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Home My WebLink About20110778.tiff • C u,,4, ,C-' x-74 - F • • 2011-0778 • 1/17/0 AEN . To r'i'd 13teKo w CcLLn i'1 ? L/-1AJNF2 • Pc- cIG. A- ND u- eOPY OA- 2y Foi+ L tzm -1t C E 15 A CCpL OP CLLr -pplica -Firri -f-o � G�vc car 5--iv -1Thrc-yo tX &ten nT 55 -7 -I- C N N - frinrr 5D$rLtS , MIKE i3t=NrJ ' (o L. 0r`I-v-1Do Dc pT G F WTZWILL n-pptcX - 3 Gu -LK5 ✓ A-pprava-C_ S No co F7,LEMs U; IT t-/- cur u_ 5A- L- c 5 .T/f ET WE "Ree,Lve-SrtcD , VLrPi5 E P/t5S T El- 1 S !Tv Ft C/%1 last/ON ON —VC /NI ►t la\I E b' ct- L)-r I t'tm D Cc u D\ r i) I+C F} 114 17e- PT. Pc NIcsi is C' 61mMe-PeihfL 8U,�- N e. LLIcis / ,-SCl5TNeS5 IL5It6c , LI vE57-ac K ANC 7n2Ic & T3o & R0E: r CT FSIOP tut_ es A IvD FClc: 1, LI5T A- 13Att merv'T • C'oM +t1tL' cr 'rL LtS kt - E c 0,1 inn rv' __... f,n(U' • , COLCRADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(07/2009) DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST,RM 818,DENVER,CO 80203 ,till-ii- ,rF phone—info:(303)666-3587 main:(303)8663561 S(303)866-3589 httpJlwww.waterstate.co.us ENERAL PURPOSE JAN 1 4 2011 Water Well Permit Application Review Instructions on reverse side prior to completing form. rifAfEh KesuuRces ER The form must be completed in black or blue ink or typed. EN STATE 1.Applicant Information 6.Use Of Well(check applicable boxes) Name of applicant Attach a detailed description of uses applied for. r / .ZT A-C le- A-N D 1-)- -U O y 0 k e y ❑Industrial ❑Dewatering System (c2 dWe-JNtlbil) MaiNg address ❑Municipal o Geothermal(O production or O reinjectionn)- k1t/ Po $O jC 163 / /a/e/ H W s a ❑hrigadon other(describe): Re S1.c(ar tka.t l k acre car rip code FORT 10+� etl '34.0 boa 1 %Comm erc al Lt weS-i-oo It -(-. r gat twin©A7 Telephone* �"� E-mail(Optional) T.Well Data(proposed) an U'S 'l i-+iSS h.e et 53 6t rna I ..con Maria'Parlpig rata Annual amountm be Wildman 2.Type Of Application (check applicable boxes) t 9wn t 1 At/41'14 Le_ acre feet Trial depth Aquifer ❑ Construct new well ❑Change source(aquifer) (07 0 few La.ra.M t;e. F's tints ❑Replace existing well 0 Reapplication(expired permit) %Use existing well O COGCC well 8.Land On Which Ground Water Will Be Used 0 Change or increase use O Other. Legal Description(may be prmi led es all enactment): 3. Refer To(if applicable) Writ pornkt* Water Cart ma N A-het E 4aiy5—A- (, Detigaled Basin Determination* Wei o name f 4 r Tp�k f k c-1 EJ 4.Location Of Proposed Well(hnportantl See Instructions) mooed for crop n gaeon.attach a skated map that showsirrigated area) cagy en \Ai (Jl S W 1/4 gibe N� 1/4 A. *Ames B. Ewer•Toeship NOS Rage Eor W Pr'rdpel Merida, C. List any atherw walls or water lights ka�ontli'st art Seca I Is ❑ (a7 ❑( 6W% Distance et well from section tines(section Ines me typically not property lies) ,a,9,,.4 o afromEncis erg. p Ft boa❑E N w 9.Proposed Well Driller License ff(optonal): For replacement eels aiy—land drection from old well tree well 10.Signature Of Applicant(s)Or Authorized Agent feet direction The making of false statements herein constitutes perjury in the second Well location edges(knd`rde City.State Zip) O check drat address is sane as n can 1. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. 'Q i ( I-7-W .5 `4 cc 24-4-104(13)(a). I have read the stabnrrents herein,know the contents la O 1.-w�!'"f"d't'k, thereof and state that they are true to my knowledt-1�er SO(p21 Sign hae(Mlstbeodaealzombie) ID C ' Date Optional: GPS well location information in Uitr format You must check GPS unit lot p required settings as follows: !ham IA /�.'r Fmmet must be UIM ' name&bile 1w K-� ❑Zone 12 or D Zane 13 FaN^g H-tat_zia OA-1L N( Units mad be Meters �J DaaermustbeNAun Office Use Only ng Unit must be sotto tone moth USGS nep-erne DWR nom no_ Suface elev. was GPS twit ceded for above? 0 YES Remember to set Datum to NADa3 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 al a tadment (I T A-C(.} ED PEED T`a1/14/20113 3646774; M Debbie Gonzales(20) Total Trans And:$100.00 CHECK Check Number: 10064 Check Amount: $100.00 B. *arms tapered/ C. Dee ADUAMAP • L I.SF7 5ei-F wE D. VA die be the only wel on*is parker?VIYES ONO Of no—fat dereels) WS CWCB TOPO E. State Pact p(option* WATER SUPPLY INFORMATION SUMMARY Section 30-28.133,(d), C.R.S. requires that the applicant submit to the County,-Adequate evidence that a water supply that • is sufficient in tame of quantity, quality and dependability will be available to ensure an adequate supply of water. 1. NAME OF DEVELOPMENT AS PROPOSED /v/A. iJW�IIin5 2. LAND USE ACTION tA--S ty B� v p{'�<< h� V i F Lr.! .�; rtY'S' ct._y 141x 4 - v - c)o v I 3. NAME OF EXISTING PARCEL AS RECORDED fU IA/`/:-f Se<_ 1 d K vvy k r f No(rh 14-Ly�r L 1r 7 U/t'S C`- SUBDIVISION _. _ FILING BLOCK r, LOT 4. TOTAL ACREAGE 1, 5. NUMBER OF LOTS PROPOSED PLAT MAP ENCLOSED A YES G. PARCEL HISTORY - Please attach copies of deeds. plats or other evidence or documentation. c ke se d- to ;rn tlS12_ i4ppi A. Was parcel recorded with county prior to June 1, 1972? 0 YES J NO B. Has the parcel ever been part of a division of land action since June 1, 1972? YES 0 NO if yes, describe the previous action R Er t-f $2- 7. LOCATION OF PARCEL - Include a map de1niatinq the project area and tie to a section corner. 1/4 OF Ni IV 114 SECTION a, TOWNSHIP I (21.N ❑ S RANGE (c 7 0 E PRINCIPAL MERIDIAN: "16,6TH 0 N.M. 0 UTE 0 COSTILLA 8. PLAT - Location of all wells on property must be plotted and pernit numbers provided. IISurveyors plat ❑ Yes ❑ No If not. scaled hand drawn sketch O Yes ❑ No 9. ESTIMATED WATER REQUIREMENTS - Gallons p.r Day a Acre Fort par Yaw 10. WATER SUPPLY SOURCE rif EXISTING 0 DEVELOPED O NEW WELLS - WELLS SPRING PROPOSED Ae1f_ ,(CHM ORO HOUSEHOLD USE 1 / of units -3€c GPO AF WELL PERMIT NUMBERS a Auurut o UPPER ARAPAHOE D OMR oawsai o ietr6l ARAPAHOE 0 LOWER mama MeataW FOX wets COMMERCIAL USE 1 0 of S.F. GPD AF o oMMMER O aumr 0 area IRRIGATION 1 / of acres GPD AF STOCK WATERING i1� O of head GPO AF 0 MUNICIPAL 0 ASSOCIATION WATER COURT DECREE CASE NO.'S OTHER GPD AF 0 COMPANY O DISTRICT TOTAL GPO AF NAME LETTER OF COMMITMENT FOR SERVICE 0 YES 0 NO 11. ENGINEER'S WATER SUPPLY REPORT 0 YES IA NO IF YES, PLEASE FORWARD WITH THIS FORM. (mit may be required Wort our raai.w is complatadJ 12. TYPE OF SEWAGE DISPOSAL SYSTEM SEPTIC TANKILEACH FIELD 0 CENTRAL SYSTEM - DISTRICT NAME 40 LAGOON O VAULT - LOCATION SEWAGE HAULED TO O ENGINEERED SYSTEM iAtt.ch a away of.agin.erinq design) 0 OTHER ie4;O „ DEPARTMENT OF NATURAL RESOURCES y A` { DIVISION OF WATER RESOURCES k x *• Bill Ritter,Jr. ?it 1876 4,. Governor Harris D.Sherman Executive Director Dick Wolfe,P.E. Director/State Engineer James R.Hall,P.E. Division Engineer January 30, 2009 Jack R. Cary 10161 Highway 52 Ft. Lupton, CO 80621 Re: Use of Well with Permit No. 92145 Dear Mr. Cary: This letter is to confirm our conversation of Friday January 30, 2009 that water from your • well with permit number 92145 may be used occasionally for drinking and sanitary purposes by delivery drivers or other persons arriving at your small farm for business purposes. This will not impact your ability to use the well for the currently permitted domestic and livestock watering purposes. Please contact me if you have any questions. Sincerely, 71,etatc David L. Nettles, P.E. Assistant Division Engineer DLN:dln\WeldCtyWell92145LtrA.doc Cc: Well Permit File • Water Division 1 • Greeley 810 9th Street,Suite 200•Greeley,CO 80631 •Phone:970-352-8712•Fax:970-392-1816 www.water.state.co.us wivis32 • COLORADO DIVISION OF R RESOURCES 'u `reRM RUST �W-ce4,.lai..�ws,• iter nan St. RECEIVED 'SusMITTED.NO OR TO - TNE EXPIRATION Or TIE Denver, Colorado X203 RERMP%TPPE OR ir IN BIAICK INK. Late Ragiatration - AUG 0 4'7 r STATEMENT OF BENEFICIAL USE OF GROUND WATER ~ ►MENDMENT OF EXISTING RECORD SOWATE RED W SW PERMIT-NUMBER 92145 tes STATE OF COLORADO COUNTY OF 1 SS. THE AFFIANT(S) con g, posy whose address In 194141. C^lrt horsy 52Fort Tatptnnt Cole- £10621 being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well is located in the Sur Y4 of the NW 14 of Section 2 , Township 1 N (N.or S.) Range 67 W 6 P.M. at distances of 2340 feet from the Barth section line (E.or W.) (North or South) and 700- feet from the west section line;the total depth of the well is 630 feet; water from this well (Fast or WM) �{,�a l was first applied to a beneficial use for the purpose(s) described herein on the sP day oTy 60 years , 19—; the maximum sustained pumping rate of the well is 15 gallons per minute, the pumping rate claimed hereby is 15 lions per minute; the average annual amount of water to be diverted is 2 acre-feet; for which claim is hereby made for Domestic & Livestock purpose(s); the legal description of the land on which the water from this well is to be used is SW)1W. Sar 2• TMp. 1 N; ND- 67 W. which totals f3A acres and which is illustrated on the map on the reverse side of this form;that this well was completed in compliance with the permit approved therefor; this statement-of beneficial use of ground water is filed in compliance with law; he (they) has (have) read the statements made hereon; knows the content thereof; and that the same are 6 true of his (their) knowledge to Q�� 3 7 Signature(s) (/l/� �9�i a./7/LA _ FOR OFFICE USE ONLY Subscribed and sworn to:befcre me on this �— day of ap %-:'-&--;.--i , " 19Z —,Prior. Date • 14_ i�Cee tc G.j ° i t1 - Q Well Use_ My Commission expires: Qr .4 7 /9 7R (seer _ ` ; i . —'a, —'4. '4. Sec , Notary Palle T. P.M.ACCEPTED FOR FILING IN THE ICE OF THE STATE ENGINEER OF - , R. • COLORADO HIS 4 DAY OF Q4J USt , 197r. Yield W.D .� pp / lei ; drj• Co •E ENOINEE Ci1..... '1-.,{r'%, )�T;•y'7'Vi_ Index WHITE COPY FOR DIVISION OF WATER RESOURCES PINK COPY FOR WELL OWNER ACCEPTED FOR THE IRRIGATION OF NOT OVER ONE ACRE OF HOME LAWNS AND GARDENS. ,-i Well drilled by 4 lel cfr#4 "' 1 t gilt- Lie. No. • Permanent S p�l ,/ pI6 m,P e47/4_ - , • Pump installed by o Lie. No. t Meter Serial No. O Flow Meter O Installed 9) -407-2— 77 + Owner of land on which J water is being used e (/ la THE LOCATION OF THE WELL MUST BE SHOWN AND FOR LARGE CAPA¢ITY IRRIGATION WELLS THE AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSSHATCHED ON THE DIAGRAM BELOW. This diagram represents nine (9) sections. Use the CENTER SQUARE (one section) to indicate the location of the well, if possible. I I I I I I — + — + — + — + _ + — + - 1 I + — + — + — -I- — + — + _ I I NORTH SECTION LINE I NORTH • -- + — + U, — 4 + — + d N J _ + I U i w r + - + mH - Q i - + - r w I I SOUT�i SECTION LIIfE I +2 • .+ - + - + - + - + - + - I I I F I I . THE SCALE OF THE DIAGRAM IS TWO INCHES E]UALS ONE-MIL E — -I- — + — + -- + — + — + — ( ( ---1( M i I e,-- WATER EQUIVALENTS TABLE (Rounded Figures) An acre•foot covers 1 acre of land 1 foot deep. 1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm). 1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. III100 gpm pumped continuously for one year produces 160 acre-feet. (WHITE AND PINK COPY TO BE FILED WITH THE.STATE ENGINEER PINK COPY WILL BE RETURNED TO OWNER) -_____-- . WELD COUNTY HEALTH DEPARTMENT 1516 Hospital Road Permit No. �� • Greeley, Colorado PH. 353-0540 application for permit to install, construct, an Individual Sewage Disposal System. Owner - Address .I Phone Directions to site: Hwy - Rd. N mi, E mi, S mi, W mi Legal Description: Ptn. Sec. ,T N, R W, Sub. Lot_Blk General Information De t. Use Onl . No. Bedrooms No. Persons Perc rate (av� of 3) / • Li ht No. Baths Basement Plumbing Soil Type celpe„ „+ — f,7 , Size of Lot .;,' ,ii' ; -L-• H2O Table Depth p J H2O supply (If well give depth) Lot Grade New Home " Mobile Home Modular Addict Engineer Design Yes �-N< Type of sewage disposal requested: If YES—reason: Septic tank ___ Privy____ Other Comments: This is to certify that the system is NOT within 400 ft. of a public sewer ilkI Installation instructions: (Minimum Requirements) I Septic Tank �DDD 47'9Gals. Absorption Trenches '� Sq. Ft. Other or )¢y Special Instructions Seepage Bed Mr/ Sq. Ft. This system will be constructed and installed in accordance with the above specifications and regulations regarding individual sewage disposal systems in Weld County, Colorado. This permit shall expire at the same time as the building permit, or, if no building permit is issued, the permit shall expire 120 days after its issuance if construction has not been commenced. Date: - Owner: . Applicant: The plans nd f ions as shown e approved pending payment of permit fee. /f ec J e j a.c.uD,_ Date: ® 3 .Z-f≤1 Sanitarian: �-44.41 7 The above system insp e0 and found to comply with plan andieyra flioq• Systems Contractor: Y (.r Date: / ,dn'0- /1/- �/ Sanitarian: -�,,n_ / /_ y"4-71"rtg"- Engineer Review: �L (Date) (Signature) Srmit Fee: $ Received by: __ Date: _ __. --. 19-79-122 Weld County Planning Department ' GREELEY OFFICE JUN 13 7nnA • RESOURCES ..1Ov. , 'o DIVISION OF WATER RESOUR çEIVLD DK* ._ 'ao,^` * BID Ritter,Jr. 1876 it Governor Harris D.Sherman Executive Director Dick Wolfe,P.E. June 10, 2008 Director Kim Ogle Weld County Planning Dept. 918 10th Street Greeley, CO 80631 Jack Cary Dear Mr. Ogle: This referral does not appear to qualify as a"subdivision" as defined in Section 30-28- 101(10)(a), C.R.S. Therefore, pursuant to the State Engineer's March 4, 2005 memorandum to county planning directors, this office will only perform a cursory review of the referral information and provide comments. The comments do not address the adequacy of the water supply plan for this project or the ability of the water supply plan to satisfy any County regulations or requirements. In addition,the comments provided herein cannot be used to guarantee a viable water supply plan or infrastructure, the issuance of a well permit,or the physical availability of water. • According to the referral information, proposed lot A will be served by an existing well constructed under well permit no. 92145-A and proposed lot B will not require a domestic water supply. Well permit no. 92145-A was approved for domestic and livestock use including the irrigation of not over 1 acre of home lawns and gardens. The well can be used to serve proposed lot A as long as the well is operated in accordance with the terms and conditions of the well permit. Should you have any questions in this matter, please contact me at 303-866-3581. Sincerely, g jultJoan a Williams Wa =r Resource Engineer • Office of the State Engineer 1313 Sherman Street,Suite 818•Denver,CO 80203•Phone:303-866-3581•Fax:303-866-3589 www.water.state.co.us • II 1:„,,, / as-- -- --- a. co B §§ ) B B - |`- = r a ; o ) § era . k - 04 4. - - CO CD Cc\ » a0E \8% ` W a §) / \{/ r /a§r $! k» \\\/j \/ � � � ; ){ \ § CD • 4 \� II _ / _ / ,.5 CD cr k { >kk ) a! • § !� A as! c � � di Cs.ar t o ci uP§k§| k ) a k %•§ , Ggfak��°b k \ Ii ■Asa r » . .�� gece§�mw ! � ka3 ! - ;§§|m § ■#3;! ° §m\® ` `/ �l=2 § s• - k6 / 08)-05 s•° 4+ k�} ° \a � k �{ % qs1 2 2 , e ! |#( • I • To The Weld County Health Department: Jack and Heddy Cary RE 4821 Special USR Review To Whom it may concern. Regarding our disposal of waste oils. The following is the name of the company we call to pickup our waste oils. Tri-State Oil 1770 Otto Road Cheyenne, WY 82007 Phone # 303 825 0742 .?,4'^(rS '1, ry-.h. - 4. <d i . /-r} ht TRi STATE OII: - - EPA*W1'D9B8869400 COR'000001677 . '-' ,..,:,;. •,1... TR1 STATE OIL . <<::.. ter.B1'7635.5992' 303-825-0742 . 4k: ..,..:c...:i.,.....: ',.:::" EPA WYQ9888t99g00.. COR 000001$17 ,, �w `',:-''• ?. Ltt • '1770OTF.(�`ROAD -.;:'',.1..•-• pH 307-635-5332 OR ..9 87.6-0742 : e+kt • i‘•--- s£ ��' � -:�'•., .k. •CHEYENN��INY :82007 7 1770 OTTO ROAD ' . .. • .j.ti* ' * ;`:4�' " CHEYENNE,WY 82007 :;,".:..;,-,:-,:r• y • Customer's Order No. Phone No. . Date :Customer's Order No. Phone Nc Date y i 7- 4//.) )(NI I () -> 6:5---)- 913-- " 16 .076 cci Sold To _ r Said k' + 4/ Tr L. c:),...,,, t :.irr TriAcfr Lonhe(4-ionr ti. Address Address • •ci •ty City ,...,,,,...... t- il Sold By Cash C.0.131' arge On Acct.4 k J:, (-4 dse. -au�ut y Sold By ..ash C D. Charge On-0 I.Lido-rh Acct. Mds€. `Paid Out r yRet d. ' I Ret'd. I Oty , Description: Pr:',"_-.P Amount Oly. I Description [. Price i, Aniotin • 4 /, ' ,.;/.��» ;r:4. t:,l S L.-. . y'5 � }Ion r uv �1 � so t-' 1 • (,: TOTAL HALOGENS<1,000PPM --F TOTAL HALOGENS<1,000PP�11 • PLEASE PAY FROM '- PLEASE PAY FROM THIS INVOICE THIS INVOICE All cwrns and reMmed pools MUST be accompanied IN this DI. P,tl Nei ms and returned goods MUST be o urnpenled by Coi bill i Tax Tax . Recd. :. _ ec-1---Led _ `. r' t • fil -- • J' i"ot,tl 4, Total G y t: 4 ,'p. '`.!y�r�`.f.'x�`;; .{rte y�7��" ... ..,..t. ,,,,,,,,,„:,-,,..„..:,: ��1/,/'�_- f. . ,,„_Thatik v Hello