lit I lit S I ATE ENGINEER
GWS5 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg.,1313 Sherman St.,Denver,Colorado 80203
(303)886.3581
857
• WELL PERMIT NUMBER 239959 -
APPLICANT DIV. 1 WD 2 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
SE 1/4 NW 1/4 Section 23
DAVE FARLEY Township 3 N Range 66 W Sixth P.M.
C/O FARLEY FARMS INC DISTANCES FROM SECTION LINES
P O BOX 363 1420 Ft. from North Section Line
PLATTEVILLE, CO 80651- 1470 Ft.from West Section Line
(970)785-0616 UTM COORDINATES
PERMIT TO CONSTRUCT A WELL Northing: Easting:
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 assure the applicant 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)(II)(A)as the only well on a tract of land of 80.00 acre(s)described as the E1/2
of the NW1/4, Section 23,Township 3 North,Range 66 West,6th P.M.,Weld County.
4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than
three(3)single family dwellings,the watering of poultry,domestic animals and livestock on a farm or ranch and the
irrigation of not more than one(1)acre of home gardens and lawns.
5) Production is limited to the alluvium. The depth of this well shall not exceed 60 feet or the depth at which sandstone or
shale is first encountered,whichever comes first.
6) The maximum pumping rate of this well shall not exceed 15 GPM.
7) The return flow from the use of this well must be through an individual waste water disposal system of the
non-evaporative type where the water is returned to the same stream system in which the well is located.
8) This well shall be constructed not more than 200 feet from the location specified on this permit.
�t4 - y/5/OZ
APPROVED ,�y
21)
JMW 2, a
`Receipt No.0488008 State Engineer DATE ISSUED APR 0 8 2002 ey PI TION DAT APR 0 8
Form No. OFFICE OF THE STATE ENGINEER
GWS-25 CO8 LORADOg., 3DIVISION OF 13 Sherman St., n WATERo oRESOURCES
• (303)888-3581 827
WELL PERMIT NUMBER 247419 -
DIV. 1 WD 1 DES.BASIN MD
APPLICANT
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 SE 1/4 Section 23
DAVID FARLEY Township 3 N Range 66 W Sixth P.M.
FARLEY FARMS INC DISTANCES FROM SECTION LINES
BOX 363 3000 Ft.from North Section Line
PLATTEVILLE,CO 80651- 1400 Ft.from East Section Line
UTM COORDINATES
(970)785-2339 Northing: EesBng:
PERMIT TO CONSTRUCT AtL
iiISSUANCE 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 assure the applicant 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.
ll nstruction Rules 2 CCR 402-2,2) The of a variance construction s been granted well all be In by the State dBoa d of Examiners of iance with the Water eaterWellll Construction and Pump Installation
Contractors in accordance with Rule 18. 6)A)as the only wel on a tract of 3) of the Southeast 1/4 of Sec.23,Twp.3 proved pursuant to CRS )North,r Rng.8 West, i land acre(s)
x h P.M.,Weld County,more particu al rliy described on the
attached exhibit A.
4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than
three(3)single family dwellings,the watering of poultry,domestic animals and livestock on a farm or ranch and the
irrigation of not more than one(1)acre of home gardens and lawns.
5) The total depth of the well shall not exceed 595 feet,which corresponds to the base of the Laramie Fox-Hills aquifer. At a
minimum,plain casing shall be installed and grouted through all unconsolidated materials and shall extend a minimum of
ten feet into the bedrock formation 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 maximum pumping rate of this well shall not exceed 15GRM.
8) The return flow from the use of this well must be through an individual waste water disposal system of the
non-evaporative type where the water is retumed to the same stream system in which the well is located.
9) 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 producing
Interval of the approved zone or aquifer Indicated above.
NOTICE: a cotrection to the tion of the well are hereby notified ths permit at youas have the right to n approved r appeal the Issuance�of this permit, y filing ant to the written request e with th sed floffice A. u
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.)igY ' i/�0/0
APPROVED ...-C‘vec _lain -4
MTT By
State Engineer
Receipt No.0503791 DATE ISSUED 01-30-2003 EXPIRATION DATE 01-30-2005
i-arm No. Vrrit,t ur inc 0 IMI C CIV%IIVCCR
GWS-25 COLORADO DIVISION OF WATER RESOURCES
818 Centennial Bldg.,1313 Sherman St.,Denver,Colorado 60203
(303)866-3581 827
al t
WELL PERMIT NUMBER - 247432 - 1i
APPLICANT DIV. 1 WD 1 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
NE 1/4 SE 1/4 Section 23
MELBA FARLEY Township 3 N Range 66 W Sixth P.M.
FARLEY FARMS INC DISTANCES FROM SECTION LINES
BOX 363 3000 Ft.from North Section Line
PLATTEVILLE, CO 80651- 1200 Ft.from East Section Line
(970)785-2339 UTM COORDINATES
PERMIT TO CONSTRUCT A WELL Northing: Easting:
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 assure the applicant 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)(II)(A)as the only well on a tract of land of 80 acre(s)described as the East 1/2
of the Southeast 1/4 of Sec.23,Twp.3 North, Rng.66 West,Sixth P.M.,Weld County,more particularly described on the
attached exhibit A.
4) The use of ground water from this well is limited to fire protection,ordinary household purposes inside not more than
three(3)single family dwellings,the watering of poultry,domestic animals and livestock on a farm or ranch and the
irrigation of not more than one(1)acre of home gardens and lawns.
5) The total depth of the well shall not exceed 600 feet,which corresponds to the base of the Laramie Fox-Hills aquifer. At a
minimum,plain casing shall be installed and grouted through all unconsolidated materials and shall extend a minimum of
ten feet into the bedrock formation 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 maximum pumping rate of this well shall not exceed 15 GPM.
8) The return flow from the use of this well must be through an individual waste water disposal system of the
non-evaporative type where the water is returned to the same stream system in which the well Is located.
9) 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 producing
interval of the approved zone or aquifer indicated above.
NOTICE:This permit has been approved for a correction to the location of the well pursuant to the attached exhibit A. 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.) � ��a I
%i/� ,
!ROVED
4^' 2 • #1.4.4. ., ,,, < c2 ----
State Engineer By
Receipt No.0503792 DATE ISSUED 01-30-2003 EXPIRATION DATE 01-30-2005
Forth-it-7 OFFICE OF THE STATE ENGINEER
,GWS-25•.‘ COLORADO DIVISION OF WATER RESOURCES
818 Centemial Bldg.,1313 Sherman St.,Denver,Colorado 80203 827
(303)868-3581
• WELL PERMIT NUMBER 231884 -
DIV 1 WD 2 DES.BASIN MD
APPLICANT
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 •NE 1/4 Section 23
Township 3 N Range 66 W Sixth P.M.
PARLEYS FARM INC
DAVID FARLEY DISTANCES FROM SECTION LINES
P O BOX 363 900 FL from North Section Line
PLATTEVILLE,CO 60651- 2460 FL from East Section Line
UTM COORDINATES
(970)785-233 Northing: Easting:
PERMIT TO CONSTRUCT A WELL,
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDMONS 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 assure the applicant 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. e Water W2) The of a vaari�ance hhasuctionobeen granted by the State Board ofExaminers
f this well shall be in compliance with thmi ers f WaterWel Construction and Pump Installation
grovel
Contractors in accordance with Rule 18.
•3) Approved pursuant to CRS 37-92.802(3Xb)(II)(A)as the only well on a tract of land of 40.00 acre(s)described as the
NW1/4 of the NE1/4 Sec.23,Twp 3 North.Rng.66 West,6th P.M.;Weld County.
4) The use of ground water from this well is limited to fire protection.ordinary household purposes inside not more than
three(3)single family dwellings,the watering of poultry,domestic animals and livestock on a farm or ranch and the
irrigation of not more than one(1)acre of home gardens and lawns.
5) The total depth of the well shall not exceed 565 feet,which corresponds to the base of the Laramie Fox Hills aquifer. At a
mnimum,plain casing shall be Installed and grouted through all unconsolidated materials and shall extend a minimum of
ten feet into the bedrock formation to prevent production from other zones. ..
6) The maximum pumping rate of this well shall not exceed 15 GPM.
7) The return flow from the use of this well must be through an individual waste water disposal system of the
•
non-evaporative type where the water is returned to the same stream system in which the well Is located.
8) This well shall be constructed not more than 200 feet from the location specified on this permit.
NOTE: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 andlor
carbonaceous shale that overlies the Laramie sand portion of the aquifer.
NOTE To Insure a maximum productive life of this well,perforated casing should be set through the entire producing be Interval ofhe ability of this well to withdraw as authorized amount of water from the approved zone or aquifer Indicated above. may
able aquifer00 NO :years upon which the amount of water in the aquifer is allocated, e to r anticipated s vwa water level declines.less than the• /r �`
APPROVED 4, 06 , A
Stare Er m
JLV Tire FEB 2 8 2001 BYE)(pIRA ION DATE 8
DATE ISSUED
Receipt No.0471933
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
• PHONE(970) 304-6415 FAX (970) 304-6411 I'inaled
Permit#: SP-0100166 Sec/Twn/Rng: 23 03 66 Status: ISSUED
Owner: FARLEY DAVE Applied: 04/12/2001
Applicant: FARLEY DAVE Issued: 04/13/2001
Permit Type: RNEW C=Commercial,R=Residential+NEW,REPair,VauLT Finaled:',l l 2)1.
Parcel#: 1211-23-0-00-008
Location: 16400 CR 32 PLATTEVILLE 23-03-66
Legal Description: 16637 W2NE4/E2NW4 23 3 66 EXC UPRR CO RE
S (2R)
Installer:
Description: HOUSE
Commercial: N Residential:Y Acres: 160
#of Persons: 3 Basement Plumbing: Y
#of Bedrooms: 5 Bathrooms - Full: 2 3/4: 1 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit#: 231884
Percolation Rate: 14.5 Limiting Zone: 8 ft 0 in Description
II Ground Slope: 1 Dir: SW Soil Suitable: (Y/N) Y
Engineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1500 gallons Absorption Trench: 1045 square feet
or Absorption Bed: 1410 square feet
Actual Installation
Septic Tank: 1600 gallons Absorption Trench: square feet
Absorption Bed: /4-8S square feet
Design Type: G7.4,
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 hermit is not transferable. 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 He nd Environment.
x 7-tS-O(
/c En ro .tai Health Specialist Date
"Donn:S_FINAL SfS
an parcel izj,i300volz
' cam 30
v 2s ,o 410o
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tAcpd h y�7
WELD COUNTY HEALTH DEPARTMENT
, . 1517 16TH AVENUE COURT, GREELEY, CO 80631
(970) 353-0635 EXT 2225 FAX (970) 356-4966
emit # SP-9800011 Sec/Twn/Rng: PERMIT
rmit Type : RNEW c=commercial, R=residential + NEW, REPair, VauLT -apt rea
Applied: 01/14/1998
Parcel No: 1211 23 Expires : 01/09/1999
Location: 16400 WCR 32 23-3-66
Legal Desc :
APPLICANT FARLEY DAVE Phone : (970) 785-0616
P.O. BOX 363 , PLATTEVILLE COLORADO 80651
OWNER FARLEY DAVE Phone : (970) 785-0616
P.O. BOX 363 , PLATTEVILLE COLORADO 80651
Description: HOUSE
Commercial (Y/N) : N Residential (Y/N) : Y Acres : 160 . 00
Number of Persons : 3 Basement Plumbing (Y/N) : N
Number of Bedrooms : 5 Bathrooms-> Full : 2 3/4 : 1 1/2 :
Water Public (Y/N) : N Utility Name :
Water Private (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y
Water Permit No :
Percolation Rate : hi 5--
Limiting Zone : >rft _ in Desc :
96- Ground Slope : / yv Dir: S' /&) Soil Suitable (Y/N) : /
N Engineer Design Req' d (Y/N) : In 100 Yr Flood Plain (Y/N) : 'I
F�the application information supplied and the on-site soil percolation data the following minimum installation specifications
are required:
Chambers
Septic Tank: /5tt) gallons, Absorption Trench (6Y5-- sq. ft . `
or
Absorption Bed /1//O sq. ft . y6
In addition, this permit is subject to the following additional terms and
conditions : Act, oPHe-rt WLLp C1+h7 L ,5L,S _ ' l&,1c47rW1S 4-001.-Y,
NOTICE
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 o£ 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 not transferable. 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 inspection of the completed system by the Weld County Health Dep ment.
n
X ' Lv ���� /es/ 9k
• Envnmental Sp cialist Date
. /
t DU SEWAGE . . . Ss Y TEM PERMIT NO, G-870022
��,ilF=1 J'!I�' INDIVIDUAL DISPOSAL
• WELD COUNTY HEALTH F'1 DEPARTMENTHEAL
TH NEW PERMIT
ENVIRONMENTAL L. T H SERVICES f:::[:::,`>
1516 HOSPITAL ROAD, c;I: EEI...E.'r, CO G06.31
3.53---06.35 is X T 4'?'- 25
OWNF:FR, SOUTH WELD AG ADDRESS 420 LONGVIEW CT. PH (:3:;0:_ ) 776-51
1...ONGMONT CO 80 501
ADDRESS OF PROPOSED SYSTEM 16174 WCR 32
F'LA.T.TF:''J:[LLE:: CO 80&,1
. I_t:AL. DESCRIPTION (.'I.:- S'IT-E:: : r-'W'+ SEC 23 rWI- 3 I NG 6;s
S'I.IRDIV]:: :I:I : LOT 0 BLOCK. t:! FILING 0
USE TYPE : COMMERCIAL AIRPORT
SERVICES : P'EEREONS 6 BATHROOMS 1 .00 LOT SIZE 1 .00 ACRES
BEDROOMS 0 BASEMENT PLUMBING NO WATER SUPPLY F'WE.:L.L.
APPLICATION FEE $150.00
REO ' 1) BY Dt:iREEN SCOTT SIGNED BY NORMAN E. FLACK
K
DATE 02/13/07 '. . DATE 02/13/87
4
PERCOLATION RATE 9. 1 MIN PER ]:NCH LIMITING ZONE 4 FEET
SOIL TYPE r::. SUITABLE„1tL.EE PERCENT GROUND SLOPE. 0 DIRECTION
REQUIRES ENGINEER DESIGN N YES
FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON—SITE:: SOIL PERCOLATION DATA
THE FOLLOWING MINIMUM I NE T'A1._1.-ATI ON SPECIFICATIONS ARE: REQUIRED :
:
SEEPT.:I:CC TANK 1000 GALLONS, ABSORPTION TRENCH SG FT:.
• OR
ABSORPTION BED 100 Q. f: T .
INWDI T'ION, THIS PERMIT IS SUBJECT TO THE: FOLLOWING ADDITIONAL TERMS AND
CONDITIONS : .__. ......_....._.._---.._......_____._w_ __..
THIS PERMIT IS GRANTED TEMPORARILY TO ALLOW C.ONETRUCTION .T(:i COMMENCE. THIS PIE:Rr1II
MAY BE REVOKED OR; SUSPENDED BY THE WELD`:COI..JN' Y HEALTH DEPARTMENT FOR RLAE(3NE SET
FORTH IN THE WEI..D C:CUN._(..Y INDIVIDUAL SEWAGE 'ig]:SPOSAL-- SYSTEM REGULATIONS ]INCLUDING
FA:I:LURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL
APPROVAL.. THE ISSUANCE OF TI-IIS PERMIT DOES NOT CONSTITUTE:ASSUMPTION BY THE
DEPARTMENT OR ITS EMPLOYEES OF I...:I:A1'I:I_.:I: T Y--"`F'01- THE: FAILURE OR INADEQUACY OF ..111E::
rw 3GE k DI..:OSAI... SYSTEM.. .
Qja-.,,. 5— -- `I 50i St:.(:i.i..T. PERKINS 04/29/97
rc - -4—g1 Dc_ ENVIRONMENTAL SPECIALIST DATE.
THIS PERMIT- IS NOT. TRANSFERABLE AND SHAI...L BECOME VOID IF SYSTE:M CONSTRUCTION HAS
,401 COMMENCED WITHIN N ONE YEAR OF :I:"(E ]:E;SUANCE A BEFORE L ISSUING FINAL APPROVAL OF
THIS PERMIT THI- Wi..:!...i:) (COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI—
TIONAL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA—
SIS. FINAL PERMIT r^II"'PI",OjV'Y',(... IS CONTINGENT UPON THE FINAL INSPECTION OF THE (: (:iM—
F;'L-EE:.r ED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT.
e f �,.y']�
SYSTEM :I:NSTAL..LER _. _.. _.._............................FINAL_ 1:NSPFC ]:Ot DATE { ,r" -- 7
SYSTEM ENGINEER APPROVAL _.. ...--�/Ll ---_._...._.....................
TYPE OF SYSTEM INSTALLED, - r- -__ . :i.RONi ... .TAI... SPECIALIST
dl::: ]ISSUANCE OF THIS PERMIT DOES NOT i:i'1F'I_.Y COMPLIANCE WITI"I OTHER STATE, COUNTY
CAI_. REGULATORY OR BUILDING REQUIREMENTS, NOR SHALL IT ACT TO CERTIFY THAT
ai_Ji JECT SYSTEM LiII I:::F,:p ; E IN COMPLIANCE WITH APPLICABLE r°STA•I E, COUNTY AND
... :OCTAL_. REGULATIONS ADOPTED PE::R: (.Ii':ti.l T 'T'(1 ARTICLE 10, TITLE '.`.i , CRE 1973, s"AS AMENDI:EI,
.. :t.E.i-'r FOR THE PURPOSE OF ESTABLISHING FlNAL. APPROVAL OF AN INSTALLED S , (•lE:rt FOR
`:'c'tJAi•r(:;I::: OF A', LOCAL OCCUPANCY PERMIT PURSUANT
TO CRE 197; 25-10-111 c:a'i ..
On peat( 121123v000r2
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Weld County Environmental Health Services Departmenl
y�E \ 1555 N. 17th Avenue
��' PI Greeley, CO 80631
Vine Septic Permit - Final Phone: (970) 304-6415
Fax: (970) 304-6411
OLORADO www.co.weld.co.u5
Application Number: SP-0400357 Status: Reaa9ttl'FYhal
App Type: Health\Residential\New\Septic Applied: 09/27/2004
Applicant Name: FARLEY MELBA Issued: 11/15/2004
FARLEY MELBA Finaled: Oct bq/
PO BOX 363
PLATTEVILLE, CO 80651
Owner Name: FARLEY MELBA L TRUST
Parcel #: 121123000033
Legal Desc:
Site Address: 16994 CR 32
Aop Specific Info:
1/2 Bathrooms 1
3/4 Bathrooms 0
Application Date 09/27/2004
Associated Building Permit
Associated Building Permit Number
Basement Plumbing No
Full Bathrooms 2
Location Description 16994 WCR 32
Number of Bedrooms 2
Number of Persons 2
Mier Water Supply Utility
cel Acres 80
Private Water Supply Well
Private Water Supply Permit Reference 247432
Number
Public Water Supply No
Public Water Supply Utility N
Repair Reason Type
Septic Permit Expiration Date 09/27/2005
Waive Fees No
Waive Fees Comment
Year Installed
ENS Perc Test (Site):
Engineer Design Required No
Engineer Evaluation Received Yes
Engineer Job Number 2004-194
Engineer Letter Received No
Ground Slope 0
In 100 Year Flood Plain No
Limiting Zone Feet 8
Limiting Zone Inches 0
Limiting Zone Qualifier >
Percolation Rate Qualifier
Percolation Rate Value 23.2
Slope Direction
Soil Description
W1Type Suitable Yes
iance Required No
LOtA of 12S-on Po (cf/ f 211230000 0,
/, Weld County Environmental Health Services Departr
fart; 1555 N. 17th Ave
Greeley, CO 8(
LD/�► Phone: (970) 304-E
COLORADO Septic Permit - Final Fax: (970) 304-E
www.co.well
Minimum Installation:
Absorption Bed
Absorption Trench 450
Additional Terms and Conditions
Bed Option 1 20
Bed Option 2 33
Bed Option 3 42
Chamber Option 1 Biodiffuser
Chamber Option 2 Infiltrator Quick4
Chamber Option 3 ARC 36
Septic Tank Size 00'
Trench Option 1 •
Trench Option 2
Trench Option 3 21
Actual Installation: Chambers
Septic Tank: I 2.50 gallons Absorption Trench: 5-U" sq ft Z3
��^ Absorption Bed : sq ft
Design Type: Chamber Model
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 Evnironment reserves the
right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval was contingent
upon t e inal ins yen of the pleted system by the Weld County Department of Public Health and Environment.
X IfWP rAr `/ L � f
/Environmental Health Specialist D to
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. WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, CO 80631
• PHONE (970) 304-6415 FAX (970) 304-6411
Finaled
Permit #: SP-0200179 Sec/Twn/Rng:23-03-66 Status: ISSUED
Owner: FARLEY MELBA Applied: 04/25/2002
Applicant: FARLEY MELBA Issued: 04/30/2002
Permit Type: RNEW C=Commercial, R=Residential + NEW, REPair, VauLT Finaled:
Parcel #: 1211-23-0-00-013
Location: 16440 CR 32 23-03-66
Legal Description: (i
Installer: Y�5 Walk
Description: MOBILE HOME
Commercial: N Residential:Y Acres: 80
# of Persons: 1 Basement Plumbing: N
# of Bedrooms: 3 Bathrooms - Full: 2 3/4: 0 1/2: 0
Water Public: N Water Source:
Water Private: Y Cistern: N Well: Y Well Permit #: 23460
Percolation Rate: 11.2 Limiting Zone: 8 ft 0 in Description:
WGround Slope: 0 Dir: Soil Suitable: (Y/N) Y
ngineer Design Required: (Y/N) N In 100 Year Flood Plain: (Y/N) N
Minimum Installation Chambers
Septic Tank: 1000 gallons Absorption Trench: 522 square feet
or Absorption Bed: 711 square feet
Actual Installatio
Septic Tank: gallons Absorption Trench: square feet
C Absorption Bed: square feet 23
Design Type: Oft
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 fmal approval of installed system for
issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2).
This permit is not transferable. 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 epartment ofPubb is Health and Environment.
X �� VvU til D.
Environmental Health Specialist 1J ate
•m: S_FINAL
on part-e► izli230000i3
WELD COUNTY DEPARTMENT OF PUBLIC SOE#
ir
HEALTH AND ENVIRONMENT ORG PERMIT #
^ �f 1 1555 N. 17" AVENUE REPAIR #
C� GREELEY, COLORADO 80631 LOAN #
`
IIIk
PHONE: (970)304-6415 ISDS #
FAX: (970) 304-6411
• STATEMENT OF EXISTING FOR SEPTIC SYSTEM
COLORADO (PLEASE FILL OUT IN BLACK INK ONLY)
PARCEL NO. 121 I2_3000012
PROPERTY OWNER J1(kVLd lariat Hoag 17-145r PHONE NO. (S7D) 7' G '5QP I c,
MAILING ADDRESS PO C30X 3G2" 1 P1a,..kiev1 \le Co 7So(o51
City State Zip
�lcbl i ne1O 4
DESCRIPTION OF BUILDING (ex. house, mobile/modular home, shop, office) e Ot Le
SITE/LOCATION ADDRESS \ Q I LA u) C. R_ 3-3. 9lo.A4ev % \le_ Co 8 065 I
E Z ^ City State Zip
LEGAL DESCRIPTION PT PT�t V" SECTION a..33 TOWNSHIP° 3 RANGE U/L? V/
SUBDIVISION LOT BLOCK FILING
CENCUS TRACT LOT SIZE/ACRES `S O. 1
COMMERCIA ES O RESIDENTIAL YES /f O1
NUMBER OF PE NSl,Qk o ID BASEMENT PLUMBING YES /``
BEDROOMS 0il 51 - FULL 3/4 I 1/2
WATER SUPPLY ' S O NAME
PRIVATE UBLIC YE /NO WELL(VE)NO CISTERN YES O LL (STERN# U / q_
• SYSTEM SIZE: Septic tank material is constructed of and has gallons capacity.
FIELD: Trench square feet or Bed square feet YEAR INSTALLED
You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate
location,length, width, and distance from the dwelling.
The undersigned property owner hereby certifies that the above described septic system is in fact installed, as
described, and exists at this time on the parcel of ground identified by the above legal description and further states
that the system is/is not in good working order and to the best of his/her knowledge is/is not failing to function properly.
I further understand that any falsification or misrepresentation may result in revocation of any permit granted based
upon this information hereby submitted and in legal action for perjury as provided by law.
1 — S — 1l 10—(2.-Q,c-_ 1-0-7,OIL. � Tr�44ee
DATE OWNER
s +h V
Subscribed and sworn to before me this day of ZIA-N afk1 20 i I. ,
By v"-el-RA- L. F14(UL
Witness my hand and official seal \II.V,PO4i My o mission expires 6 )s 13
"Av\ititora_,Y 5 -10 ( ( C2 "Iv
t
DATE ( PAMELA ANNE OTARY PUBLIC
E THOMPSON F
• STATEMENT OF EXISTING '.EWED BY.:
�fit ' .'' '4' ENVIRONMENTAL HEALTH SPECIALIST
• 1111k s -
Company Name: A/2.1-5 -54-4/ r3 nod ,$— 'icy Phone number: 97&-7f 6:U5--
Customer Name: %?9,i c/'Ji /'1J.Fe-itrivt
Address of Pumping: /e/ `3y 1,i14.12- 3;7, 13_ti-rrEu'L i, c%
Pumping Date: 4,2-a 4-aa,a
1. Tank Size: J)57i Gallons Pumped: %vZ5O
2. Lift Station: Yes/14t- No .< If yes, functioning: Yes No__
3. Excessive water running back into tank from field? Yes No X
If yes, estimate in gallons:
4. Liquid level in tank over inlet line? Yes No X
5. Tank Construction(check one)
Concrete X Metal Brick Plastic or Fiberglass
Cesspool or Seepage Pit Other •
• 6. Tank Construction Observed:
One Compartment Two Compartment X
7. Inlet/outlet tees and/or baffles in good condition? Yes X No____
8. Filter on outlet cleaned and inspected (if applicable)? Yes/ea No
9. Access to clean-out lids within 8 inches of grade?
Inlet: Yes No Outlet: Yes No •>(
10. 20 nil. plastic replaced and sealed over tank lid (flood plain only)?YesJl/j4f No
11. Tank/lid structurally sound and water tight?Yes X No
12. Obvious cracks/leaks observed? Yes No X
If yes, explain area:
13. Other conditions noted which may affect proper functioning of system?
Newi,. 465nvt/)
14. Reason for Service:
Maintenance )( Real Estate Sale_Emergency/Backup_Other
• 15. Notes: Mr4h9 /1tu/ IANK CeM12,441/9 /O jar;�Jrry�
Au Gr 172r9,N/,Er-J i/.vnrw< n/
In Account with
° I
mO
Art's Sanitation Service
uC �' /'
Arthur C.Beierle/Bradley A. Beierle
• I /s j I PO Box 387, Platteville,Colorado 80651
4>' ", 1 Prompt,Dependable Service Every Day except Saturday
v f
i . _,' , Metro: (303) 659-2355
f l/ if i Platteville: (970) 785-6335 0 C P`1
/�I^ Septic Tanks Grease Traps Lift Stations
,✓— < _� 1- _ _ Holding Tanks--Electronic Locator Service
Recommended Septic Tank Cleaning Cycles:
1.2 People:Every 3-4 years 3-5 People:Every 2 years 5-7 People:Every year 7+People: Every 6 months minimum
Serviceman: Ai--e--11-...3. O,1#a 4.?-477- 7/p Date: 7,2-2o- (0
Record 11 Name: y4-//ej fin4FIn1.tee_ Phone: 7e3-B6, (Co
County: f.✓-e. /o Billing Address: — O a— a z av
City, State,Zip: $7c /,4q
Job Address: /b/gy. AcK 3-) /7 .%e
Clean: Septic Tank X Grease Trap Lift Station Holding Tank Other
Tank Size: 7 7sa Gallons Working Capacity 7 St) Gallons Removed Building: Vacant Occupied>< /
Tank Construction: Concrete7C Plastic_ Metal_ Other Structurally Sound&Water Tight:YesxNo_ Compartments: !/
Baffles/Tees: Inlet:Good Bad Miss g Outlet•.Good Bad Missing Lift Pump Functioning: Yes No
System Working Level: Normal_ Below 2S.. Above Solids Extra Heavy: /'t�O
AD,
' Field Running Back: Yes % NoX How Much? /
. Any Ot r Problems Observed:
for Service: Maintenance Real Estate Sale Emergency/BackupOther
7
GGtni1,4O cat" (cm? /a2-gq-r7/O `-k-j;L>rr Tt!)
Cost: $
Additiiojtal Services:
[ .../f Service Call $ .00
[ ] Inspection Service: NAWT [ ] Standard [ ] Diagnostic [ ] $ .00
I ] Digging Labor. @$ .00 pert Hour $ .00
[ ] Locator Service to locate septic tank and mark approximate location of access lids $ .00
[ ] Extra Equipment/Extra Pumping Time: $ .00
[ ] Other. $ .00
Credit Terms: Total Cost: $
All services shall be due within the above state terms or 30 days of not stated.Any accounts that are 30 days Past Due will be charged a monthyly late fee of twenty-five dollars
($25.00)or 5%of the balance,whichever is more.Any accounts 90 days Past Due will be turned over to a collection service.The customer will be responsi a for all sts incurrec
in the collection of the Past Due account,including attorney and court costs.
Signature: X � �
Damage Waiver
Art's Services assumes no responsibility for damages inside of the curb or property line where damage may occur to: yyy
I acknowledge the Damage Waiver and authorize the driver to cross the property as referenced above.
Signature: X
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