The URL can be used to link to this page

Browse Search

Home My WebLink About20041884.tiff COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(6/2003) DEPARTMENT OF NATURAL RESOURCES 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 ;ENERAL PURPOSE Water Well Permit Application Review instructions on reverse side prior to completing form. The form must be completed in black ink. 1. Applicant Information 6. Use Of Well (check applicable boxes) Name of applicant Attach a detailed description of uses applied for. tO4-5 ` `4-L „n D O Industrial O Other(describe): 342-1( Mailing addreesss t t 11'11 01/4X-It_ '1 "- ❑Municipal (aq 3 lAfl 4 3 O Irrigation , City State • Zip code 1I�1�.[fJ�� ^ � �D�I' � [Commercial -�jtdr7�� p�Cp,kIIM•t�Oq ODSI 11(.' Te,dpnone8 - W 'L -- 7.Well Data (proposed) Maximum pumping rate , Annual amount to be withdrawn ( 1 gpm 2. Type Of Application (check applicable boxes) 15... .. . . . .. . .. .. ...... . (,( acre-feet Total depth Aquifer - - ❑ Construct new well [a'Gse existing well 2 Q� C 11 ❑ Replace existing well ljfhange or increase use 38d feet I T by.lV k«S ❑Change source(aquifer) O Reapplication(expired permit) 8. Land On Which Ground Water Will Be Used ❑Other: Legal Description(may be provided as an attachment). W. Refer To (if applicable) V\0—C�'l Well permit# Water Court case# �Q Sc-lit Pr Designated Basin Determination# Well name or# ^ cO* lik d\S 80u?t A- 4.co Location Of Propocod Well If used for crop irrigation,attach a scaled map that shows irrigated area.) County ( 9 9 .,..^ I I\Q CI 1l4 of the 1/4 A. #Acres /_ ' /B, \AOwners'�/�rs,� Lion Vv a•TTownship Nor S Range E or W Principal Meridian (a .36 Wes l Y I0/P. 33 3 et c,5o ❑ry toil- C. List any other wells or water rights used on this land Distance of well from section lines(section lines are typically not property lines) 00 n e_. Ft from❑ N❑S Ft.from❑E❑W 9. Proposed Well Driller License#(optional): For replacement wells only-distance and direction from old well to new well 10. Signature Of Applicants) Or Authorized Agent feet _... direction _ The making of false statements herein constitutes perjuryin the second Well location address e (if applicable) degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. la Q(K 3 to e 43 Hudson ( p g0(y4• a- 24-4-104(13)(a). I have read the statements herein, know the contents Optional: GPS well location information in UTM format th of and state that the are true to my knowledge Sin re(Must be on 1 sr re) i Date Required settings for GPS units are as follows. i Format d•.oust be UTM ��(/r��J t/( I Zone must be 13 d_. 3 l'V 1.._. Northing P t e title Units must be Meters S4kt 11/41 rl .At.E ) I�AEINT Datum must be NAD2�(C0NUS) Unit must be set to true north Easting Office Use Only Were points averaged,OYES O NO USGS map name DWR map no • Surface elev 5. Parcel On Which Well Will Be Located A. Legal Description(may be provided as an attachment) Receipt area only Set a40-Cite eC ....... WE #of acres in prcel C. Owner WR • 6-38 .e5 Pao-ear CWCB D. Will this be the only well on this parcel,pace ONO(if no—tut other well,) TOPO 2004-1884 MYLAR E State Parcel lDC(optional) 5BS DIV WD BA MD 121133%n0b0O°I COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST(6/2003) DEPARTMENT OF NATURAL RESOURCES GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS .pplications must be completed legibly, in BLACK INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned to the applicant for more information. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the original form. FEES: This application must be submitted with a $480 filing fee. (An exception is a $240 fee for an application to replace or deepen an existing permitted well, if completed in the same aquifer.) Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources, and Visa or MasterCard (card number and expiration date must be provided on a separate attachment). Fees are nonrefundable. USES: This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot, geothermal, recovery wells, and other uses not otherwise noted in the following list: RESIDENTIAL use wells—Use of form GWS-44 is required LIVESTOCK watering on a farm, ranch, range or pasture(not feedlots)—Use form GWS-44 MONITORING/OBSERVATION wells—Use form GWS-46 GRAVEL PITS— Use form GWS-27 REGISTRATION of an existing well —Use form GWS-12 (must have been in use prior to May 8, 1972) ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form) 1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be sent. 2. Check all boxes that apply. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of water right, the case number or determination number must be indicated. If applying to replace or change the use of an existing well, the permit number of the existing well must be indicated. 4. The county, Y< of the % section designation, section #, township, range, principal meridian, and distances from section lines for the proposed well must be provided. (An option to providing distances from section lines and the % of the % section designation is to provide an accurate GPS location in UTM format. The required GPS unit settings must be as indicated on this form.) 5 Complete all boxes and provide a complete legal description of the parcel of land on which the well will be located. 6. Check all boxes that apply and attach a detailed description of the uses applied for. 7. Complete all boxes. 8. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation is a proposed use, provide a map of the land area with proposed irrigated areas accurately drawn, including section numbers and section lines. A list of all other wells or water rights used on the described land must be provided. 9. The well must be constructed by a Colorado licensed well driller, an authorized individual in accordance with the Water Well Construction Rules, 2 CCR 402-2, or under the"private driller" provision as defined in CRS 37-91-102(12). 10. An ORIGINAL signature must be on the application. The individual signing the application must be the applicant or an officer of the corporation/company/agency identified as the applicant. An authorized agent may sign the application, if a letter signed by the applicant is submitted with the application authorizing that agent to sign on the applicant's behalf. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk (303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683), Montrose (970-249-6622), Glenwood Springs (970-945- 5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to our web site at http://www.water.state.co.us for general information, additional forms, and access to state rules or statutes. .VJVIG AL-LS-200t 02123 ON WiTIA "mom 393 666 3509 P.esI01 „ Peeei`1ad. OFFICE pOpFpTHE STATE ENGINEER awsxs _�we,+N"_a _ IlWISION OR 1"E souRCES ate y.,� annpnk.Ore. neat eeasPa, WELL MONT MCMINN fro 774 7 4 /9' auto DA/. 1 WO DES.SAWN MD � J APPROV R WILL LOCATIdq WELD COUNTY Ile aN N! 11.4 ;Wiwi 33 WES MOSER INC 7081**S N Range 86 W SbdP P.M. 12623 WC*e3 pLATANCES FROM SECTION burs HUDSON,00 nee Pt.horn NOrm Seet%%n LMe 210 Ft.fforn Eat feelbp on. t$Th)63LCOYe yaw WOtle4NATFS MATT TOCO T A SILL NOrtdtg: Castkq: 'MASCO OF T1418 raptor 00*0 NOT.CONFER WATER RIGHT cat N1 OF APPIOVAL 1) the veil shin M Wee h plan o r $y so t0 Crp;M no mewls New to g46np aft eight*. The name of els en don nel seam Oh epptleerlt that m Injury we cahrr to now Nom tow or es If mace enoMosOW wr ar a setae a Mont Mon snsWte Neel In s ern!end aeons, 2) Th cones/Won at one woo an Do in wmpaonwwrtb boo Wait Wes Conefrac*w Rwee 2 cea 4Q24,unless morons d e nrbnm has been awned ey the Shea Sere ci Exantisn of Water Well Cenebuetgn aid Pump IrmNWbn Curaetma In eacerderros Mltn Ride It 3) ARMS gunman!to CRS 37P2402(3310 for the nbcwion of an exedra wet Fern*no,to7Tt The uld adi roust be Mused In a;wren,On Rae,e t/the Wow wee Censwabn Rules wnlwr.Nasty$0)den ci pompous of pis new we. The 4691004 Wed At,Ma0000t Amon Wm moil be DemelM d lie aubre24.0 to e4MR Ih1 due std WO wee awed 4) Thum al giro as horn at dna b Mmit*d a ere eve oesn,ardlnary household purposes IMAM.rot men Men 1 snots tsnwy dwskeq(s),We Irrigation at not more ten,0 000 spun toot of hums prises and lawns.and me wad M Swat anima. 1) Produottn from this wee w' ommen to me aids Pox Maus mutter.which eurayw cs Ii the Inmwl beanen 290 Net ern 840 feel babw 0w wound;Meas. Plan oxlip etwM be headed loo gni$W to priori oct le lon nom othee ton.a, e) The ssuinnuei ponying Ns of INS weh nog net head t6 GOu. 7) Thy wed afro be constructs*Nei mare tern 200 Nei from Ow Leadan vernal an err part. MOT!The n$br a thin resit to windrow at*stand senwn of wear Iran Sib nen»nnwole swam men be less than tee 190 yew upon which the amount of mete in INS tauter to siomed,due to a tiuiu*edwSW*Ylu as Sint. MOTE:To IMVre a mtxkni^n moductin IS at this wa6,p.rf0ret*d asNns*Odd be ern*Waugh the site producinq 04wp of Ow epployeg in a Mar Mend aeon. n PPPROV� Jr t ALV _.Q_r_I�" ♦4 i� re;t:npkrsr (SATE!nub .�UL 12 2001 12114:200: 1 2 2503 TCTAL P.02 • ZA. S<1ltel Band 'I'1ai el a I.A7,tF.taf.A/.F GQ:LT kRAZ/FA/TR Paul an I PUMP INSTALLATION AND TEST REPORT Pa eels Use aaM IGOhn.52 STATE OF COLORADO,OFFICE OF THE STATE ENGINESR 1,LWELL PERMIT NUMBER 1:10.7; 2 OWNERHAMCO) E rt Mang Addasa 543IKk City, SL Zip @Q14 Phone (470 ) ohr4 -o< ens • _ t RIP! Q-is-ca I. WELL L CES FROM BE OCATlai 44:1 ! ' 1/4 F14 Sec, '3a) Tsp. , N .pangs In 5 „ . DISTS1Oa b IL from, ILSaa.ling. and &jJ) K.from En"G..e Sac. ins. SUBDIVISION; LOT`BLOCK FIUNQ(UNtTj STREET AODRE M AT WELL LOCA'RON: 4. PRIMPMQAT segHgrtU mammon Qcmps d i3�13-11 , erstectutr C Pump M a No. 1 L td51 Amps IA Dear GPM J K �yaa� � a HP 1 Volts .5�p , Full Load Amps pump Intake Depth 't µ ' Pips Size ]/ 4 Inches, Kind vY C. SC,y4 • ADDITIONAL INFOf M FOR PUMPS EATER T 5091)1; TURBINE DRIVER TYPE Electric U Engine Olt* Oeelg i Mead feat, Number of Shalt as inches. 6. QTHER EQSPIM lr.; Alt*Matted U Yee®No. O'iul a Depth ft. . Monitor Tube Staled In Y210110,Depth It. "-maw Meter Mt. Maur Sett No. maw Readout©Gagne,0 Thousand GMlors, Acre marl Beginning Reading . a TEST DATA: 0 Cheek box if Tea dale is submitted on SwpNmencal Form. One Fitt 3_-(1 Taal WLssvp10e Tana Stale ••♦ s1- Rats(GPM) Cate MWuredT Punpirq LvL a5 O � V. DISINFECTION: Type H 1'LJ Ant VW L C iJ P a. was Gushy analyak awileble.Oats ti]No i 0. Remarks 10. I haw rase SM atateme is pads tine, and know the torn then, SM hw they w bus to my knowledge. (Pursuant to aaaks 24-10.(13)40) C.R.B., the raking S Isles statements twain constitutes pet)uty in the eaccnd degree end S punishable se a dew 1 mledarneenat.)r-trrnfretrpili J CO-, PCSPhone S�170) 33-S i 19 Ur.. No.®►S� • Name/The Wisest mi.or plat) tlgnjlbse Daly VA '3R1i'I doted i13?1 a b 4Stvt a4.B S.D-LT R2R1162It2 .01 • /� XMW N0. WELL CC'i'p an.0 �.. �J UC110N AND TEST REPORT roe pn,ao We ant 14" lir,COLORADO, OFFICE Cl INE STATE ENGINEER Sharman St. Rn]„ it Denver.CO 80203 - 1. WDJJ„K NIJM$ER F+f n 3 z I - , towNER.4ip107 e.S u Cat 8nAwaiRes t, i 4 a' 'ac R TNC S,a,t�ts a..be•nol..wnna..,L u.)SOKI (J) (a. Co.4.45 a Rig aPv ei -I-at ow SSC, LINES: a. ` ,• G • a1/4 N € 114,Sea. 3:2, Twp, ?—, N , Range b6 _k L...„ • .Tram jQ d >�.�, rang 4 1 fl f!, from k: I i Saa line. OR SUeOM P—+� LOTKOCK FILING(UNrn 81146 11 AT ELL LL CA "a OFK)UNLIYAIRSUUDE ELEVATION t DRIWNGMETHOD R VAR'I 71' DATE CQI jxiw_Q-7-p 1 TOTAL DEPTH 38 CL ft. DEPTH COMPLETED a 8(] tt. Q OisO(.na•.n..... aio� 'Taa*r— & HOLE bWM. (in.) From(R) To(1q Oawi ripkpn al Materiel rm.Us C.tw•w,Mr Lwttteen r• C ,5 w•t AwtA � � Pric 3.''• "_�. 'o (TQA11Lt. - rja TG Ror.,c 7. PLAIN CASING P • COAL OD t Kim wan SR* From(n) To(n).., " pCt" . .Tr€i. a x . t:TEE ar T; PVC. " . bO t ( c O''' '' --• ' ^ ' PEAL. CASINScreen Slat Size: SI • t-6. PVG -0.4 .- : , Y'O_ . � , s7Q9t Atop COAk I-4 ix _ µ•-'. 1.04.0 Wr7b1 r'nat )_Lj v. --i ;1i e.Y �_ iv: r t� ALE B.FIL ER PACK 0. PACKER PLACEMENT: MltIOPIpA Still Sl: • atwnral .DA y oe,xn, 10. GROUTING RECORD: ;.Y hwerke Amount Density Interval Placement C,kMENT °Ibz,_ 1 .13E, z ''aq6 i I1' 131SIN , ft Amt used .iG 7se •. T 1 C �P IOU`L• . U Cheek beat k Teat DES is euhmlttecl on Form No GWS 39 5upp iimant i well Test. i EN) Asti , A•D measured a- Z.O t A 1 Production Rate j� gpm. i • h DetVThti.measured , Test length (hrs.) r% l • , sadism*.end knew the aenr.rti tin*and tog w., am tin to my ww� .ee..(w.a.r t to e.w+oa 24-4-104(15)(a) San n.nin a.n.Mar ✓(7- , p.iyrr N W. coed dirt and 4 purninto a.Mon t nJ.u.m.na.)• J N.•—a" W. y • -Y h' '.' i' al�zri ► w '56 s- liIP) .UC, NC _ • a�y r —•w , y a tllSn y 51- - Otue ' ,r • • V • FR '}1114-I Ndl4 TS?) 8 a 1SZVERE2L6 AQ:T.T 1tRRL t6RiTR 12-31-03 01:0PPM FROµ-DIVISION Ot' ' ER RESOURCES 303E662223 T-12E P.02/05 F-204 - FORM MO STATE OF COLORADO For Otte.Usa only OW810 OFFICE OF THE STATE ENGINEER awl ale Cbntarmial Aide.1319 Sherman Os,{kmsr,Colorado Wes pay eeaadm RECEIVE'. FOR INSTRUCTIONS,SEE REVERSE SIDE JUL 1 S 2000 STATEMENT OF BENEFICIAL.USE • w.rea5,;.,, WELL PERMIT NUMBER 052576-F srarEo aeh" 1. WELL°WH i . NAME(S) Wes Moser a Sons, Inc. Marling Address 1013 F.Levenchavenue City, St.Zip Greeley, Co 80631 / Phone ( 970 ) 356-9160 Q42.p91/4' 2. WELL.LOO JQN; COUNTY Weld OWNER'S WELL DESfNATION well t7-052576-F tAddrew) � testy), Da or GIP).GIP) SE 1/4 dew NE 1/4,Sea 33 TWp. 3 u N.ar❑B., Range 55 Da orEiw. 6th P.M. paannelmlimm 1326 Ft tan 1:1 N. or El S. Uner, 1.316 _Ft from 0 E.or I::.i W.Line. 3. The wen is being used for the following purpose(s): irrigation 4. Water from the well was first used beneficialy la this perm*number,for the above described purposes on 0 4 .,4 / 19 74P° eso set report s date.fiich 4 Liters m.Leered dies et ma pemU 5. The pumping rata calmed is ma gallons per minute in comolnanlon watn use r -r 6. The average dnnuai WOWS of water diverted IS -p22 Ea Set , 052492-r, 052494-F & 7. The land area irrigated (watered) by water from this well is: 914 al As or 0 Square feet, INtstibe4 described as: Els Sec. 27, NP, Sec. 33, 1342 a 351 Sec. 34, Township 3 North, Range 63 West MwruNutpuon) or as Subdivision Lot(s) Block Fning/Urdt 8. Well Wiled by: N/A - existing well. UC.No: Pump installed by: Lie No; a Meter Mtg. by Serial No.: - Dade Installed: -- I(we) have read the statements made herein. know the contents thereat, end state that they are true to my (our) knowledge [Pursuant to Section 24.4104 (13)(e) C.R.S..the making of false statements herein constitutes perjury in the second degree and is punishable as a Class 1 niitdemeanor,j 10 Name/ ine (gases type"Print) ignature ' , kiS eA'•-a•.d •ate John Moser f ,4� E•l'"""'' cs G/ai A saes • FOR OFFICE USE ONLY • stew Engineer By on Court Case No. Div. Co. • Basin MD Use j 12-31-03 01:0?PM FROM-DIVISION OF'ThER RESOURCES 3036662223 T-126 P.03/05 F-204 _ 1 -.I wnrae,_ ^ ° /, , COLORADO PIVISION OF*ATER RESOURCES I r��G ��J h ,---, I THIS I'QRM MUST au N AM4 -ER G 300 Columbine Slag.. 1845 Sherman St. • - WITHIN'eODAY'OF.COM%.ETION �/ Denver, Colorado 80203 -� Cr THE WORK DESCRIEED HAIL .7r ON.TYPE OR PRINT iIl eLACR.' WELL COMPLETION AND PUMP INSTALLATION REPORT W INK. PERMIT NUMBER .act 7 71- A "^jw'0'- wELL OWNER i/ .S MOO f p$_�;�r; S is Y.of tee re '4 of Sao. _3,3' ADDRESS&x J/Q — Q, ie plf" & 9'44 r.._3__._e__, R. __.t-, A 14 P.M, DATE COMPLETED• ' Sept. 2 .19 25 HOLE DIAMETER 8" 'WELL L00 In.from 0 m 90 ft W 6" From Ti, — Type a,d'Coigr of MatadiLot.aur in. learn 90 1O 3�5 ft D clay in. from to ft. 40" Elands DRILLING METHOD ery 60 80 gr sell CASING RECORD: Plain Casing 80. 103 shale 10.1: 101 con Sizie5/9 stood steel from 0 to 90 ft J,2'r 123 peat. coal formation- „ 125 1i$ : shale Size Ll'il & kind Alasticfrom 0 to 310 ft. 1334 coal. lIF9 270 shale: Size___,& Kind from to_ _ft. 270 273 black peat . `279" 31) shale- Perforated taring 310 37) white sand formation ta� 370 375 shale Sias_=3_&kindtlaetic from—11L to 375 ft. 310-70 Size_&kind_ _ from ._.to ft Size & kind from to ft GROUTING RECORD Materiel Cement Intervals 75-150 ft . Placement Method poured GRAVEL PACK Size Wong Interval TEST DATA • One Teed Sept. a , 192 Static Water Level Prior to Test 160 •• ft. Type of Test Pump Bailer Length of Test_ 3 hrs. Sustained Yield tMetered) 15apm . TOTAL DEPTH 375 rt. Use additional pages neaenary paeomfilete in. Final Pumping Water Level 190 ft. I 12-31-03 01:08PM FROM-DIVISION OFFER RESOURCES 3038662223 T-126 P.04/05 F-204 roewna WELL CONSTRUCTION AND TEST REPORT For Mao u.e only waneveab STATE OF COLORADO, OFFICE OF THE STATE ENGINEER CV 790 y 5" 131S_Sharman St.. Rm MB. Denver. CO 90203 i 1. WL PERMIT NUMBER . 2 . -g RECEIVE) 1 2.OWNER NAMES)_ .Jt?4 Hos Ttjc SEP 042001 Melting maws 1 6 2, l./C.2 C watg„Tr.,.se. S9 w4ER Rona FPO) t3q -QCity, St.MP 9�9q 3. WELL LOCATION AS DRILLED: S k' 1/4 N e 1/4.Sec.3' Up. -1 „H.,Range A di s,j__. DISTANCES FROM SEC. LINES: .J t9 AP, ft from AWAIT,Sec. fine. and ,Q t n h.from 454,T,Sec.Sie.OR SUBDIVISION: LOT`BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: 4- GROUND SURFACE ELEVATION It. DRIWNG METHOD TROT AR`•1 . DATE COMPLETED ft-1—o1 . TOTAL DEPTH 38 CS R. DEPTH COMPLETED_tS 80 ft. r— s.—GEOtOGICtoo: ' CHILE DIAMt (in) From ft) To Cl) -- Copt Cbwriptioa of Mia(rye.,set cos,Water LocsIatl if C1-'4 nc snls... SA-tun ?r- 5 I SA-$.]6 rr r1�, $� r')- fi SAt.a1 SR At Ifil, 1;roe To `RDC.< 766- .S H A Bb- SOFT PLAIN! COAL_ O CASING Kktd Wail Size From(R) ToOn fi- I 0"5SI+A L E n TEEIti O )05-(O6 RS2SJC 'BTee`I-. I lOb-l rs SHALE PVC h1 a fr 13tS- I% RO�Ic i34-- l ila Cnt k PERF. CASING:Screen Sint Size: —____' I p- 4.90 SUAL 146. Pvc •¢47. &Pio IiRn R2O-&fit SANb STor•Ip Am CORM- IA be &kD-ets'S SHALE W n f CnAL I4 iv -.--, -- a264"SO 5 Su ALE aqI- 3613 A:Wt-LI;E SAN N N I S70 `� tUZI- Sien Si-IAL.E S FILTER PACK: a PACKER PLACEMENT: Material Out!ELc_ Type Sims ' Interval &coy ESQ_ Depth '``1e.GROtmNrseconD: — - Materlal Amount Density Interval Piacement REMARKS; CFJ3dot7 S56 TT ..1,15.13 .0:41.2.6 PnSr i j u • r,,spkow Er!ittJt I 11. DISINFECTION: Type i- Ts_ Amt. used I CLIP 12 WELL TESt DATA: 0 Check box if Test Data is submitted on Form No.GWS 99 Supplemental Well Test TESTING METHOD $14i I..g Static Level R. Date/TiMe measured . • Production Rate gpm ii Pumping level ft DateR6ne measured L r —O , Tea length (In) S Romarke , ' 13. I have road the atementa made haeittad know the content:thereof,and that nee an true to my Knowledge.Villa*to saalion 24-4-154{ {µ C.ILa..the maldeg of false Siena Main aerWeaac perjury In teo woona degree one la punnhapb as a deal mieaaneanor.I CONTRACTOR eR r R 4J C-L'�� -�,�3Q Hp Phone Ai-0)66-1 - i f Pl Li*, NAPA; . Melina Address I-IC) sax IJYY 1l1��L /03 min Name/This(Please type or Pln0 Manatee Dew /aienaG t,s fa�LC✓r•iSr v riso. /'/s.rc�'— ,er "J v -C/ L r 12-31-03 01:06PM FROM-DIVISION OF'-`ER RESOURCES 3036662223 `1 T-12e P.06/OS F-204 • %' - ,,,^`+w� r .4 .�, r�11'f1.:i1, .. '?Zf'rli`y '�aS�'r,,ryf,fywY,�r4 ,1 ToS '!� Two scolao(Yapllai ., ,, 1, 'y'!t'"f' I, 4 ---••.: 7 • •• , , ; J �. I. ' J ,,. ___.:Jute •:7 t• ..i Q4lniJt1Y113TAt1'1 wIa r,?t. - ' "'• worry 2 p' b i Ihipsoil 1!» 4 . U•J 7 OM . _____•S2 .- .•.,.'.#7iF cc r Fe. ',re.1 R, tam—It 16, 17 Gfraaal / - 4 :i..-.: 1ir0.l°ib- . ..Oi,, 1T 35 : 'mac�:.i!!„tu ,z .. 35 39 okt "`tr at��o {w It. 39•v' 150 . . Say__ - :..[:::... — I-..• �rca•; ,.: 50 51 Gravel = ...t. OS .v .•,---- Y y121 1 51_ 5AL. —.0107'....-2..- t: f y-"a -• iaswe war TI +,sa,J • -.. iau rcdf 59 761, Grant m 41x7. - . Fb kutt ala+paat O. lit;m•63 nm rt, 613.9. 7 t __447-4-2.....A...-.....4.........TG t Tsprla"Ss to11ownlpaan :ow., •.tonal:3t'ASlabs=JHa 7'oacativast -^--- rd Yi,:T ..:y am• • •,--• » I"- • • .. . ...--r. "riipOY. 1 .* L .':=IN [I :4-• •lii 1t;tc usnanttric s7wa 7 1 - •1 Y . k. ,,et, }•mow 1 I { , t'1 .' at ..rt..... F 1J Mi 0•YIt{ff Jl'I no, siea "1 61 "M MM. % was WI Artil4nactiom..:-I L �[ rtnlJ ih It: ' •. :4 a 144 • PI {y , • 1 1 I `b: ye-l�;Viit.,`T•.•Ii wal pi In4tha .IP •1 Jra I.... " tag ea+TYa7 to '`r u Ia- 111.1 .,II:, 111r: ••, i'•... i1. ... ., Ir. m P!!:". ! •1 ?e t',:J.T 11: ' TPI../>p:,Td ,. •.. . te u1 tla area oasoatr Alit 14711 VIA r:1.!41710 vie . I.!11 I 0lf.3t' .%,'. ., 1.-..C41.! la ` --a[oP ,{$OWIti • .dncI •'.I3• -nti•Iil. _•. ,1..•,. . . ..}fi t. .,. •.,.F ` • WI,' 7 .Pr11f'.t ?71r'11Elsa - -. 1'.A:% Arm' q CMaT . S ' .,"r1 -411a. iuc: .4 n_ i.Jlt .,--. • ..+. «..� �.M *WI ....--,_._.tMie.O a'. �I.i, w 'W'�rigie 3' 1,,C\ ;r,;'\r ' *WI •I r•1 !:A-?f! no 7.^• •'h1Jr :.re v.3.1I ..ww,.,,�� .w,� I it ':' 1- J.�77..T.C si' T•--- _nY]a. _._--.._.--.....,f.`c 1' 41M sell s; - r ut w :1r/ IM $1-LIN16ioidtbsi oni; �.._ ....._ .J,:J.filV1.5 - _y1M room - • NI the son la too .4 .....-- • ,,•••...-.lr..--....r...o 4:It'i •:ii _ •rYoS� ':f imid'dltbMl'aia t ItralaMn-Olia01U.14.3 1:y.-.3..1 1 x i . . ,i it'L 'r --:'►JAik,^c• 'r'_ 41an at . asdol,'• rr r I 1. , t . y • 4311 Highway 66, Suite 4 Longmont, CO 80504 Office (970) 535-9318 Denver (303) 485-7838 Fax: (970) 535-9854 AGPROfessionals, LLC July 29, 2003 Weld County Department of Public Health& Environment 1555 North 17th Avenue Greeley, CO 80631 To Whom It May Concern: Enclosed is a design for a septic system at the Moser residence located at 12623 Weld County Road 43, Hudson, Colorado. If you have questions, or need further information, please call. Sincerely, Eric W. Dunker, P.E. Environmental Engineer Enclosure Cc: John Moser Your "Pro Ag"Environmental Professionals WELD COUNTY DEPARTMENT OF PUBLIC HEALTH &ENVIRONMENT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 --WEBSITE: WWW.CO.WELD.CO.US APPLICATION/RECEIPT Initials: SKE Permit Number: SP-0300299 Receipt Number: HAP-03301 07-30-2003 Amount: $375.00 Payment Method: Check Notation: CK#2732-AGPRO Owner Name: MOSER WES & JOHN Applicant Name: FRAZER SHARYN Parcel Number: 121333000009 Location: 12623 CR 43 Account Code Description Amount 2560-41400-4221-4203 New Septic Permit $375.00 2560-41400-4221-4203 Repair Septic Permit $0.00 2560-41400-4221-4203 Vault Permit $0.00 2560-41400-4221-4203 Variance Request $0.00 Description: HOUSE Commercial: (Y/N) N Residential: (Y/N) Y Acres: 6.38 Number of Persons: 2 Basement Plumbing: (Y/N) Y Number of Bedrooms: 4 Bathrooms: Full - 3 3/4: 0 1/2: 0 Water Public: (Y/N) Water Supply: Water Private: (Y/N) Y Cistern: (Y/N) Well: (Y/N) Y Well Permit Number: 104319 TERMS AND CONDITIONS A permit fee,as set by separate ordinance of the Board of Weld County Commissioners,shall be required of applicants for new individual sewage disposal systems(ISDS),payable at time of application.Permit fees are non-refundable;permit applications are nontransferable. If both a building permit and an ISDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit, the ISDS permit shall expire at the same time as the building permit. If an ISDS permit is issued for a property that does not require a building permit,the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent. Expired permits can be renewed by payment of the permit fee only if: A.There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B.The surrounding land,its use or zoning has not changed so-as-to cause the original application not to be acceptable under these regulations. NOTICE 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(WCDPHE).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 that the proposed system will not be located within 40O feet of a community sewage system.The undersigned certifies that all statements made,information and reports submitted herewith are,or will be,represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein.Applicant further understands that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted,and in legal action of perjury as provided by law. X 5AUZh� fnai 7/ u3 Owner4licant Date Form:RT_HAPP ��JJ ((MD - 33O - o tkoq 1,1 a I R K) 1U 10' ROAD/PROPERTY SETBACK II TRENCH CONFIGURATION:4 Rows OF 7 INFILTRATORS EACH 8 I �'"� C7 Row OF 8=577 savt• > w w 0 BED CONFIGURATION: B Rows OF 6 Z 0 INFILTRATORS EACH= 748 SOFT. a U4 o 05 BED CONFIGURATION:6 Rows OF 8 N Z C INFILTRATORS EACH= 748 SOFT. 0 EC a 0_ D-Box(SET LEVEL TO ACHIEVE EVENLY DISTRIBUTED � CC SEPTIC SYSTEM DESIGN NOTES FLOW TO EACH Row OF INFILTRATORS) N w 0 I.EFFLUENT PIPE:3"PVC SDR 35 MINIMUM. I J Z Tn MINIMUM FALL: I/8"PER FOOT. 1500-DAL SEPTIC TANK - 0 2. 1,500-GALLON SEPTIC TANK MINIMUM. .i - 3. SEWER LINE:MINIMUM FALL OF I/8'PER FOOT. i'_ \ / 4"PVC SDR 35 PIPE MINIMUM. / ." No BENDS GREATER THAN 45 DEGREES. MINIMUM OF ONE /20' DWELLING S TBACK� ; -- CLEANOUT BETWEEN BUILDING AND SEPTIC TANK. �ii \/ 4. VARIOUS CONFIGURATIONS AVAILABLE: \ • M /i / m TRENCH CONFIGURATION:37 INFILTRATORS MINIMUM,I.E.4 TRENCHES OF 7 8 I WITH 8 z / Q J// 0 C BED CONFIGURATION:48 INFILTRATORS MINIMUM,I.E.6 ROWS OF 8 OR 8 ROWS OF 6 I 1100' WELL SETBACK 1 a 5.KEEP INFILTRATOR BASE LEVEL WITHIN I'. ce `oo I I W.a 6. I2"MINIMUM FILL ON TOP OF INFILTRATORS. — I I 7. MOUND UP BACKFILL SO PRECIPITATION DRAINS OFF 1 WI( cd w C ro ABSORPTION BED OR TRENCHES. I I 8. No TREES OR SHRUBS TO BE PLANTED WITHIN 6'. II I,� y m 9. FINAL INSPECTION REQUIRED BY AGPROFESSIONALS AND I \ Y \ w o WELD COUNTY HEALTH DEPT. �\ J\ O P4 2 RE � v " % \ �WELL a O t 5 ;I .40 " il CD g w ` � -I f 0 0 25 50 ( ( SCALE: 1' 1` AGPROfessionals,LLC Percolation Test&ISDS Calculations Date of Test: 7/25/03 Site Name: Moser House Site Description&Use: Residence Number of Bedrooms: 4 Number of Bathrooms: 3 Number of Employees: NIA Confining Layers: None Encountered During Site Investigation Minutes between percolation readings: 10 Hole#1 Hole#2 Hole#3 Hole#4 Hole#5 Hole#6' Time Time Distance Amount of Distance Amount of Distance Amount of Distance Amount of Distance Amount of Distance Amount of Elapsed from B.M. Fall from B.M. Fall from B.M. Fall from B.M. Fall from B.M. Fall from B.M. Fall 9:20 16.250 24.875 22.875 20.625 17.750 9:30 0:10 16.625 0.375 25.625 0.750 24.875 2.000 22.625 2.000 19.625 1.875 9:40 0:10 17.125 0.500 26.125 0.500 25.625 0.750 23.500 0.875 20.625 1.000 9:50 0:10 17.500 0.375 26.500 0.375 26.000 0.375 24.250 0.750 21.375 0.750 10:00 0:10 17.750 0.250 27.000 0.500 26.500 0.500 25.125 0.875 22.125 0.750 10:10 0:10 18.000 0.250 27.500 0.500 27.000 0.500 25.875 0.750 22.875 0.750 10:20 0:10 18.250 0.250 27.750 0.250 27.625 0.625 26.500 0.625 23.500 0.625 10:30 0:10 18.500 0.250 28.125 0.375 28.125 0.500 27.250 0.750 10:40 0:10 18.750 0.250 28.500 0.375 10:50 0:10 19.000 0.250 28.875 0.375 s j' •• • e�cr •: a r • • ! !. Y• d{� Drop last 3 readings 0.750 1.125 1.625 2.125 2.125 Perc Rate(in/min) 0.025 0.038 • 0.054 0.071 0.071 Drop last 4 readings 1.000 1.375 2.125 3.000 2.875 Perc Rate(in/min) 0.025 0.034 0.053 0.075 0.072 Average Perc Rate(last 30 minutes)(in/min) 0.052 Soil Profile: 0-6" Top Soil Average Perc Time(last 30 minutes)(minln) 19.35 6-24" Sand 24-48" Sand Average Perc Rate(last 40 minuteskin/min) 0.052 48-72" Sand Average Parc Time(last 40 minutes)(min/In) 19.28 72-96" Moist Sand •Hole#6-would not hold water-not utilized for calculation Eric W.Dunker,P.E. 1 of 2 • AGPROfessionals, LLC Percolation Test& ISDS Calculations Site Name: Moser House Site Limiting Factors: None Encountered During Site Investigation Residence Number of Bedrooms: 4 Design Flow* (Based on Number of Bedrooms) (From Weld County Health Department ISDS Regulations Table 1) 1) Residential -Single Family Dwellings 75 gal/person/day 2)Commercial -Day workers at offices 15 gal/person/day 3)Commercial - Factories& Plants 15 gal/person/day Average Basis: 75 gal/person/day Average Flow• 75.0 gal/person/day x 8 persons = 600 gal/day Design Flow: 600 gal/day x 150% = 900 gal/day Septic Tank: From Weld County ISDS Regulations-30 hr. retention time required for Septic Tanks, in no case shall them be less than 1,000 gallons capacity. 900 gal/day x 1/24 day/hr x 30 hours = 1,125 gallons Therefore, utilize a minimum tank of 1250 gallons. Absorption Bed. QpO From Weld County ISDS Regulations- The equation for an Absorption Bed is: �+O�G......UPAe ; A= (1.3 *Q*(T)5)13.5 C3�Q n',, where: A=Area for Rock& Pipe bed system in square feet 4 , Q = Design Flow in gal/day / : ylrr' T= Percolation Rate in min/inch T(Percolation Rate)= 19.35 min/inch • '•••07•-ZY . Area. 1,471 sq.ft. for Rock and Pipe Bed System :` Areal 735 sq.ft. for Chambered Bed System (50% reduction given) 15.6 sq.ft./chamber: use 48 Chambers Absorption Trench: From Weld County ISDS Regulations- The equation for an Absorption Trench is: A=(Q*(T)5)/3.5 where: A=Area for Rock& Pipe bed system in square feet Q = Design Flow in gal/day T= Percolation Rate in min/inch T(Percolation Rate)= 19.35 min/inch Area: 1,131 sq.ft. for Rock and Pipe Trench System Areal 566 sq.ft. for Chambered Trench System (50% reduction given) 15.6 sq.ft./chamber: use 37 Chambers Eric W. Dunker, P.E. 2 of 2 ., Job �O 1-415 34I' 9!fk /11.7.1.e." �ps:Li.-, c:� A -.) Job No.IL RO Sheet No. of Calculated by Ec•s Date by/cs(o y '••'•PROfessionais, LLC Checked by Date I 1 Highway 66, Suite 4 Longmont, CO 80504 Phone: 970-535-9318 Subject IQ`es.i Q•-ie_., c.,)/ 5 e. h�r-dam d- ,'�o �. -r Fax: 970-535-9854 (A-e-vr el? _f1�J L/ l- p 1 4_ Ag. . . lo ..._._. . _"l ��D+'L_.. . .. +r yT�_ ...... 4.. r.•mss.. .. frte rmp.�,. -- 4G6. Kee) ..._.._..�..._._.� _. j- . _......,.......M....._4.. V __ ..__,_... ... ... ... • _-.4. _._.._ .. .. • _ i I i y • ' I C- Sr'IIP4..r..L.i . r. 17 s"dt',0 . i , } . } s. Fo. ' .7r ! v1 i G`P [a . . i t } __ �.._.........:.__,,... ._.... ;..............__i._ --_:__..._L.._ ..1.... ...__-4..... -4. ..:__._...._ -_�---t -- i ! • i r , c 1 `' f ' i i i ',ZO1 3 .13� ....-^ ..._..i....... i i , l i i_ 1'4-4 ! ' • i• . : ()..5 t",',. 3e 04o 4i(b...! f4t.. o f- !/Tbcr�c ft .,t«r _ i • t •i I i ..C , r : ! Hi____ . t f, ! J ,E I .i i 1 tU(A.' , :4Jois..l{�....�Bcj i4 1i33� Zc� ! , L . • _....._._• -.!lam :_}.tati.. _..,._....•..}---F---.+-'--_!_ f..-..�?7.o.._-_.___. _._._ 22..0". 1._ .L...._±/.. ,. , ' 1 `- . f , A, , i LKPfft s. ....kil.k� •tr ` .1 As.J� i S r� �, �! ter- ... _..__ __..........._•__......�-._.__ .._-_ ... __..._...._..__ 1 . • ..• __ . ... .:...._....:....-_....._. ...._._..__L--..:._...w....�.• _.•i.._ _.. _ ! ! i . . I ,'� ! -i._ \. I,. i kk !' • I `•'• • l s - __.._4.__..A••-,----t--,---t----i---1-.. tom__ --2.- i. ...-_1 • _ ...�..... I �'E `i ---- — i ,----- -1--I i i ! I --•f- }----__...._..»_...- ' i 1 1 • E 4 i I ! ! i i • Hello