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Home My WebLink About20040474.tiff 76. 'I'^ I Oi.MATKI5T BE "el IE P or THE NC earl nsION �C LO ADO DIVISION OF WATER RESOURCES lnN riF RECEIVE') k M'? yFC Olt .300 Columbine Bldg., 1345 Sherman St. RECEIVE') 'HINT I i BLACK INK. :OPY.LLE ACCEPTED I ' Denver, Colorado 80203 ITAT' NT MAILED , )N R _ AFFIDAVIT ST. STATE OF COLORADO i I�itu 09 7F' SS COUNTY OF dell IEi}�g]@ pv�V��"� j�@' Vim" R ro ,r's 1I t V 9& _V, C stm,m"rnNNINE.M X STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD '.. PERMIT NUMBER _020624—P LOCATION OF WELL THE AFFIANT(S) Gordon Brorrn raunty .. _ __ whose mailing Cornish .Plains tivcstoch — ------ - ---- — address is flt. 2 Box /422 --- IT; , al ii,, t'3 .. City Ft. Tumor, CO.,, 2r/¢riph i Twp. 6 — ,P OP sp . Rag. 61 -- P M being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon, the well is ,ocated as described above, at distances of 12, feet from the i'+Ortn section line and 2390 feet from the I�,on.w an as„+1 ',.7 st section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the 5th, n.s, ow wrs.i day of Larch , 19_._; the maximum sustained pumping rate of the well is 50 gallons per minute, the pumping rate ''imed hereby is _ 50 gallons per minute; the total depth of the well is ,? " . feet; the average annual amount of water to be diverted is _ 33 acre-feet; for which claim is hereby made for 1)oidestic & Commercial Livestock purpose(s); th<'' legal description of the land on which the water from this well is used is PN:!y of NEI4 of Sect. t'-, T6N 1?63;f S1'.II. which totals .1IC acres and which is illustrated on the map on tf";e reverse side of this form; that this well was completed in compliance with the permit approved therefor; this statement of beheficial use of ground water is filed in compliance with law; he (they) has (have) read the statements made hereon; knows the :ontent i hereof; and that the sane are true of his (their) knowledge. Signature(s) ' -1A •�1ZL ✓ l'�/ ,. `, `.p t,t1'vr_!t !.. FOR OFFICE USE ONLY Subscribed and sworn _ •9.9.,t, to before me on this -' day of IN\'`'-"'i ' , 19 t�` Court Case No. My Commission expires: Or V " 'Z1 1°11r1\ I Piro. Ma _ Oar 2 ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: Se` — -- Weil Use y _ �.1 Disl. ''.Of Basin Mon. Des __ _..__.—. + 1 AUG 301916 rte- ��i DATE STATE FN NiI _R %'a''. 'A''' 2004-0474 Form No. OFFICE OF THE STA t c ENGINEER "WS-25 COLORADO DIVISION OF WATER RESOURCES �- F`;" ,�y �.�t./irk., t 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 (303) 866-3581 857 WELL PERMIT NUMBER 171247 -- APPLICANT DIV. 1 CNTY. 62 WD 1 DES. BASIN MD Lot: Block: Filing: Subdiv: APPROVED WELL LOCATION WELD COUNTY NE 1/4 NW 1/4 Section 4 GORDON BROWN Twp 6 N RANGE 63 W 6th P.M. PO BOX 311 FT LUPTON CO 80621 DISTANCES FROM SECTION LINES ( 303)857-2936 150 Ft. from North Section Line 2190 Ft. from West Section Line PERMIT TO CONSTRUCT A WELL ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONomONS 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 and Pump Installation 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 17. 3) Approved pursuant to CRS 37-92-602(3)(b)(II)(A) as the only well on a tract of land of 40 acres described as the NE 1/4 of the NW 1/4 of Sec. 4, Twp. 6 N., Rng. 63 W. of the 6th P.M., Weld County. 4) The use of ground water from this well is limited to ordinary household purpcses inside 3 single family dwellings, fire protection, the watering of poultry, domestic animals, and livestock on farms and ranches, and the irrigation of not over one (1) acre of home gardens and lawns. 5) The maximum pumping rate shall not exceed 15 GPM. 6) The return flow from the use of the well roust be through an individual waste water disposal system of the non-evaporative type where the water is returned to the same stream system in which the well is located. 7) This well shall be constructed not more than 200 feet from the location specified on this permit. "227 in 7-02i-93 OWNER'S copy r.. APPROVED MAM L� - q 227 "' r 'M L State Engineer JUL 22 1JJJ Nl. Receipt No. 0353589 DATE ISSUED EXPIRATION DATE JUL 2 IS :N D ? »+r 1 i~ C SYSTEM M ,.,r......, .�_T. NO.V . .>._.•...• •�.. _.,,._. r:t_� I''_�-?r•C7.:G-`it_. '_, f � ,'• -.:iYt. .. :13::': ._'7 COUNTY HEALTH DEPARTMENT RF ' '" - n ' ENVIRONMENTAL^5HEAL.TH 'SERVICE'S L 1517 i. `T H AVENUE COURT. G{REE.L.EY. CO 80631 ' 353-0635 EXT.2225 • :.:. 17.;: 4,i!..,:..: • .;. OORDOIID. ADDRESS PO X . H , ..:'.' '•- _ . . ._. rr DR. C] BOX. 311 �"' ' r�:t.�^', FT L.UF'TCN CO 20621 .. .: R:'jPOSED SYSTEMSYSTE 32510 WCR 74 CO (3'-f !EATON L?i•`•1 80615 • .-E_-. ... Y. 7:1: 7':` OF S:ITE:: SEC. 4 TWP, 6, RNL 6.7 .... ,,.. LOT LO 0 BLOCK 0 FILING 0 .. ::'T,• '.• F•f:::. " COMMERCIAL CORNISH PLAINS LIVESTOCK, :::,,.,la:::: : - r, PERSONS R Ch : 1 i f 1 ' C 15.00 .r.• .. .....__ . 2 BAT -.at.t .. ._�._ �.aT .SIZE ACRES ' )' EDF OOM4 C B 'SEMEN•' PLUMBING IN+G NO WATER SUPPLY PWEL.L ......_:r•! ..rt'• ' ...E $125.00 • ')f_.,.- Y ... _.J!JI�. 4 SIGNED BY DR. GORDON D. I{-;OWN Dr'. . __ 05/09/95 DATE 05/;►9/95 =i..i-1T.';DN RATE: 7.0 MIN PER INCH LIMITING ZONE B FEET '.:::::::.- TYRE SUITABLE PERCENT GROUND SLOPE 0 '. DIRECTION -‹.QUIRES ENG: NEµER DESIGN YES IN 100 YEAR FLOOD PLAIN ZONE NO 1 ... —:n,' 7'H^. .;r!-.....IC.iT.ION ].NFOr�i'*i( r•ION SUPPLIED N 1T S F. C•O �r-- . . . AND THE ON—SITE E;. SOIL EFti.. �.�4.r=..; :�..::.: _,,. .... "L .' W Ni ''INiMUM INSTALLATION SPECIFICATIONS ARE REOUIRE_D SEPTIC TANK 10X; GALLONS,- ABSORPTION TRENCH 74("; SO. FT. • DR ABSORPTION BED SO. FT. '•• .::F:; PE MIT : ;B•:JECT TO THE FOLLOWING ADDITDONAL TERMS ANC I - • ,..-., ::•, •: '-�: .... , ... ._.. TEMPORARILY _ .✓ -;:,�•. :...., r-,t'•rar.; 1='Y: TO '"ON5?"='.�},-._.I J,ti,_.,. ... ' •. _.. ALLOW •,•._:_, % : TO COMMENCE. T fi-' :S ,,;. .. . ._...: C;•:.F:::` CR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR - --.... 1 r WELD COUNTY 'Ni'`:VICJi_!A'r. SEWAGE DISPOSAL SYSTEM REGULATIONS I;`f: -'._T +' '_� f - • . _....`w: . ... ,!EE r ANY TERM OR CONDITION IMPOSED THEREON DURING TEMF'IJRA}≥ti ,.:'t «"•ar'.•'_. I •...... .' : ��r` _. HE :ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION i.. .... 'H'._.:- V-.7 MEN- .✓R, EMPLOYEES OF LIABILITY FOR THEFAILURE Cat INADEQUACY DE . dr ;'-' C'.h•}.1"•!'tit: MF:NTC'.L SPECIAL'S' '7'ERat ... NC': TRANSR itiA;"t,_..F. AND SHALL BECOME V.:.= IF SYSTEM :ONSTC : h - +•y"'+ ... ......._.;.' WITHIN ONE YEA":, OF ITS ISSUANCE. BEFORE ISSUING FINAL. AC.P r:C'17, .. : R!-!1 •r , ;_.f' !1 ! CO h,., HEALTH'r6,t E.' ',: i RIGHTRESERVES ?"C l:i17';..S •,::.......- • . t_>✓l¢>i : N r: r-,•'1 >•1 I T I0 f r' i I :C DOURREGULATIONS _. �-�.... ... .= ,�,.,.:• �.._i`!: � • _ E•�rt.:il ..�' ... 1 TC} MEET r+ ON CONTINUING 177_N _.. > 'r :_ APPROVAL IS CONTINGENT NT UJF'ON THE FINAL INSPECTION OF THE _-•r-.�,•,•• - • . . . :S r 7.-:,tt TiAE WELD }1. NTY HEALTH DEPARTMENT. :: • . ... E"' I' ._.. TA':LIED ENc' r.A'�hN , ..,..A, C.I :':_... _ ......._ { :T:_:i Imo•;•..7 C. : .F 'T'!..JI. PERMIT 1I^ DOES 7• F' s WITH -..... �. ,._._.. ,v. �.;+ F- _*1P,. !+IC•+1. IMPLY COMPLIANCE t�''Hc:.=. STATE.T:.... �..__,... :':�. :I r:t•� 0k �. ING RE!. ! _- 0' -r r. .••r�r OR, I'._.:-._.,J REQUIREMENTS,N? �. NOR SHALL t i.:E: " 1-1-- ,,.. ' ._ . TEe WILLOPERATE IN COMPLIANCE WITH APPLICABLESTATE, I2 U;,. f .. .... _.. �. .. .. r ..rr\ :..• A;.'l'�.E :.. . PEPj,:,NT TO ARTICLE - TITLE L . CPS r ... • . - ..: r..a C.....•I •s E CF ....,._ Y,L I N G F:NAL 4/1 1 C I L t DF AN r 'INSTALLED - ... ... :. RMIT PURSUANT TD CRG _ ... .., ,,,,..r.. e.,..\... ,>. -7Y 3kg_,J �s' , ICI wo lb" .53-.2 --74..-4.e$6I 2, �L A.W� -5/ AA. D' i ez►1cte5 25' L.oi+i RZ oF soy s8-2 3itzg 26%Z Pit t,30o �Z • . E.. / O st . . • INDIVIDUAL,i:.l... SEWAGE DISPOSAL SYSTEM PERMI'T' NO,. 7,-(.;".)021ei.) ,. ; `.:E....I\ COUNTY HEALTH DEPARTMENT NEW: :.:r..: _,.. ENVIRONMENTAL MENTAL. HEALTH SERVICE: 1747 16 f*•! AVENUE COURT, CF:C''."LEY , CO 9J0i:i, 353-0635 E:XT.2;x25 T=.:::.,;,:>,f r::=.... DP ADDRESS P.C. _ _ ... ..... ....,.,.. ...,._ ;.,...,:�:.,... �,, 30,5/4714,0A974/ FO QT: LUPTON ON CO 80621 Tpl-_:... I. ....:'t:: ,.,:F'r'.CON OF SITE . EEC 4 T.A F"'r E 6 !„ 63 j. RNG ...: l ....: _OT 0 BLOCK ) FILING .,.•,MM... :ORNISH PLAINE LIVESTOCK S :::: :•? C.'•OM:. ; I:r .......: :.NT ,..,I...(.:iMB:CN`.:: NO WATER f::.R SUPPLY r...Y i'wF:!. f._ . - : • . :: . .:O'F EY, i)I:AN?+)E :SIGNED BY GORDON D, BROWN • ...... . ......N RATE 7.0 MIN PER INCH LIMITING ZONE 3 FEET. : . {:...... PERCENT GROUND SLOPE 0% DIRECTION • ....... ..:7;E::: ` C Ei 1l DESIGN YES ...`` "': 'E: APPLICATION INFORMATION SUPPLIED AND 'r'1'•fE. fl E:I:•r•fE: SOIL PERCOLATION . .. ... .. W...N:.. MINIMUM INSTALLATION SPECIFICATIONS ARE R r_.rl t;:... C:I' • SEPTIC TANK 1000 GALLONS, ABSORPTION TRENC:, 120 EQ. FT. . OR .. ABSORPTION BEDBEDSC! FT., .r.�...; ..... r.:; r<• PERMIT IT •�r�r SUBJECT TO THE FOLLOWING'C f'vION^' TERMS AND • -:-77-/'T t .!.':f\'..r: T j •.L:�t :, •f TOALLOW CONSTRUCTION" COMMENCE. r. H•E i�!":r: : ... . . .. .. ... TO . ..)i'��r IE:iV C:r... THIS...,.. ., ... : .._. . .. '<::."D r:::. . ..:U...'r E'•EYtiED BY THE WELD D COUNTY HEALTH DEPARTMENT is n i;rE: {"ONk _ a Y f".1E:?1...'rI•• FOR REASONS... . •..`ti :1 :. i:' COUNTY INDIVIDUAL SEW DISPOSAL „Y;,T,_V REGULATIONS *.'NC'......... .. . ...._ ... :'1`...,._T ANY TERM CR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL -_ . . . . .. ,. :..,.::, ..,'; !(::,... '::, "i":., ,.. PERMIT I?`:?!.::S NOT CONSTITUTE ASSUMPTION P•7 "H:.. ... . ... .W. f.:iY..E....... OF LIABILITY FOR THE FAILURE OR :r:NA;;!.EQ ;: c''' Ti-i.... T....-:- C'... 77-7.7: - -,...a • 9 T& 444a, • !='A M SMITH 1 1 , >4, ,� ! NVIRONMF::y1TA I'CI:(i...I:::T DATE r.. . . P ,•;:t.? H,..i3.... . ..... . .... ....:_. AND SHALL -.w(ai'i'�: VOID IF SYSTEM 1N „ f.., . - L ,•.• �tf � 'r ... . :E'. . . ...... WITHIN ONE YEAR OF ITS ISSUANCE.. I:r≥~:F(:)r'.++'_= ISSUING FINAL /',P;::-,.::iW:d_ ... :.::ERMIT THE; E','':_'....•, L I I`. HEALTH DEPARTMENT 1rRESEr.:VES w•r..i tr RIGHT TO TM,,,,T77; ..:_:N :„. r7.7.!...- AND I CONDITIONS E:.`C>,?f.!I F'E"I) TO MEET OUR R REGULATIONS ON A C C N T I ,r .. :... .. ...,... PERMIT, /-';1'f .tC1L'. ... .:.r` CONTINGENT UPON THE FINAL .:''.'. . .......T:'.")f,t OF THE 724- . ..... ...... ::: .,V 'EM BY THE ........D ...T.NTY .....AL.TH DEPARTMENT, .......r^ .1': 7 i`\ I"' .../. 7'1.4.. io ... !.:.7.!:.:...;....,._ .... :E:i`:r.,... i:: 'are I?rtT ..� .. , .......--:- --„,. ,".„.7",-„,,.... . • ... .... ial2C•k_, ^`f M.it Its •I CT •jim ... ..... ... .`i:::!.:: OF "i S i::: -c::`•S:c r I.:c:E:s.' NOT IMPLY COMPLIANCE WITH OTHER STATE'. ..'`.T•• ., ...':.C: ._:... : . ... . . ... . ... ... .�....-:.,. .., REQUIREMENTS, NOR SH;::,'._.... I ACTr"C•r.,:, r• : �r:'(?.. .:off ,.;-T•; , E� ' �'� �1r TO ' . WILL .... 'i:'.RAt ... ,.N COMPLIANCE WITH APPLICABLE STATE, -:7::: " . ....... . , .~O ,.. r....:';" ' �;:I r i.:'f T O ARTICLE t I r._ . : 11 TITLE ..;r'� , r ` .., , A' +�,; ': :: �. .ry•%'• , _, •1"•..fir ?� a.:7 ... ., FO....: T,. ... (P'j R `OS'I::. '.1i' ESTABLISHING FINAL. APPROVAL OF AN INSTALLED .. . .. . ..... 7:1:::: .. ...:7-7 :17: •" LOCAL OCCUPANCY . 'f::: .,t...T I"U.,«s'ANT TO CRS 19'73 25 'I {% ! l ':,,. ) .. WELD COUNTY HEALTH DEPARTMENT 1555 17th Avenue 75-6633 Greeley, Colorado 2 Ph. 353-0540 RECEIPT NO._ 633 ._ Application on for permit to Install, Construct, Alter, or Repair an Individual Sewage Disposal System. Owner—D*' 47ogog.(J /jignwxj Address / //;/& - A0 v 17/7z. - /-/%%4hone 't'S- oval Direction to site /en,,. 4n S 7f ,n n 740 Ai-•rQJ 7 Legal Description S Gee .2 - 76—,e L kJ j a(NiS 'J General Information , // I Dept. Use Only 7Y/ofCSC! . .. No. Bedrooms �� No. Persons mt." /Perc. Rate (Avg. of 3) / 1:..4. mac, No. Baths 1 Basement Plumbing --".1. Soil Type c Size of Lot O 2 0 .z 4 p J.4 a...,.r.. H_0 Table Depth 2 ( 1120 supply (if well give depth) , , ,-//� Lot Grade 4 ,3 Type of sewage disposal requested: Requires Engineer Design_Yes,'' No Septic tank '� Privy Other If yes — reason K / D Comments: " Installation Instructions: Septic Tank 75-0 Gals. Absorption Field 770 Sq. Ft. r Other Seepage bed 390 Sq. Ft. Special Instructions This system will be constructed and installed in accordance with the above specification 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 ommenced. Date: 7i'!icZ/S — /975 Owner: X� �z Applicant: The plans and specifications as shown are approved pending payment of permit fee. Date: y/2.z/ 7.5-- / Sanitarian: 4.,—,_ 2 /Z...../7/ ern(..,e,-.7,t__The above system inspected and found to comply with plan and desc iption. / Systems Contractor: , (..,e,-.7,t__ Date: 5730 25---- (((/// Sanitarian: `r r.�� , U Engineer Review: ,.-- (Date) (Signature) Permit Fee: 3,---9....C. 04 nr Received by: g7 /Leach---- Date: /e; /,"/".5 4 ..w Q 1- 4.• l ; • RECEIPT NO,__� _ • Application for permit to Instr' 'Construct, Alter, or Repair an Indivia,,.4l Sewage Disposal System. Owner ..._,.....-/--,_ fir r1n s�JGiri )�J Address /— f`•o r 6_a Phone 69V Direction to site r.,,' P D 71- ,� re,eub � Legal Description // n nTOy • L itei General Information Dept. Use Only No. Bedrooms__&___No. Persons / M / Pere. Rate (Avg. of 3) No. Baths %/ ► zur•„kilio,�� Basement Plumbing Ofd ` /�� Soil Type Size of Lot /g t �th.r /o H_0 Table Depth H,0 supply (if well give depth)_ /fJ— 90 Lot Grade 43O Type of sewage disposal requested: Sep is a — — Requires Engineer Design ye No Privy � If yes — reason Comments: Installation Instructions: Septic Tank 7ST1 Gals. Absorption Field �� Sq. Ft. Other Seepage bed Cf a 'special Instructions Sq. Ft. This system will be constructed and installed in accordance with the above specification and regulations regarding individual sewage disposal systems in Weld County, Colorado. rds ill perms shall days ire at tits the time ifeas the construction building gs permit,rt or, if no building permit is issued, the permit mmenced. Date: 7— /97„ S` Owner: Applicant: The plans and specifications as shown areapproved pending payment yment of permit fee. Date: The above system inspected and found to comply with plan Sanitarian and description. Systems Contractor: Date: 1Y^' Sanitarian: Engineer Review: (Date) (Signature) Permit Fee: $4z22st ,, D Received by: Date o7 Hello