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Home My WebLink About20053152.tiff MAY-04-05 09:09AM FROM-Colo Div of—Water Resources +3038663589 T-677 P.002/002 F-281 Form No. UttlUt Ur Mk i I Al t tNUINttkt GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 (303)866.3581 LR WELL PERMIT NUMBER 263D48 • APPLICANT DIV. 1 WD2 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY SW 1/4 SW 1/4 Section 22 HERBERT& KAREN LEGG Township 2 N Range 66 W Sixth P.M. 15027 W COUNTY ROAD 18 DISTANCES FROM SECTION LINES FORT LUPTON, CO 60621- 134 Ft. from South Section Line 542 Ft.from West Section Line (303)857-2596 UTM COORDINATES (Meters,Zone:13,NAD83) REGISTRATION OF 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 civil court action. 2) Construction details for this existing well have not been provided to this office;therefore, it is not known tf the construction of this well Is In compliance with the Water Well Construction Rules,2 CCR 402-2. The Issuance of this permit does not relieve the well owner of responsibility or liability in the event contamination of the groundwater source results from the construction or use of this well, nor does the State Engineer assume any responsibility or liability should contamination occur. 1) This well is recorded and permit approved in accordance with CRS 37-92-602(5)for historic use as indicated herein and described In CRS 37-92.602(1)(b), being a well producing 15 GPM and used for ordinary household purposes inside 1 single family dwelling(s),fire protection,the watering of domestic animals, poultry and livestock on a farm or ranch, and the irrigation of not more than 1 acre of home gardens and lawns. 4) The date of first beneficial use, as claimed by the applicant,is December 31, 1965. _25.05 PROVEDogifia id 2, I State Engineer Receipt No.0537467 DATE ISSUED 04-29-2005 PIRA ON DAT ( � 2005-3152 Form STATE OF COLORADO For Office Use Only No. OFFICE OF THE STATE ENGINEER GWS-12 818 Centennial Bldg., 1313 Sherman St., Denver,CO 80203 2'2005 (303)866-3581 Fax (303)866-3589 http://water.state.co.us/default.htm REGISTRATION OF EXISTING WELL NAME. ADDRESS AND PHONE OF THE WELL OWNER: NAME(S) . f/E i3ff oe, A.cnu L-EG C7 MAILING ADDRESS /3327 UX-i if C ' J U 464/ STATE: ZIP 2/ l� U ,��1(p:2/ TELEPHONE NUMBER (303) es7 GG WELL LOCATION County /J( / %> Owners Well Designation /S6.;i.7 IDC,t if pi. 4.(413-10k) CO g062l 5(4)0!%- (Address) /,, (City (State) (Zip) lo/c24;lo/c24; 1/4 of the .41/4. Sec. .Twp. c,2 J N.or❑S., Range 414. ❑E.or I I W.. (i*') P.M. r Distance from Section Lines 7a Ft El N.or IRIS. Line, 3CCC Ft 0 E. or 1,21LW. Line. Subdivision Name , Lot , Block Filing/Unit Optional: GPS well location information in UTM format The following GPS settings are required: Easting Format must be UTM. Units must be in meters. Datum must be NAD83. Unit must be set to true north. ❑Zone 12 or❑Zone 13 Was GPS unit checked for above items? 0 YES❑NO Northing The well has historically been used for the following purpose(s): '" , ��--yy.� . o '� .�ff�(: �l � ]I.LCLUf l) q (i �LC �GL'/ �(//L'. Water from the well was first used beneficially by the original owner for the above described purposes on The total depth of this well is jt'3 9U feet. The pumping rate of this well is /J gallons per minute. The average annual amount of water diverted is acre-feet. The lawn and garden irrigated(watered)by water from this well is '70 O Acre or®Square feet. Number The making of false statements herein constitutes perjury in the second degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.23-3-104(13)(a). I have read the statements herein, know the contents thereof,and state that they are true to my knowledge.ifizadi /tt�uree(s))of the T'e�padtrri'ler / Print e and Title of Well Own sr Date mzf".tL2 C, 7 For Office Use Only WE WR CWCB r TOPO MYLAR _ Div WD_ Basin MD APPLICATION OR INDIVIDUAL SEWAGE DISPOSAL SYSTEM No. WELD COUNTY HEALTH DEPARTMENT New ENVIRONMENTAL HEALTH SERVICES 1518 Hospital Road, Greeley, CO 80831 Repair '353-0540 EXT. 270 BP OWNER ' '2'7, r• ' ADDRESS .: PHONE • ADDRESS OF PROPOSED SYSTEM />" ' - < t/' , • • r' LEGAL DESCRIPTION OF SITE: PT -+` '• S ,T , R SUBDIVISION LOT , BLOCK , FILING USE TYPE: RESIDENTIAL 'i ,"!.•••, ) INSTITUTION COMMERCIAL OTHER SERVICES: PERSONS ?) r %2 BATHROOMS LOT SIZE rI1 r.„ - • • BEDROOMS BASEMENT PLUMBING WATER SUPPLY TYPE OF SEWAGE DISPOSAL REQUESTED: ; ,;,,.. /77 ,. ,,,r" Applicant acknowledges that the completeness of this application is conditional upon further 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 will 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 on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and In legal action for perjury as provided by law. Application fee Rec'd by ';' Date ' �' 1 Owner/Agent Signature Date FOR DEPT. PERCOLATION RATF 4..;. ( WATER TABLE DEPTH USE ONLY SOIL TYPE PERCENT GROUND SLOPE REQUIRES ENGINEER DESIGN ( )YES 'No • INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT From the application information supplied and the on-site soli percolation data, the following minimum Installation specifi- cations are required: SEPTIC TANK TO (-42 GALLONS,ABSORPTION TRENCH � ..� SQ. FT. or ABSORPTION BED ) 7.r SQ. FT. In addition,A this Permit is subject to the following additional terms and conditions: UT \ `'ii c. Ir'a', Wo suer-1" -I- ,it-- t c4'c. r3 each rnn�iie- ht ;yc'. ( Inn) �-, _fA 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 the failure or inadequacy of the sewage disposal system. —r e- Il �� a g Environmental Specialist Date This Permit is not transferrable 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 and conditions required to meet our regulations on a continuing basis. Final Permit approval is conti gent u spection of the completed system by the Weld County Health Department. Pon the final in- SYSTEM CONTRACTOR iffa7j &/e(ii FINAL INSPECT SYSTEM ENGINEER t APPROVAL a-; - tQ Environmen al Specie st Date The Issuance of this Perm li 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 pursuant to Article 10, Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of an installed system for issuance of a local occupancy permit pursuant to CRS 1973 25-10-111 (2). Original-Applicant;Copy-WCHD WCHD—EHS February, 1981 Ot APPLICATION c,..—., INDIVIDUAL SEWAGE DISPOSAL SYSTEM No. WELD COUNTY HEALTH DEPARTMENT New ENVIRONMENTAL HEALTH SERVICES ^ 1516 Hospital Road, Greeley, CO 80631 Repair %'353-0540 EXT. 270 OWNER " .% t':{! ,L ADDRESS ', -' 1" BP " ADDRESS OF PROPOSED SYSTEM - . , - ' ', '_ PHONE LEGAL DESCRIPTION OF SITE: PT `-• S 1 ,T , R SUBDIVISION BLOCK • LOT , FILING USE TYPE: RESIDENTIAL '> •//•:• 'e A1/2-)01,-1 INSTITUTION COMMERCIAL OTHER SERVICES: PERSONS 3 r ,, BATHROOMS - ' LOT SIZE -. .,:.. -r ;' 4,,,, ; BEDROOMS --9'' -5- BASEMENT PLUMBING WATER SUPPLY F2'( TYPE OF SEWAGE DISPOSAL REQUESTED: . 'h. c, 7,1,,,Y, ,,'?„7,',!'. ( Applicant acknowledges that the completeness of this application is conditional upon further mandatory and additional tests and reports as the Weld County Health bDepartmene required tfory hpu poses of the evaluae Weld County Health tion of the applicaartment to be tion; and ade the Issuance furnished yof th the eppermittis su or bject 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 will 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 on by the Weld County Health Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. Application fee ••,/- ,_ ,/, 1 'c'. Rec'd by Date ' v'' ! OwnerlAgent Signature Date ..-. FOR DEPT. PERCOLATION RATE '-'k ' ( WATER TABLE DEPTH USE ONLY SOIL TYPE PERCENT GROUND SLOPE REQUIRES ENGINEER DESIGN ( )YES""""" No 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 "3 L'(.) GALLONS,ABSORPTION TRENCH I ---' �-.: SQ. FT- or ABSORPTION BED / /.Y SQ. FT. in addition, this Permit is subject to the following additional terms and conditions: tar M .,. - i.: Two 5p . • - +a vH G N" =,on `lc l7 h�blie he �L (f inn, �.li fL/7 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 the failure or inadequacy of the sewage disposal system. �L ,r r, 1� a / g V ;Environmental Specialist Date This Permit is not transferrable 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 and conditions required to meet our regulations on a continuing basis. Final Permit approval is conti spection of the completed system by the Weld County Health Department. gent upon the final in- SYSTEM CONTRACTOR • t, D /re!� FINAL INSPECT ,.r'- SYSTEMCONTRACTOR ENGINEER I APPROVAL g (� ( a—; - V Environmen al Specie st Date / The issuance of this Perm 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 pursuant to Article 10,Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of an Installed system for Issuance of a local occupancy permit pursuant to CRS 1973 25-10-111 (2). Original-Applicant;Copy-WCHD WCHD—EHS February, 1981 Hello