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Home My WebLink About20113107.tiff • JULY 21,2011 I, JEFF RECK, OWNER HEREBY AFFIRM THAT ONLY WATER FROM THIS DOMESTIC WELL, THAT I AM PROPOSING TO CHANGE TO COMMERCIAL- EXEMPT WILL NOT BE USED OUTSIDE OF THE EXISTING SHOP. IT WILL ONLY BE USED FOR SANITARY PURPOSES. IT IS THE ONLY SOURCE OF WATER ON THIS PEOPERTY. DATE: (7.7_ ii • • 2011-3107 1/0 WATER SUPPLY INFORMATION SUMMARY • Section 30.20.133.(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 ,Q ec 1�-- 2. LAND USE ACTION 1,`a (Ow o/-1 3. NAME OF EXISTING PARCEL AS RECORDED J e r y J ( r / SUBDIVISION FILING ( BLOCK LOT 4. TOTAL ACREAGE � g( 5. NUMBER OF LOTS PROPOSED _-- PLAT MAP ENCLOSED IVES 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? O YES 0 NO If yes, describe the previous action 7. LOCATION OF PARCEL • Include a map deliniating the project area and tie to a section corner. A/14/114 4.41)114 114 OF SECTION '.2` TOWNSHIP q CYN ❑ S RANGE c,(Cil1 ❑ E PRINCIPAL MERIDIAN: 0 6TH la4.M. 0 UTE ❑ COSTILLA W. PLAT - Location of all wells on property must be platted and permit numbers provided. Surveyors plat 0 Yes O No If not, scaled hand drawn sketch 'Yes 0 No 9. ESTIMATED WATER REQUIREMENTS - Gallon per Day or Acre Feet per Year 10. WATER SUPPLY SOURCE l_`'''fXISTING O DEVELOPED 0 NEW WELLS WELLS SPRING PROPOSED WETS-iCHECK oeE, HOUSEHOLD USE # of units GPO AF WELL PERMIT NUMBERS o Auviw. C UPPER aMPasot gO p ❑WPM DAWSON C tOWEa ARAPAHOE '7 o J tam OAWSaN o! MME roc NUS COMMERCIAL USE # SOD of S.F. GPO AF a tam O MU* C OTHER IRRIGATION # of acres GPD .• AF • STOCK WATERING # of head GPO AF O MUNICIPAL WATER COURT DECREE CASE NO.'S o ASSOCIATION OTHER GPO AF ❑ COMPANY ❑ DISTRICT _ TOTAL SAO GPO AF NAME LETTER OF COMMITMENT FOR SERVICE 0 YES ❑ NO 11. ENGINEER'S WATER SUPPLY REPORT 0 YES I r NO IF YES, PLEASE FORWARD WITH THIS FORM. (The may be required before our review it comoieted.l 12.TYPE OF SEWAGE DISPOSAL SYSTEM [?'SEPTIC TANKJLEACH FIELD 0 CENTRAL SYSTEM • DISTRICT NAME IP. LAGOON O VAULT - LOCATION SEWAGE HAULED TO 0 ENGINEERED SYSTEM 1Attech a copy of AnOineenng design, 0 OTHER •OFCC !\ DEPARTMENT OF NATURAL RESOURCES ' - I DIVISION OF WATER RESOURCES • i • ., * MO Ritter,Jr. 1816 * Governor Mike King_ Dick Wolfe,P.B. Director/State Engineer CHANGE IN OWNERSHIP/ADDRESS/LOCATION REQUIREMENTS Well Permit Number: /92 808 This form is being returned to you for more complete or a correction of information. The information requested is checked below. Make the necessary corrections or additions on the form. not this notice. Please initial and date any changes you make on the form and return it to this office for processing. See our web site at www.water.state.co.us to locate any necessary forms. 1. ❑Complete the new Well Owner name and address. 2. ❑Enter or verify the Weil Permit Number. Only one Well Permit may be amended per form. 3 Completely fill out the Well Location section. The well Location includes 'h, ''I., Section, Township, Range,Principal Meridian(P.M.),distances from the Section Lines and Subdivision, Lot, Block and Filing number if applicable. At a minimum you must supply Yy %a, Section, Township, Range&Principal Meridian OR Subdivision, Lot,Block and Filing number. Otherwise your form will be returned. Mark the appropriate boxes for North or South and East or West directions. 4. ❑The Well Location given does not correspond to the location of the Well Permit Number. Verify you have reported the proper permit number. Our records indicate the well is located or will be located in the • Y.,of the /, Section .Township . Range , P.M. in the Subdivision, Lot , Block Filing ,Distances from Section Lines 5. O The new Well Owner must sign the document. Sign the first block, print or type your name in the second block and date the last block. 6. 0 No well construction (form GWS-31) or pump installation report (form GWS-32) has been received stating the well was completed before the expiration date. If the well was constructed, please submit these reports to DWR. See our web site at www.water.state.co,us to locate necessary forms. itc....v.k 0 Other (trey /L f oC.t.-� f `0 — r/LY/o..1—E_oto—cI If you need assistance in finding a Permit Number, The Colorado Division of Water Resources, Records Section, is open from 9:00 AM to 4:00 PM Monday—Friday. They can be reached at(303) 866-3447. In order for the Records Section to help you locate a Permit Number,you must provide the following information: Location of the well and names of the current and previous owners. This information can be obtained from your County Assessor's Office. If you need to check on the status of your Change in Ownership/Address/Location form, or assistance filling it out, please contact the Ground Water Information at (303) 866-3587 between the hours of 9:00 AM and 4:00 PM Monday through Friday. 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 Form STAT... yr COLORADO For Office Use Only i No. OFFICE OF THE STATE ENGINEER GWS-11 818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 akb/2003 (303) 866-3581 Fax(303)866-3589 lir CHANGE IN OWNERSHIP/ADDRESS CORRECTION OF THE WELL LOCATION Insert the Well Permit Number )Ki( c§ C • S '` = i, Name, address and hone of the person dai ti m�io ownership of the well: � ' NAME(S) 1" h LL' I: Mailing AddressI /° L. ( 1 C/c. 4G IG �'zi City, St.Zip ( i /' / Phone ( `/7t' 1 //D I 1G & 7 This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above. This filing is made pursuant to C.R.S. 37-9p-143. WELL LOCATION: County IL, L f.o O rep Well,Designation.. — 7( GL' L 4l ca. ei (e- (Address) (City ) (State) (Zip) 1/4 of the__ 1/4, Sec. Twp. ❑N. or❑S., Range _❑E. or❑W., _P.M. • Distance from Section Lines Ft. From ❑ N. or❑S., Ft. From❑E. or ❑W. Line. Subdivision Name — _ Lot , Block , Filing/Unit The above listed owner(s) say(s) that h she (they)own the well described herein. The existing record is being amended for the following reasons: hange in name of owner ❑Change in mailing address ❑Correction of location for exempt wells permitted prior to May 8, 1972 and non-exempt wells permitted before May 17, 1965. Please see the reverse side for further information regarding correction of the well location. I (we) claim and say that I (we) (are) the owner(s) of the well described above, know the contents of the statements made herein, and state that they are true to my (our) knowledge. Pletase print the Signer's Name &Title I Signature(s)of the new owner. Date c c— /�� iO — — It is the responsibility of the new owner of this well to complete and sign the form. Signatures of agents are acceptable if an original letter of agency signed by the owner is attached to the form upon its receipt. For Office We Only • State Engineer By Date Form No. OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES • 815 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 (303) 866-3581 857 • WELL PERM- NUMBER /97 O d a - APPLICANT DIV. 1 CNTY. 62 WD 2 DES. BASIN MD Lot: Block: Filing: Subdiv: APPROVED WELL LOCATION WELD COUNTY DOYLE MCCARTHY NW 1/4 NW 1/4 Section 12 23010 WCR 37 Twp 4 N RANGE 66 W 6th P.M. LASALLE CO 80645- DISTANCES FROM SECTION LINES (970)284.7962 100 Ft. from North Section Line 1260 Ft. from West Section Line PERMIT TO CONSTRUCT A WELL 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 the 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)(c) for the relocation of an existing well, permit no./fit ddb . The old well must be plugged and sealed according to the Water Well Construction Rules within ninety (90) days of completion of the new well. The enclosed Well Abandonment Report form must be completed and submitted to affirm that the old well was property plugged and sealed. 4) The use of ground water from this well is limited to ordinary household purposes inside one (1) single family dwelling,the watering of domestic animals, and the irrigation of not more than 20,000 of home gardens and lawns. 5) The depth of this well shall not exceed 60 feet or the first shale/sandstone layer, whichever comes first, which corresponds to the base of the eluvial aquifer. 6) The maximum pumping rate shall not exceed 15 GPM. 7) This well shall be constructed not more than 200 feet from the location specified on this permit. �„�f� �g-q6 APPROVED /d z ' '�� " /� �I y • RAN p�/ ( / l GI lo1 State Engineer Receipt No. 03953176 DATE ISSUED FEB 0 9 1996 EXPIRATION DATE FEB 9 1998 O ��..��...... oc...........a..1 m$maingemam JUL-06-2011 WED 03:31 PM W C ENVIRONMENTAL HEALTH FAX NO, 970 304 6411 P. 01/04 a WELD COUNTY DEPARTMENT OF PUBLIC SOS (03GCl/ q HEALTH AND ENVIRONMENT ORG PERMIT II • � sr 1666 N.11"AVENUE GREELEY.COLORADO 00631 REPAIR LOAN I g Wi�P C PHONE: (970)3046116 ISM 4 _)3/PI FAX: (970) 304-6411 COLORADO STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. /O1? J7 - 0 -en, 'D L y PROPERTY OWNER 12Oy1& /✓1LCn,-pit PHONE NO. ( 5190 Ztr'- 75ce. M AILING ADDRESS Z.Z r U-"o..' A"✓c 4 i1Alit 644 A//6)'.e City State Zip DESCRIPTION OF BUILDING (ex. house,mobile/modular o_ ,shop,office) � ,pp SITE/LOCATION ADDRESS 17 rI0 mri- yid Ln., //t c 4 !7L y, City State , Zip LEGAL DESCRIPTION PT atiCti. PTIVIA SECTION /Z TOWNSHIP 7 RANGE Ze SUBDIVISION / LOT BLOCK FILING _ CENCUS TRACT LOT SIZE/ACRES /L O COMMERCIAL YES RESIDEN IAL. N[O NUMBER OF PERSO Z. BASEMENT PLUMBING YES O • BEDROOMS_ BATHROOMS•FULL 3/4 1/2 _ WATER SUPPLY-PUBLIC YES/NO NA PRIVATE YES/NO WELDS O CISTERN YES/NO WELL/CISTERNS/521!2? SYSTEM SIZE: Septic lank material is constructed of (.44ta cI' ' and has ./41/77 gallons capacity. FIELD: Trench 2d square feet or Bed square feel YEAR INSTALLED gallons. /1i/ You are required to draw a diagram of the system no 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 ad further states that the systenba is not in good working order and to the best of his/her knowledge is no ailing to function properly. I further understand that any falsification or misrepreseatatloa may result in revocation of any permit granted based upon this i01'ati ereby submitted and in legal action for perjury as provided by law. - 0,42\ 2 a DA 'riaCWtr: J. ; f,% R SIGNA t and marmite ar t , 10�, Subs , • ; and sworn t re the.this /7r h.- day of d G By e, A ( LJk4� Witness my 7 icial seal. Ct ission expires e e 11-17-aOdci,DATE NOTARY• STATEMENT OF EXISTING INSPECTED&REVIEWED YP VVU-ir ` al l ENVIRONMENTAL HEALTH SPECIALIST DATE JUL-06-2011 WED 0331 PN W C E,N'JIR0N."IENTA: HEALTH FAX. NO. 970 304 64: : P. 02/04 •IA /I we i( HouS • TAA/ cittil plika poo_ rm11,4 sli, # • ' COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(07/2009) - DEPARTMENT OF NATURAL RESOURCES {Ft,.: r9-ts¢_+, 1313 SHERMAN ST, RM 818, DENVER, CO 80203 phone—info:(303)866-3587 main:(303)866-3581 fax: (303)866-3589 http://www.water.state.co.us • GENERAL PURPOSE JUL 2 1 2011 Water Well Permit Application WATER RESG f Ct Review instructions on reverse side prior to completing form. STATE ENGINE€E The form must be completed In black or blue ink or typed. ' (it `'' 1. Applicant Information 6. Use Of Well(check applicable boxes) Name of applicant Attach a detailed description of uses applied for. .If_.-P /?,e LK— ❑ Industrial ❑ Dewatering System Mailing address --- ❑ Municipal ❑Geothermal(❑ production or❑reinjection) 1 /O g !.f,J9 (0 `i Sr ❑ Irrigation ❑Other(describe): City / / I Stair Zip code ommercial Telephone Pcele E-mailLLopt�enali �D�3 7.Well Data (proposed) y v-e 1 eJ 15 LG�Q(✓ nu ( (op 3g/ to lc Maximum- pumping rate 9p Annual amount b be withdrawn '1 (( m 2.Type Of Application (check applicable boxes) ' acre-feet e-_ Total depth Aquifer i ❑ Construct new well ❑Change source(aquifer) ❑ Replace existing well ❑Reapplication(expired permit) feet ❑ Use existing well ❑coccc well 8. Land On Which Ground Water Will Be Used 2'Change or increase use O Other: Legal Description(may be provided as an attachment) 3. Refer To (if applicable) em Well permit# r Water Court case /42 808 name or Designated Basin Determination q Well name or# 4. Location Of Proposed Well (Important! See Instructions) ---- - ------ I ------ -- (If used for crop irrigation, ttach a scaled map that shows irrigated area.) county d _e--- �I' .a ' ,1 , A. #Acres B. Owner (�� /V i/4 of the /V �/t/ 1Id —._ - • Section Township Nor S ; Range E or W r Principal M1ntlian ._ — I n � C. List any other wells or water nghts used on this land Distance of well from section lines(section lines are typically not property lines) X00 Ft.from Iiii N❑S j a(Q p Ft.trom❑E iY 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 cdy,state Zip) El Check it well address is same as in Item 1. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. p 24-4-104(13)(a). I have read the statements herein,know the contents / 7 A LI O t.ye z ifp tale,af/re O thereof and state that they are.true to mmyknovAe'ge. Sign here(Must be original signature) - —pate Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows: 7/a l I/ Format must be UTM PliftleiA. .�� /� ❑Zone 12 or 0Zone 13 Easting 'J 1--1 R-ecg-, 9w sue-el-- Units must be Meters Office Use Only Datum must be NAD83 Northing Unit must be set to true north USGS map name OWRmap no. Surface elev. Was GPS unit checked for above? ID YES Remember to set Datum to NAD83 5. Parcel On Which Well Will Be Located I Receipt area only (YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description(may be provided as an attachment). I tall actlUlt1 ::',351523 $ wl3drvlsfonEXCllr jo!✓ NO • /O /Sfrccorcled I.)app ?,F21 aril 3:(6:01 PM rltr�rth ate,3ocq @?-Rece�oA /OO 3//,y9 b ernq 4 r�- el fife- �' rHE rtchtn I nisi1 Cdi J� h N 'IMF of�/le At �/� CHECK*5129 ¢ICCu.til of Sec¢-,on /z/ -re rvashrp c/Ni,/2aa1e.[e!Q Wes_/-c Ilk % Pi'1,iCoati-nest-r.�ta_1dt9r_ occe B. #of acres in parcel I C. •Qwner A(DUAMAP 2.21 J ef-F Rf..r lc. WE • D. Wll this be the only well on this parcel?FAYES ENO(if no—list other wells) WR CWCB TOPO E. State Parcel ID#(optional): MYLAR SB5 DIV WD BA MD • SEPTIC SYSTEM: AFTER AN INSPECTION OF THE CURRENT SEPTIC SYSTEM (ATTACHED) WE HAVE DECIDED TO PUT IN A NEW SYSTEM THAT WILL ACCOMODATE FUTURE GROWTH AS WELL. WE ARE AWAITING FOR THE LOCATES TO COME BACK SO THAT WE MAY DIG THE HOLES FOR THE PERC TEST, WHICH WILL BE DONE BY TONY EVANS, ELITE CONSULTING WITHIN THE WEEK. THE PRESENT LEACHFIELD WAS GRANDFATHERED IN BECAUSE OF THE DATE IT WAS BUILT, BUT PRESENTLY RUNS UNDER THE DRIVEWAY ACCESS. WE ARE IN THE PROCESS OF PUTTING IN A NEW • SYSTEM IN ORDER TO BRING THE SYSTEM UP TO CODE TO MEET THE REQUIREMENTS OF OBTAINING A SPECIAL USE PERMIT. • ADDITIONAL NOTES: I REQUESTED THAT AN ENGINEER INSPECT THE SEPTIC TANK AND DO A PERC TEST ON JULY 22, 2011AS OF THE DEADLINE TIME: 8-2-11 AT 4:00 I STILL HAVE NOT RECEIVED THE REPORT FROM HIM TO INCLUDE. WE HAVE VOLUNTARILY ELECTED TO BRING THE SYSTEM UP TO CODE, AS THE SEPTIC SYSTEM WAS BUILT IN 1961 AND THE LEACHFIELD WAS PLACED UNDER A DRIVEWAY. I REQUESTED FOR LOCATES LAST WEDNESDAY AND THEY WERE TO HAVE BEEN COMPLETED BY FRIDAY SO THAT I COULD AHVE A PERC TEST PERFORMED. I AM STILL WAITING ON • THE LOCATES. THE PERC TEST WILL BE DONE THIS WEEK AND WE CAN APPLY FOR THE PERMIT TO UPDATE THIS SEPTIC SYSTEM ANOTHER ENGINEER SPOKE WITH LAUREN AS DID I AND SHE SAID THAT AS LONG AS WE WERE WORKING TOWARDS THIS RESOLUTION THAT WE DIDN'T REALLY NEED TO FILL OUT AN APPLICATION. WE ARE REQUESTING THAT THE USR BE GRANTED PENDING APPROVAL OF THE NEW SEPTIC SYSTEM. lite onsulting, nc. PO Box 2440 Longmont,CO 80502 970-381-8878 eliteconsultinginc@hotmail.com August 2, 2011 Laura Reck 7108 W 10th St Greeley, CO 80634 970-539-1612 RE: 17240 WCR 48 in LaSalle, CO Ms Reck I did a site investigation at the above mentioned property on July 28, 2011. The septic tank was found on the east side of the residential house and was accessible. At the time of inspection there was water constantly running into the tank. The Baffle was observed broken and lying at the bottom of the tank. The rest of the tank seemed to be clear of debris. It is my understanding that 500 gallons was pumped out of this tank the day before I did the inspection. . You gave me a copy of a `Statement of Existing for Septic System' dated November 17,2003. It states that this is a 1000 gallon tank installed in 1961 and that the leach field goes to the south. The leach field was not exposed to do an inspection. If the leach field is to the south, it is currently being driven on by large trucks via a driveway. You also gave me a letter from Pam Smith, Weld County Department of Public Health and Environment, about this system dated December 5, 2003. It is my understanding that the existing building to the west of the house is tied to this septic tank as well. I would suggest installing a new septic system for the building to the west and terminating its use of this septic system. Please contact me if I can be of further service. ,O�U\qu111R�l lluvi[rit God Bless a`\O D%ja .t..,ct�� .4.9 P,U c 31 Tony Evans, PE � � Elite Consulting, Inc. GC 2''t I�` ' � ��1'�'liiilfl1111141\\ • Elite Consulting,Inc. ite nsulting, • c. PO Box 2440 Longmont,CO 80502 970-381-8878 eliteconsultinginc@hotmail.com August 2, 2011 Laura Reck 7108W10tSt Greeley, CO 80634 970-539-1612 RE: 17240 WCR 48 in LaSalle, CO Ms Reck Please find attached my invoice for the septic inspection at the above mentioned location. It is my understanding that you would like me to do a percolation test for a new septic facility for the west outbuilding on this property. Please let me know when you would like this done. God Bless • ?l v Tony Evans, PE Elite Consulting, Inc. • Elite Consulting,Inc. Hello