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Home My WebLink About20113119.tiff Apr 12 11 10:02a AC Trucking LLC 3035023188 p.7 AUG_05-2006 TUE 04:37 PM N C ENV R0NMENTAL HEALTH FAA NO. 070 304 6411 P. 01 fttia 1 . !JkkcFAX TRANSMISSION. +ELD;MINTY DEPARTMENT Or PUBIC HEALTH AND ENVIRONMENT I$55 NO TI4 17'-Ave.. CNEREY. Co B053 I ApMxelelmitow rAx: 970.3044A 1 6 • rMowc:. 970.30454 I sans soucancw 5.wu!t5IMd Fax: 070-304-B4 I e rMOMG 570-304-6420 EINIFOMMEMTAI MELLTH• r.x: 970-304-6411 PMOME: 970-304.641 5 S r To: 5 4—' Cr it-5O Date: - • Fax: 3 63 Spa _ : \ e Pages: S Phone: '1 • From: l _tA 3ca L C^wI Sobject:S '0-1 e I _ems inn fi PP o R !s al 4 . -& c COMMENTS: dJST Fa L)no ter c. PAC- ; I t APQ �� S t eeI con_ (trail_ re\ Y>,t1Y s-4 5-1--1 "n) t cse;(4_4. �� -cr., us-, Ss iv\k_ o Cg>`rrosrriznz. oz. k_iis_144.avvi This_facsimile isintended c Ilvjor the_use of the individual oi_entity to which it is addressed ard may contain information tl t is privileged,confidential—and exert from disclosure under applicable law. If the reads of this facsimile is not the intended recipient nor the employee or agent responsible for delivc ing the facsimile to the intended recipient,you are hereby notified that any dissemination,dirt button,or.copying of this commmtication is strictly prohibited. If you have received this core natation in error,please notify us immediately by telephone and iettnn the original message o us at the above address via the U.S. Postal Service. Thank you. 5Po) oc)a?'(P 2011-3119 Apr 1211 10:03a AC Trucking LLC 3035023188 p.8 JUL-23-2008 WED 0300 11 H C ENV RONMENTAL HEALTH FAX NO. 970 304 6411 P, 02 matt 0000°I iti WELD I *BITTY DEPARTMENT OF PUBLIC se et QRG P RRC difo ALT I AND ENVIRONMENT i 1.III 1555 N. 17Th AVENUE REPAIR 5 • Sra. GREET cY.COLORADO flDti31 LOAN>l PHONE : (970)334-6415ISDs M O(PO'!(' • FAX: ( 70)304-5411 STATEME qT OF EXISTING FOR SEPTIC SYSTEM (PLEAS: l FILL OUT IN BLACK INK ONLY) PARCVT1l I;09 I OL©OOC PROPERTY OWNER_T413 Ls-As ' Cottle. L.LC. PHONE NO. 13031 $b-7- 1S12- MAILING ADDRESS ro5gy LjICR 31 r+ Lurie. GO $ofr,zl City State Zip DESCRIPTION OF BUILDING(es. km se,mobile/modular home,shop,office) lin US.F SITE/LOCATION ADDRESS it, c Lt/02 3 I City State Zip r L LEGAL DESCRIPTION PT S L PT N A± 1 SECTION JO TOWNSHIP?I RANGE 000 SUBDIVISION LOT BLOCK FILING CENCUS TRACT LOT SI7FJACRFS go COMMERCIAL_ YES la RI SIDENTIAL S.S/NO NUMBER OF PERSONS f el .SEMEN[PLUMBING YES/ BEDROOMS_ B. .T'HROOMS FULLL_ 3/4 1/2 WATER SUPPLY'PUBLIC YES C ) NAME PRIVATE /NI I WELL NO (<ISTERN YES! WELL/CISTERNS °vac:FT-CC S SYSTEM SIZE: Septic tank material is Destructed of . Fri-gt and has____itga a gallons capacity. FIELD: Trench S0_,square fec or Bed square feet YEAR INSTAT TIM a i4--15S Yea are required to draw a diagram oft Ie system on the reverse side of this form in black ink only and indicate location,length,width,and distance fret I the dwelling. The undersigned property owner hereby certifies that the above described septic system is in fact installed,as described, exhts at this time on the parcel of gr Iliad identified by the above I ai description and further states that the system 10 good working order and to Ns of his/her knowledge is/I ailing to function properly. I further understand that any faishlicads tor misrepresentation may result in revoeadon of any permit granted based upoo this Information hereby submitted Ind la legal action for perjury as pr dad by law. // /4/ 2 ovk {'NE dcj I? IL. 1 DATE O R NATURE // t Su bed and sworn before me Is 1 day of 1 ).�I.'G r PI �J'.•� __, 20_ � dd Witness my hand and official sec. My commission expires: .� I741or ATE NO TAR S ./..4 r ^srt-40'A D STATEMENT OF EXISTING INSPEC ION REVIEWED BY I U��it+ : l Ay P. 'Ili a ENVg HEALTH SPECIALIST DAT • Apr 1211 10:03a AC Trucking LLC 3035023188 p.9 HW'UO'LUUB IUC U9;3/ rr1 N t. tNY. KUNIICNIHL HtHLIH I'HA NU, biU 3UR 0411 r. u[ Page 1 of 4 Aced&Automaton GetPerSot250- '050'3 e "'",sy. "'9,}i^j""�,il.,g 1;&T Menu .Favorites 1 Neely t Logout .a . ��t: tt User ID:WSW ACCE 5martManeger Application Property People Fees Cashier Workflow Attachments Inspection Rep Application -Summary Application Type: Hea th/Residential/New/Septic Applkatten: J 0100288 _.__ __..� Owner HOMO: SAL ;ERMAN RICHARD E&CAROLYN SUE • Owner Ad W: 365 5 23_SIE,BRIGHTON,CD 80601 gets: 152 14 CR 20,WELD,C2?) Application Comments: Q j Melt Application Status: Iwo d Parcel No.: 130 22000056 File Date: 06/l 1/2001 Description or Work: H0t SE Application Spew Info.: EH! APPLICATION DOCUMENTS Au itertaHon Form: At lwrlsatien Form Signed By: Ds a Authorization Form Signed: Me r: SC :System Diagram: • Pa eMetlen Moks Flappd: Pu spin.Receipt(For Loans and ISOS): Da a Pumped(For Loans end TADS): EH! SEPTIC GENERAL to Winn Desalptlen: 15294 CR 20 22 02 66 Re nab Reason Type: A. oida ed Building Pmrt As misted Buildup Permit Number: Ap motion Peat 06/07/2001 Se tic Permit Exaltation Date: 06/07/2002 Wi We Foes: We We Pees Comment: MU ober of Persons: 2 Nu tuber of Bedrooms: 4 at ant Pfumbine; N FW Bathreoms: 2 3/ Bathrooms: 0 • -1/ Bathrooms: 2 Pu lie Water Supply: _ Pu lie Water Supply Utility: On sr Water sipplyUenty: Prl ale Water Supp)ye . Meta Water Supply Permit Reference Humbert Pa el Acres: 5 Yet r Installed: ENS PERC TEST(SITE) Pen :down Rate Qualifier: 229064 • https://accda-web.co.weld.co.us/opc Monsipamit/index.cfm?FUSEACTION- etPerSet... 08/05/2008 • Apr 12 11 10:04a AC Trucking LLC 3035023188 p.10 _ nW'u:rcuuo tuc uq.Jr rut PI nv V cl LILtu1e.tr RE.J1Ltn nl inn . ory Inn JV, r . ti+Page 2 of 4 Aceela Automation:()ctPc1Se1250-1150S • Per :elation Rate Value 133 Lin king Zane Qualifier.Li r tine Zone Feet 00 Lin lane zone Inches: Sol Oeoeripteri CLAYSTONE Gn end Slope: 1 Sio to Diredlon: CLAYSTONE Sol Type Suhabic N In 00 Year Flood Plain: N En: Inner Design Required: Y Eat inset Job Number: Eat :neer Letter Received: N En. Inner Evaluation Received: Y Vs lance Required: N EH: SEPTIC IFESTALL(SITE) St do Tank Slam 1.250 Ab orptlan Trenehl 0 AO orption Bed: 6,940 Ch tuber Option 1: Tn nth Option It 9e Option 1: Ch mbar Option 2: Tr: itch option 2: _ ee I Option 2: Ch ember Option 3: Tn itch Option 3: Be i Option 3: Ad lidenal Terms and Condition= N El# SEPTIC ACTUAL(FINAL) Se do lank Size: 0 Ah arption Trench Spedfleation: 0 • Alt orptltal Red Spedfleatlen: 0 Ch nitsNadel: Nn abet of Chambeet Ad Ronal Terms and Condition!: De ion Typo Lit Station: 0 Lit Station Sim 0 To k Anchored: N Wi ter Reduction: 0 Sae :Information Ac es: 5 SP ITYPO: RNEW AN died: 06/07/2001 RC /Approved: 07/24/2001 Oh i Permit a 1: SCS eh I Permits 2: 050 RIl t Permit+{3: 551 CU is Code: 1000 al ',Code Text New Septic Construct!on En I Olson Raq'd: V En RvaluatIon: Y En Letter Redd: N In 100 Yr Flood Plain: N Is: aid Data: 07/30/2002 Ist red Textt PS to Wont 15294 CR 20 22 02 66 Pm nit Expires: . 06/07/2002 So /Teinlane: 22 02 66 Set If Approval: 06/27/2001 • https://accela-web.co,weld.co.us/ope aeons elmitfmdex.cfn?FUSEACTION QetPerSet.. 08/05/2008 Apr 12 11 10:04a AC Trucking LLC 3035023188 p.11 ODU VV LVW lVL •J •JV an n V l.a. lv.u.uu.n. uu.r... . i-. • v. ..... -. - . - . Page 3 of 4 Accela Automation:GetPe(ra(x250-; 150-S • • $ea lie: ISSUED viman; N We titan 6y: BM Ser ices as east*Plumbing: Y Pe silt Not 229064 Pd eta Water Supply: V s i f Bedrooms: 4 Y I f Persons: 2 :1/ 2 • 3/ 4 0 Oa browns-a.Full: 2 Ce is.Teat 19.04 Cl: ern; N Ca 4merdaf: N Pu die: N Re tdenUali Will: y Ina allation 01 .Percolation Nin Per Inch: 33 04 Limiting Zane Feet: D5 .Limiting Zone Inches: �Y57pNE Dt •Deaaption: 0) Ground Slope Percent 09 Soli Type Saltablo(Y/N$ SC r4Inamum Septic Tank(galke ): 250 11 44Immnam Absorption Trench(NI ft)t H v •Nlnknum Absorption lied tag ft): 940 12 actual SepticTank(gallons): Ie actual Absorption Trench(sq it): 15 actual Absarptbe Bad(sq ft): • It -Additional Conditions(Y/N): It 41R Station(Y/N): 2( at Station Gallons: 21 erank Anchored(Y/N)s 2: •Water Reduction(Y/N): Application Spec Info.Table Application Detail: Eldlil Contact Info: Nx tie Organisation Contact Type Relationship Addre Name @3 t5ERn41n gAUSERNAN RTCNARq Apples at 365S $1! HARD E Licensed Professionals Info.: Pr mart' License license Nance 8usinnese Nor Number Type 901.0125 Septic Engineer COLORADO SOT lob Value: So. 0 Total Fee Assessed: $31 5.00 https://accela-web.co.weid.co.us/op rdtiops/pelmittindexsfin7FUSEA CFION=GetPerSet... 08/052008 • Apr 12 11 10:05a AC Trucking LLC 3035023188 p.12 OVY vu CVVV IVI: unkuu111 n V Llll OVItLL:IIUIL IILOL111 IM INS VIV ./Vl VIII 11 VJ Accela Automation: GetPerSet250- 3150-s Pagc 4 of 4 • • Total Fes IatuOlced: $31.1. .00 Balance: $0.t I Worldlaw status: Ta dt Status Status D AgD Apply 06/07/200 She :meatball App ind Engineering Review Per t Mug Fina lrupeclon Boa S el Health Parr It Fina Cc ndldan Name Status Apply Datetta Appiiao 07/19/2001 Condition Status: bIS Applied 07/19/2001 big Applied 07/19/2001 • https://aecela-web.co.weld.co.ns/ope ations/pennitrindex.cfrn?FUSEAC ION—CetPerSet. 08/05/2008 • Form No. OFFICE OF THE STATE ENGINEER GWS-25 COLORADOg., 3DI13 VISIOerman N OF WATERoRESOURCES818 sT (303)866-3581 • WELL PERMIT NUMBER 74761 -F DIV. 1 WD2 DES. BASIN MD APPLICANT APPROVED WELL LOCATION WELD COUNTY NE 1/4 NW 1/4 Section 22 Township 2 N Range 66 W Sixth P.M. P C TRUCKING LLC P O BOX 489 DISTANCES FROM SECTION LINES FT LUPTON, CO 80621- 200 Ft. from North Section Line 1500 Ft.from West Section Line UTM COORDINATES(Meters Zone:13 NAD83) (303)857-3862 Easting: Northing: PERMIT TO CONSTRUCT A WELL ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT f'ONDITIONs OF APPROVAL 1) This injury will occur to another vested water right or preclude existing another er owner of a vested water right from eekingrel of In nohe a civil court action. er a 2) bThe een granted construction the State eBoard of xam Examiners of ConstructionWater ll shall be in compliance with tWelllR and PumpInstallat on Contractoaen accordance of ccordancewith Rule c s 18. 3) Approved pursuant to CRS 37-90-137(4)and the findings of the State Engineer dated January 21,2011. 4) The use of ground water from this well is limited to irrigation,domestic,and commercial use including a 5,000 square ft.garage and truck depot shop. 5) The pumping rate of this well shall not exceed 15 GPM. Production ng must be ins alto ledhand grouted to prevent the withdrawal uifer which ls of ground water from other aquifers and the movemencated 625 feet below land surface and extends to a t of ground water Plain between aquifers. 7) The dpth to the top of abo ee he aquifer,plaint casingand grout slhalllextend through thet lowermostcoal andlorhe Larame-Fox Hils aquifer is approximae. To ensure the ucarbo carbonaceous shale vthatr from zones immediately the Laramie sand portion of the aquifer. 8) The allowed average annual amount of ground water to be withdrawn is 1.1 acre-foot. 9) The entire length of the hole shall be geophyslcally logged as required by Rule 9 of the Statewide Nontributary Ground Water Rules prior to installing casing. 10) The owner shall mark the well in a conspicuous place with well permit number(s),name of the aquifer,and court case number(s)as appropriate. The owner shall take necessary means and precautions to preserve these markings. 11) This well shall be constructed not more than 200 feet from the location specified on this permit. 12) A totalizing flow meter must be installed on this well and maintained by the well owner(recorded at least annually)maintained and submitted to the Division Engineer upon request. records of all diversions must be req es 13) Pursuant to CRS 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 well owner shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98%of the water withdrawn will be consumed. applicant, A Notice was sent to theby owners h a permit no(s).228963 14) This well shall be located at least 600 feet from any existing well,completed in the same aquifer,that is not owned by the app excluding those wells whose owners were notified pursuant to CRS 37-90-137(2)(b)(II)( ). and 64214-F and no response was received. 15) The issuance of this permit hereby cancels permit no.74407-F. NOTE:The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be less than the 100 years upon which the amount of water in the aquifer is allocated,due to anticipated water level declines. NOTE:To ensure a maximum productive life of this well,perforated casing should be set through the entire producing interval of et•I( approved zone or aquifer indicated above. • APPROVED -. �' JLV State Engine DATE ISSUED 1-21-2011 PI' ION DATE 01-21-2012 Recei•t No.3648408 � ORDER OF THE STATE ENGINEER • IN THE MATTER OF WELL PERMIT NO. 74407-F LOCATION: NE %, of NW%, of Sec. 22, Twp. 2 North, Rng. 66 West, 6th P.M. APPLICANT: A C TRUCKING LLC THE STATE ENGINEER FINDS: The well permit was issued on August 16, 2010, pursuant to C.R.S. 37-90-137(2) with an expiration date of August 16, 2011. On December 22, 2010, evidence that the existing well would not be used pursuant to permit number 74407-F was submitted. The evidence submitted is as follows: The applicant submitted an application to change the use of the existing well for permit no. 74407-F. The well permit is hereby cancelled and is of no further force or effect. Dated this 22nd day of December 2010. • �� Dick Wo e, P.-. Director/Sta ng' eer Be�i Jolene -c a Water R-sourc Sp=' i:list Prepared by:Jim cc: Division 1 • Hello