HomeMy WebLinkAbout20010783 FORM 7ro. STATE OF COLORADO . .
GYVE-12 Pur Offix tke ootr .
10/89 OFFICE OF THE STATE ENGINEER
NUMBER
cis Cmeo®7 Bldg,..1313 Slieimao Sr.Deaver.Colorado 802CG :.fir--
(303)8663581 - - -
FOR INSTRUCTIONS SEE REVERSE SIDE
REGISTRATION OF EXISTING WELL
1. WELL OWNER ,
NAME(S) Sr-re; LLlSr$$ gielbktn d1 14)061 WAc4 /
'it
Mailing Address 13 z B0 wca- o
City,Sr.Zip {T, 7al# fi J ea. 7-I
Phone (303 ) JC7 2i ( `t
Ilea:pc Ko.
2. WELL LOCATION: COUNTY LAJ&to OWNER'S WELL DESIGNATION
/3284 W to ter: LtJP1teJ a, "ems
(address) (t (saw) (Z4)
N& 1/4 of the IlkAi 1/4. Sec g7 Twp.1_ LAN.or':S.,Range /4 ❑E.or t1d W. e9- pM.
/Distances from Section Lines /AZ FL firom�N.an S.Line, Pt.fmm$E.or O W.Line.
3. The well has historically been used for die following purpose(s): T7G 05E ) 9te 4---
Fr440 4 "littiect.t.4te 1 lenitif6ric Aran,- ,,ts c t:4run 4s (ahem( -4 1
S later from-� the well was first used beneficially by the original owner for the above described purpose(s)
on Apgli_ I 19 4a.
5, The total depth of this well is. S d~:f t _ - -.
6. The pumping rate is IC gallons per minute
7. The avenge annual amount of water diverted is 1 acre feet - -
8. The land area of home lawn and garden irrigated from this well is: /0, 0eC ❑Acre or Square feet,
%,)p
desrnbed as: �fN SS
fG t /J (/l� [� •
.
WW1 Desenpacej
or as Subdivision Lot(s) Block Filing/Unit
I(we) have read the statements made herein,know the contents theteo£and state that they are true to my (our)
knowledge [putsdant to Section 24 1 104(13)(a) C.R.S.,die making of false statements herein constitutes perjury
in the second degree and is punishable as a Class 1 misdemeanor.]
9. Name/Tide (Please tyke or Floe Signature Date
Srtee- Al e 80 Se/ICA-C-) -1(-)Sr-e- la?'" 7- C 0
FOR OFFICE USE ONLY
r 2001-0783
II
EXHIBIT
1._ . _ .23
-13(3182)
COLORADO DIVISION OF WATER RESOURCES FIELD INSPE-C77ON RFPOR T
eaa._ complete this fort in INK
1 L-app receipt -
ipt no(S)
—
ATE OF INSPECTION: /7/6 /1(70
'Pucnwr_ 6i fit; L E.6tj/&4641-for-i tr-1 6r e--‘14A.-
person contacted if not applicant JDRES<S' ! T Z (/i€- - J 5 W_c_name&phone#: v! 64- '-
`7 - l 7
KISIING WELL LOCATION:
/i6" /t A / f�/'�
114, f to _ 114, Sec. 11 , Twp_ GU
! u , Rng. ' f D'Jtd.,-
DIST. Kb fro61 s sec_rrne, 41, wsec rare;County vtt .,6
(if repf, give dist. & dir_ to new well site -
irde type of existing DRIL1FD HAND DUG, SPRING WELL, GALLERY WELL., GRAVFL FR, OTHER
how many other wells are located on this parcel? '11use? .--- al
are they registered? permitfrice *(s}? (�4 11 Z 14 1 1 ZI'f f 138-r{
ST.DATE WELL CONSIHUCTED 1 Ct qd _ DATE OF FI USE tggQ._---ESL PUMPING RATE /
"OPAL # OF ACRES IN THIS TRACT/PARCEL I Q ACRES
!dditional subdlparcd info=
ISE OF WELL
/''hoc cold in (indicate how many) / single family dwelling(s)
watering of perry acrd/or domestic animals(`domestic animals' would include a hew cows, horses, etc.)
watering of livestock on a farm or ranch—apprax how many head?/is this a feed lot? ; how many head?
(it-is important to spex-fy estimated historic lawnlgarden kr) irr.4,f X'` square teet/acre of lawn and/or garden
tire protection
commercial—drinking&san- only? (write details in'comments'section)
other(mire details in 'comments'section)
yey-/I no WERE THE USES CHECKED ABOVE INI-17ATED PRIOR TO MAY 8, 1972?
NOTE fF ANY CHANGE IN THE HISTORIC USE OF THIS WELL HAS OCCURRED SINCE MAY 8, 1972,please
indicate the cfate(s) the use changed.and disrims this chrangelandlor expansion of the current/or proposed use
in the 'comments'section of this form
if completing inspection(or NON-EXEMPT USES, use comments section below(include case #, #acres in. if applicable, etc.))
;ill datE;d_ /Z. II0B
dditiona/comments and/or information- 1 Ii-660/ 6 li 4 ,' 7- J
_ _ _
WELD COUNTY DEPARTMENT ,C ?UBLIC HEALTH & ENVIRONMET'
1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411
APPLICATION /RECEIPT
Initials: RB
Permit Number: SP-0000698 Receipt Number: HAP000732
12-05-2000 Amount: $315.00 Payment Method: Check Notation: 944
Owner Name: BRIGHTON INDUSTRIAL NORTH LLP
Applicant Name:BRIGHTON INDUSTRIAL NORTH LLP
Parcel Number:
Site Address:
Location: 13280 WCR 10 FORT LUPTON
Total Fees: $315.00 Total All Payments: 315.00
This Payment: $315.00 Balance: $0.00
Account Code Description Amount
256041400-4221-400 New Septic Permit $315.00
256041400-4221-400 Repair Septic Permit $0.00
256041400-4221-400 Vault Permit $0.00
256041400-4730-400 Potable Water $0.00
"—Description: HOUSE
Commercial: (Y/N) N Residential: (Y/N) Y Acres: 100
Number of Persons: 4 Basement Plumbing: (Y/N) N
Number of Bedrooms: 2 Bathrooms: Full - 1 3/4: 0 1/2: 0
Water Public: (Y/N) N Water Source:
Water Private: (Y/N) Y Cistern: (Y/N) N Well: (Y/N) Y Well Permit Number: i4 opLtecd Foe
NOTICE
Applicant acknowledges receipt of the individual sewage disposal system guide and that the completeness of this application is
conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of Public
Health and Environment to be made and furnished by the applicant or by the Weld County Department of Public Health and
Environment 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 as amended. The applicant
certifies theat the proposed system will not be located within 400 feet of a community sewage system. The undersigned hereby certifies
that all statements made, information and reports submitted herewith and required to be submitted by the applicant are, or will be,
represented to be true and correct to the best of my knowledge and belief, and are designed to be relied on by the Weld County
Department of Public Health and Environment 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 applicaion and in legal action of perjury as provided by law. This application expires one year from the signature
date. /2
Owner/Applicant Date
Form: RT HAPP
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