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Home My WebLink About20112782.tiff APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM No: WELD COUNTY HEALTH DEPARTMENT • - ENVIRONMENTAL HEALTH SERVICES New 181$Hospital Road, Greeley, CO 10831 Repair ._ 383.0540 EXT. 270 BP Li- OWNER bit V!Ivr1Ak F(1r'MS ADDRESS di/91-.3 WC n- 3.3, ,i„ If ADDRESS OF PROPOSED SYSTEM `//`73 O (4/ :k 33 „ii- ,,., PHONE LEGAL DESCRIPTION OF SITE: PT.S(.4) /S :z_ T 7 q '( SUBDIVISION LOT .BLOCK__, FILING USE TYPE: RESIDENTIAL ig ( I INSTITUTION COMMERCIAL • OTHER/! (2/7/dal ,,'214' ,actil•-• SERVICES: PERSONS to BATHROOMS c2, LOT SIZE / • . Aire-e ,4-k4Ar 2 ./d,.m-ate BEDROOMS BASEMEN; PLUMBING L.' n WAXER SUPPLY /I/n!fr. .i-.-,___TYPS OF SEWAGE DISPOSAL REQUESTED: ✓Lt!/� acs V-- gzAIA z &t • Applicant acknowledges that the completeness'-Of this application Ja conditional upon further-r mandatory and additional tests and reports as may be 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 conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25,CRS 1973,as amended. The applicant certifies that the proposed system wilt not be located within 400 feet of a com- munity sewage system.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 knowl- edge and belief,and are designed to be relied op by the Weld County Health Department In evaluatingthe same for purposes of issuing the permit applied for herein.I further understand that any falsification or misrepresentation `- of the application Of revocation of any permit granted based upon d P may result in the denial �aapplication and in legal action for perjury as provided by law. 1/0 Application 1 D �'5 Reed by�L �i73s/�.Sa�Jy// -� 5 TEED /36065 re /A�.G; 7 Date Owner/Agent Signature ' Date depR DEPT. PERCOLATION RATE RBI/0//' WATER TABLE DEPTH - 51'l r I7 ONLY SOIL TYPE •Zcct---1-.-i_ PERCENT GROUND SLOPE --.3aya REQUIRES ENGINEER DESIGN( )YES fXNo • INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT From the application information supplied and the on-site soil percolation data, the following minimum Installation specifi- cations are required: SEPTIC TANK GALLONS,ABSORPTION TRENCH 2 5 S /D� SO or In addition,this Permit Is s ABSORPTION BED 332- SO.FT. ' •object 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 thetellure or I of the,,as • d n TcI"Ig•$2- �t�v��rc,�ek5� (-/g2 Erwin nmental Specialist Date This Permit Is not transferable 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 a and conditions required to meet our regulations on a continuing basis. Final Permit approval is contin apection of the completed system by the Weld County Health Department. pP gent upon the gruel In. see attached P/at Oats apjt SYSTEM CONTRACTOR AI/ Q.n FINAL INSPECT n SYSTEM ENGINEER k I/- ` �J c APPROVAL iCLIif/ ` Envlron a Specialist 7 Date_�Z.. ("Issuance of this Permit does not Imply Compliance with other state,county or local regulatory or building nor shall it act to certify that the subject system will operate In compliance with al regulations relatio adopted pursuant to Article 10,Title 25, CRS 1973,as amended,except for the applicable uses of establishing ffiinalj approval ofan Installed system for Issuance of a local occupancy permit pursuant to CRS 1973 25-10-111(2). g aPProval of an Original-Applicant:Copy-WCHD WCHD—EHS February, 1981 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 iihone—info:(303)866-3587 main:(303)866-3581 (303)866-3589 http:/lwww.water.state.co.us ENERAL 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 Welt(check applicable boxes) N _ame of applicant Attach a detailed description of uses applied for. _'JQICIP--I S 4.s t►`))'-h 4 141 0 Industrial 0 Dewatering System Mailing address 4 /r 0 Municipal 0 Geothermal(❑production or 0 reinjection) J (, FZ'C ]1h�. � 1.A £S�Z 0 irrigation 0 Other(describe): City State Zip code Commercial 2 (> (04-Le i2-Lt k " °511-5 7.Well Data(proposed) ' Telephone S ' E-mail(Optional) Masmum pumping rate Annual amount to be withdrawn 2.Type Of Application (check applicable boxes) a5-. 9Pm Y3acre-feet Total depth Aquifer ❑ Construct new well 0 Change source(aquifer) ❑Replace existing well 0 Reapplication(expired permit) 5 5 feet a Use existing well 0 COGCC well 8. Land On Which Ground Water Will Be Used ❑Change or increase use 0 Other. Legal Description(may be provided as an attachment): 3. Refer To(if applicable) Wel permit 11 Water Court case s 2.60-453 Designated Basin Determination S ' Wel name or S Pt"1'J 4.Location Of Proposed Well(Important!See Instructions) (If used for crop irrigation attach a scaled map that shows irrigated area.) County Vi V f t As) IAlu of the .5 J114 A. #Acres _ ��}}} B. Owner (lion ( Township N or S Range E or W Pfincipas Meridian .— 7 7 0❑ (/' ❑a . (e-i,-1,, P�� web«C. ust any other wewater fights used on this land Distance of well from section lines(section lines are typically not property lines) 1 COOL- ..)....)...510 Ft.from 0 N Cg S /7 5 FL front 0 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,Zip) 0 Check it well address is same as in item a. degree,which is punishable as a dass 1 misdemeanor pursuant to C.R.S. �r `� �� R I � 24-4-104(13)(a). I have read the statements herein,know the contents 5-0 `i ,b2 3 thereof and state that they are true to my knowledge. Sign here(Must be o JJ) Date Optional: GPS well location information In t/TM format You must check GPS unit for 4.00 required settings as follows: ^/7-ao# Format must be UTM Pnn 1 ( t name`d tills l� >l-� O Zane 12 or O Zone 13 Easting kJ( 1 L- - 1 ` f- Unfits must be Meters Office Use Only `� Datum must be NADlJ Northing Unit must be set to true north USGS map name DWR map no. Surface dev. Was GPS urtit checked for above? 0 YES Remember to sat Datum to NADU3 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): B. tr of acres in parcel u C. Owner AQUAMAP 73 0 , 1 alt 1- WE Will this be the Orly wed on this parcel?DYES ONO(if no-list other wells) we CWCB TOPO E. State Parcel IDS(optional): MYLAR SB5 DIV WD BA_ MD__-__ 19 Form a STATE OF COLORADO For Office Use Only No. OFFICE OF THE STATE ENGINEER GWS-12 818 Centennial Bldg.,1313 Sherman St.,Denver,CO 80203 6/2003 (303)866-3581 Fax(303)866-3589 hlipihrater.state.co.us/defauthtm REGISTRATION OF EXISTING WELL RECEIVED Name.address and phone of the well owner. � 2 1 20114 NAME(S) Charles and Doris Cunningham WATER RESOURCES g 3967 Creedmore Lakes Road sraTCO NGINEER mailing Address COLO. E ENO. City.St.Zip Red Feather Lakes, CO 80545 ' Phone ( 970 ) 881-2730 WELL LOCATION: County Weld Owner's Well Designation 41450 WCR 33, Ault, Colorado 80610 _ (Address) (ah) (State) - (7tp) NW 1/4 of the SW 1/4, Sec. ? Twp. ' _ Q N.or I I S.. Range 66 n E.or lot I W., 6th P.M. Distance from Sedan Lines 2250 Ft.From ❑ N.or 0 S.. 75 FL From❑E.or 0 W.Line. Subdivision Name n/a Lot n/a ,Block n/a ,Filing/Unit n/a The well has historically been used for the following purpose(s): Anhp4ri r- n1CPS hathrnnm lc i trhpn gardony and lawn. ter from the well was first used beneficially by the original owner for the above described purposes on unknown, pre 1972 The total depth of this well Is 55 feet The pumping rate of this well is 6.25 gallons per minute. The average annual amount of water diverted Is l acre feet. The land irrigated(watered)by water from this well is 1/4 ®Acre or O Square feet. described as: small lawrt'and-garden around buildift rkt 41450 WCR 33, Ault, Colorado or as Subdivision Lots) Block Fffing/Unit I(we)claim and say that I(we)are the warner(s)of the well described above,know the contents of the statements made herein.and state that they am true to my(our)knowledge. Please print the Signer's Name&Title Signature(s)of the owner. Date Charles Cunningham, Owner Doris Cunningham, Owner io—s—off • For Once Use Only Invoice 1531181 _ 18/21/2884 — 14:15:54 Cashier ID: 81 WR $348.88 CYVCB '' Check Purchase- 61126 MYLAR Div WD Basin_- MD_ Fete) No. OFFICE OF THE STATE ENGINEER GWS-25 R8OLOR 0133WATERSOURCES • (303)866-3581 Lft WELL PERMIT NUMBER 260453 --- `l DIV. 1 WD9 DES.BASIN MD APPLICANT APPROVED WELL LOCATION WELD COUNTY• - NW 114 SW 1/4 Section 2 CHARLES&DORIS CUNNINGHAM Township 7N Range 66 W Sbdh P.M. 3967 RED FEARS HDEMRO LAKES.ES� _..-- 2250 FL from South Simon L 75 Ft.frorri West Section LMe UTM COORDINATES(NAD83) (970)881-2730 Eastirh0: No : REGISTRATION OF EXISTING WELL ng — - . - _ ISSUANCEOEJHIS_PERMQAOES_NOZCONEER A--WATER-RIGHT CONDrt IONS OF APPROVAL 1) does well shall be h in vwillooc r to another vested water sight preclude another owner of a vested water from does not a way as to cause no-material injury b existing water raids, The Issuance of this permit ensuues that no injury seeidng relief in a civil coral adios. 2) Construction defa1s for this mdskig wee have not been provided to this office;therefore,a is not known t the cow with the Water Wet Construction Rules,2 CCR 402-2. The issuance of this permit does not r(ie s wed w in owner of receor Habl in the event contamination of the grauidsrater source results from the relies the war use f this s wet norl does o ty ahortd contamination construction or uee of tilde nor the State Engineer assume any responsibility nanny oxw. and in accordance With CRS 37-92402(5)for historic use as indicated herein 3) well is recorded 3d and permit approved _ described single dwe 37-92 i1Xte,being a thewell�offddomeestic animals and poultry,and the I of not more than 1 and used for ordinary household purposes inside siRgla fauiiy dne8ng( ), f • arse of hnnw gardens and lawns: 4) The date of first beneficial un.as Warned by the appacant,is 1950. . {aW //— Lon of . • 1 — APPROVED Z iU ,,�/ q PAT Sista Ermines,. ear DATE ISSUED ED��+'+-�-rr�1 (( 1-19-2004 EXPIRATION DATE �4 (Neon No.0531161 20 3'JtYd swImonsi WVHE IIND 69Et-PE8-0L6"." OZ:ZI 17002/ES/Zi State of Colorado Water Resources - View Well Details: Receipt 3650310 Page 1 of 1 Colorado Deaartment Ci Natural Res nukes Co102no-9ov I ConlaC JS toJstado D171Mthil D1 • JA r r e1, c I ),,c `3 Colorado's Well Permit Search Well Constructed Help Last Refresh:10/3/2011 12:00:21 AM Receipt: 3650310 Division: 1 Permit ft: 286516-- Water District: 3 Well Name I ft: County: WELD Designated Basin: Management District: Case Number: WDID: [-] Applicant/Owners History Date Range Applicant/Owner Name Address CRY/State/air Unknown-Resent CUNNINGHAM DORIS 3967 CREEow of LAKES ROAD RED FEATHER LAKES,CO 80595- [-3 Location Information Approved Well Location: Q40 Q160 Section Township Range PM Footage from Section Lines NW SW 2 7.0N 66.0W Sixth 2250 S 75 W Northing(UM y): 4494746.5 Fasting(InM x): 520526.1 Location Accuracy: Spotted from section lines Physical Address Subdivision Name City/State/cap Filing Block Lot Parcel ID: Acres in Tract: 3.49 [-] Permit Details Date Issued: 08/22/2011 Date Expires: Use(s): COMMERCIAL AquiferALL UNNAMED AQUIFERS • Spada!Use: (s): Area which may be irrigated: Maximum annual volume of appropriation: Statute: Permit Requirements: Totalizing Flow Meter Geophysical Log Abandonment Report No No No Cross Reference Permit Number Receipt Description Permit(s): 260453-- Q311B1 Comments: [-] Construction/Usage Details Well Construction Date:12/31/1950 Pump Installation Date: Well Plugged: 1st Benefldal Use:12/31/1950 Elevation Depth Perforated Casing(Top) Perforated Casing(Bottom) Static water Level Pump Rate [-] Application/Permit History Permit Issued 08/22/2011 Application Received 05/16/2011 First Beneficial Use 12/31/1950 Pump Installation Report Received 12/31/1950 Well Constructed 12/31/1950 11 I L-] Imaged Documents Document Name Date Imaged Annotated 0ri io nal File 08/25/2011 No Copyright D 2009 Colorado Division of Water Resources.All rights reserved. Home I Contact Us I Help I Water Links Colorado.gov I DNR I Pnvacy Policy I Transparency Online Project(TOP) • http://www.dwr.state.co.us/W ellPermitSearchNiew.aspx?receipt=3 650310 10/3/2011 State of Colorado Water Resources - View Well Details: Receipt 3650310 Page 1 of 1 Colorado Department of Natural Resource.., Colorado.gov I Contact Us t$JsfiJa �i,Ylaifi, �1 • r l3 Colorado's Well Permit Search Well status UNKNOWN Help Last Refresh:5/29/2011 12:00:29 AM Receipt: 3650310 Division: 1 Permit#: 286516-- Water District: 3 Well Name/#: County: WELD Designated Basin: Management District: Case Number: WDID: [-] Applicant/Owners History Date Range Applicant/Owner Name Address City/State/Zip Unknown-Present Cuf/NINC5sAM DORIS 3967 CREEDM ORE LAKES ROAD R®FEATHER LAKES,CO 80545- --- -- _ -- 1 [-] Location Information Approved Well Location: Q40 Q160 Section Township Range PM Footage from Section Lines NW SW 2 7.0N 66.0W Sixth 2250 S 75 W Northing(tfTM y): 4494746.5 Easting(UTM x): 520826.1 Location Accuracy: Spotted from section lines Physical Address Subdivision Name City/State/21p Filing Block Lot Parcel ID: Acres In Tract: 3.49 L-) Permit Details Date Issued: 08/22/2011 Date Expires: Use(s): COMMERCIAL AqulferALL UNNAMED AQUIFERS • Special Use: (s)' Area which may be irrigated: Maximum annual volume of appropriation: Statute: Permit Requirements: Totalizing Flow Meter Geophysical Log Abandonment Report No No No Cross Reference Permit Number Receipt Description Permit(s): 2S2_04.53-. 4 1,01 Comments: [-] Construction/Usage Details • Well Construction Date: Pump Installation Date: Well Plugged: 1st Beneficial Use: Elevation Depth Perforated Casing(Top) Perforated Casing(Bottom) Static Water Level Pump Rate [-] Application/Permit History Permit Issued 08/22/2011 Application Received 05/16/2011 [-3 Imaged Documents -.-._.... Document Name Date Imaged Annotated Original File 08/25/2011 No Copyright O 20D9 Colorado Division of Water Resources.All rights reserved. Home I Contact Us I Help I Water Unks I Colorado.gov I DNR I Privacy Policy I Transparency Online Project(TOP) • http://www.dwr.state.co.us/WellPermitSearch/View.aspx?receipt=3650310 8/29/2011 Form No. OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES • 818 Centennial Bldg.,1313 Sherman St.,Denver,Colorado 80203 (303)888.3581 EXST WELL PERMIT NUMBER 286516 DIV. 1 WD 3 DES. BASIN MD APPLICANT APPROVED WELL LOCATION WELD COUNTY NW 1/4 SW 1/4 Section 2 DORIS CUNNINGHAM Township 7 N Range 66 W Sixth P.M. 3967 CREEDMORE LAKES ROAD DISTANCES FROM SECTION LINES RED FEATHER LAKES, CO 80545- 2250 FL from South Section Line 75 Ft.from West Section Line (970)356-0505 UTM COORDINATES(Meters,Zone:13,NAD83) CHANGE/EXPANSION OF USE OF 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 clvll 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 for appropriation of ground water tributary to South Platte River system. 4) Approved for a change of use of an existing well constructed under permit no.280453. The issuance of this permit hereby cancels permit no.260453. 5) The use of ground water from this well Is limited to drinking and sanitary facilities as described in CRS 37-92-B02(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. 8) The pumping rate of this well shall not exceed 15 GPM. 7) The annual amount of ground water to be diverted by this well shall not exceed 1/3 acre-foot(108,600 gallons). 8) Approved as the only well on a tract of land of 3.49 acre(s)described as Lot B,Recorded Exemption No.0707-2-3-RE-991 Weld County,reference attached exhibit"A". 9) 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. 10) 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. 11) This well shall be located not more than 200 feet from the location specified on this permit. 14.7).6. s-2 2•.7.o if • APPROVED n � Do' �o — ADB (.L! State Engineer By Receipt No.3650310 DATE ISSUED 08-22-2011 EXPIRATION DATE H/A Hello