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Wr2 OFFICE OF THE STATE ENGINEER {
FiEIRP.CT NUMBER____--�__.______^--�I iii crow*Sap.. 1313 Shrew et..Dew.Cameo 113203FOR INSTRUCTIONS, SEE REVERSE WOE
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REGISTRATION OF EXISTING WELL
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1.` WELL OWNER H .
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4 1 NAME(S) r''f�IiI P Af Qr
Mailing Address i0 O 77 (IJ � .'
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2 WEL._LOI:ATU9N; COUNTY OWNER'S WELL DESIGNATION
MOW MEW {Los
, 51/4 d St_114 SeC. 20 Twp. _ 110 N. or L....1 S.. Rang9 Oa J E. a 12 W. �/f
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Distances from Section Lines .y}�J Ft. from LJ N. Of Z] S. Line, /6/2 Ft. from 13Z E. or L] W. Line.
3.1 The well has historically been used for the foliow,ng purpose(s):,Ai�-,A L6 2) igli"r• ;dfb, -
S# d BLL/iV T iy �d/
tel4. Waxer from the weir was first used tenet-5'1130y oy the original owner for the above described puroosefs)
"" o r, 1 9/4. .
5, The total depth ct this well is feet. -
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L6. The pumping rate is /6 gallon per minute.
V. The average annual amount of water diverted is _I acre feet
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B. The land area of home lawn and garden irrigated from this well is: 22,60/1 ....,� t,._t Acre or 54 Square feet,
(Numbly)
1 described as: ' jot Bl7l7 i D _ —
iL.- twaxgewu
or as Subdivision Lot(s) Biocic __ Fiiing/Untt
I (we) have read the semen made herein, know the contents thbreof, and state that they are true to my (our)
knowledge. (Pursuant to Section 2a-4-104 (13).(a) C.R.S., the making of false statements herein constitutes periury+
in the second degree and is punishable as a Class 1 misdemeanor.;
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Court Case No. Giv. Co. WD Basin MD use A
2000-1336
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a Pal COW' e r ONISION OF WATER RESOURCES HEW INSPECTION REPORT
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nailer*We form m HWK ARP receipt
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E T ...& J PURPOSE OF INSPEC X1N: MTh RED. OTHERWANT: —
_ person contacted f not applicant
W.C.rams 6 phone et:
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STING wets LOCATION: Sac. 20 TSr
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Oadiet &da. to aft welt/MN?
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,c1a type of taleaftwelt a NANO DUO, SPRING WELL, Goeu,ER1r WELL, GRAVEL PIT, OTHER
on Wsperoet?to)how Awa NYC (no); n ,e•w.v r ____--- -
y otlletwdla'�hosedrqr — EST.PUMPING RATE 8Pm
Tr DATE WELL CONSTRUCTED DATE OFFIRST USE
AL* OF ACRES IN gig TRACT/PARCEL_L.5G�--ACRES
Viers ot'pec a i/MC address)•
1d stWp«'1 it: 5't"
qW lit-)--•— __ WAX OF ALJO. PLAN?--------.---
SE eel"iffiggied Miro o use to ona(indknee hover r"o include a can ow.)
h silting!
d palmy&so t 4---f >< er ,,�yLl�¢ogieWo..,�y.hm nali deer
..�.�. yilY {did' f � iRvur•=i-: 1; of town andfW Ranieri
u,tlYe itsioffina 9
•f1�0 titegpOM doe yr toonwnenar motion)
oat Me Maltsroonwn s'i'esta
WERE THE USES t��E
INMATEp PRIOR TO MAY 8, 197,2?
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aniorrai comments andror inlormaeal:
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We room for oonseellle on Of Wolf
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N. 17TH AVENUE
r*, GREEL.EY,COLORADO 80631
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ADMINISTRATION(970)304-6410
I I ill PUBLIC HEALTH EDUCATION AND NURSING(970)304-6420
FAX(970)304-6416
O ENVIRONMENTAL HEALTH SERVIC ES(970)304-6415
FAX(970)304-6411
COL0BA 0
January21, 2000
Ronald Nats
14077 Weld County Road 5 - -_-
Longmont, Colorado 80504
Dear Mr. Nats :
On January 20, 2000, your water from 14077 Weld County Road 5, Longmont,
Colorado, was submitted for analysis to the Weld County Department of Public
Health and Environment Laboratory.
eTh In accordance with the Standard Methods for Drinking Water Analysis, your
water was tested for bacterial quality using a Chromogenic Substrate Test. In
this procedure, our laboratory looks for the presence of total coliform bacteria,
the principle organism used to determine sanitary quality of the water. Analysis
of your water yielded the following results:
TOTAL COLIFORM ABSENT: In accordance with the
microbiological standards set in the Colorado Primary Drinking Water
Regulation and Standard Methods for the Examination of Water and
Wastewater, your water is considered acceptable.
If you have any further questions regarding your test results, please contact our
department at (970)304-6415.
Sincerely,
Connie O'Neill, Laboratory Supervisor
Environmental Health Services
CO/bg-1034
I' Enclosures
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ST WAIN C LEFT HAND WATER CONSERVANCY DISTRICT
PRESIDENT
Vernon E. Peppier March 6, 2000
Director at Large
VICE PRESIDENT
George Patterson
District 7 Ronald Nats
SECRETARY 14077 Weld County Road 5
Patricia Jones Lon ant, CO 80504
owe 4 gm
TREASURER RE: Substitute Supply Plan Application
Harold Nelson
District 1
David Macy Dear Ron:
Director at Large
Ronald Sutherland
Enclosed is an executed copy of the application and agreement with the St. Vrain
District 6 & Left Hand Water Conservancy District. Also enclosed is a sign which you
should display in an appropriate place at your home to distinguish you as a
Gordon Kennedy
District 3 participant in the Substitute Supply Program. Each year renewal notices for the
water are sent to each participant along with a current year sticker for placement on
Michael Utzenberger
DisMct 2 your sign.
Bruce Koster
District 6 Thank you for your participation in the program.
EXECUTIVE DIRECTOR
Los Williams Sincerely,
ADMINISTRATIVE ��,
ASSISTANT (�^z^inr`%
Cynthia Einspahr
SECRETARY Cynthia Einspahr
Lee Bauer Office Manager
LEGAL COUNSEL
Bernard,Lyons ST. VRAIN & LEFT HAND WATER
&Gaddls CONSERVANCY DISTRICT
CONSULTING
ENGINEER
Rocky Mountain
Consultants,Inc. c:sspltr•2
Robert C. Brand
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9595 Nelson Road,Suite 203 Longmont,Colorado 80501 (303) 772-4060
ea\ COMFfTE AND SEND TO:
v -
SYSTEM CLEANER CHECKLIST
FOR
MORTGAGE LOAN CERTIFICATION
Customer Name: L� ( I I &«-t \ O( b' £ c, (�� �5 '
Address of Pumping: 140 en p// 2 5 ` (� �^ <C% ("r °4.0
1. Pumping Date: 94 c,7 7
2. Gallons pumped (approximately): `TE. �y/�
i
3. Water running back into tank from field excessive: Yes No byes, estimate:
4. Liquid level in tank over the inlet line: Yes No Z�
5. Tank construction (check one):
- Concrete !/ - Metal
- Plastic or fiberglass - Cesspool or seepage pit
- Other
6. Tank condition observed:
- one compartment _ V or two compartment
- tees and/or baffles and in good condition: Yes 1. No �9
- access to clean -out lids within 8" of grade: Yes No )0 ,4Z (Yle -S
- obvious cracks/leaks observed: Yes No
7. Other conditions noted which may affect proper functioning of system.
The septic tank on this property was pumped on the date indicated above.
This form must be submitted with the Mortgage Loan Application and be signed by the system cleaner. The information
prod ed herein is intended to aid the Department in its evaluation and is not the determining factor for approval or disapproval.
3 J CLvll lCh SevJ[� 1>•�
Sanitation Company Name / Signature
• IN ACCOUNT WITH
'
• •l • BOB'S SANITATION SERVICE
, P.O. BOX 313 - MEAD, COLORADO 80542
le"4 ` — ROBERT E. BEIERLE .
!�!_ :•� 970-535-4455 gt 2-60
Hey, Mom...Call Bob Z " &S cle
Cesspools, Septic Tanks, PROMPT, DEPENDABLE SERVICE EVERYDAY
Grease Traps, Basements, EXCEPT SATURDAYS.
ELECTRONIC LOCATOR
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Li 0-31-4 4 Ck 5 c"'�y�vV ekit L�G.{Orcto-eti
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RECOMMENDED SEPTIC TANK CLEANING- 1 TO 2 PERSONS,ONCE EVERY 3 TO 4 YEARS;
3 TO 4 PERSONS,ONCE EVERY 2 YEARS; 5 TO 7 PERSONS, ONCE EVERY YEAR;
7 TO 12 PERSONS,ONCE EVERY 6 MONTHS
COUNTY: BOULDER LARIMER z---WELD
�1l., . 71 ✓ M AT i �' . sett '7� e.2/k
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0 Lira" tz, Kike c.-e--(-4, _ `Sr)
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_ s`�S
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.. TOTAL DUE
W. 000034 Q j ` `
Total Due within 30 30 days.
There will be a 1 1/2 % Interest Charge for those accounts 30 days overdue.
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