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Home My WebLink About20011067.tiff JAN-06-01 11:52AM FROM-DIVISION OF WATER RESOURCES 3036662223 1-851 P.02/0]j44 \�)�F{-4465 ;�r dorm E (Rev.) STATE OF COLORADO DIVISION OF WATER RESOURCES JUL 1t 1 9-57 J OFFICE OF THE STATE ENGmEzRawn e wet t .I't -: GROUND WATER SECTION �AN ths LOO AND HISTORY OF LL Resinied PERMIT calk T se -------- Ltc. WELL LOCATION . I .. try Belden A_ Eatdea Nol.L_-.- /Owner F.ur-lfav Hs r iae I6.34 County „Address Rt. 2, Ft. Lupton; C olerede ___za„y of_a___j of Beet-.16... Tenant Tem., a a RP:. 6gy , jPbt ?Used for Demo stir: LOCATE WELL. ACCURATELY IN THE SMALL SQUARES REP- on or by Same PRESENTING 40 ACSRES (dsecrlptton of site or land) N Due Started :say 13 19_11 1 ✓lMte Completed �g}1 33 19 1 z { 1 Date Tested July 13 , 19.11 I "YieldPR Spm efe W _ Z Pump type Jet Outlet 8tas _ 1 I Driven by 34 HP.RPM ��._�••- -I- -- I ^ Depth to Water__Ft. Draw doan4 _,Ft. 1 f S Depth to Inlet Ft.; Bowl Ft. Site and Kind of Casing: U the above is not applicable fill in: From 0 to 59 TyPe,_._Wt 3$' -„_ Town or SebdlvieGn From 10 Type RR. From to Type Wt. Sweet Address or Lot k Block Perforations: Sise and Type From 52_te 80 'type, psq�„r�LQ• Ground elevation _ (U known) From to Type Size How Drilled: From to 'type Size ROTA?'. Well desoription: Total Dept Rnli Ft. UE MML$1 ayoyp_..L-_to 11.-- .1-D -5—.---15- Cementing, Packing, Type of Hole to - _sin. Shut-off. Depth to Shot-off. etc. Atam. m PUT LOO OF WEIL ON RE- (from.---bb—..- 1 fn- VERSE SIDE Grant ,a s TO BE MADE OUT IN QUADRUPLICATE: Or nal-blue TT reen to and bn a gl State Engineer's Office. Sts copy to Owner. , - Ye11ow copy m • ler - e - EXFaBTT. 2001-1067 lb JAM-0S-01 11:53AM FROM-DIVISION OAF ,WATER RESOURCES 3038662223 \ T-861 P.04/04 F-466 Poets CAW.) STATE of COLORADO 6ir11916U176® 7-$S/SM APPLICATION FOR USE OP GROUND WATES JUL 141901 N� book pawn or Typewriter) OWN minas i Applicant hu .War Baptist Mission l t3ntY L CA IOII OF WEB P.O. Address ns 2. Pt. Ltmton, Cols. Sett...1A-8 y � A ' Quantity applied for .4 Alt &oraSe "'t_.�L ER0. 5. V • ,.,'P.M. Og . Used for Doassetgo Purposes on/at Buss 9lrset Address or Lax & Block No. penal description of land die) Town or Subdivision Total sac irrigated amt other rte. N �A. TED pATA P WEW. Pole aias:j Into s into . i 1 'r .._" [+seats Casing MUDC__ia. lrom,�-_toas,-it. ....-r-- _ _• * well in Pori.;. train s _ 40 sore iron. from ft. w t t , E (small) tlee s agates DATA: T3•pe_MaF 8iss� . ""'r-- -. innas possible. Use initiation dates soli 2 liar R* • I t (Use Supplsmtemst Pain Por a Coal dW) pss 00 fee'required for Industrial. TES APPLICATION APPROVED emoterdat or leriptttoa nets. NO. 91.95- App a . :Yi6: Sept s a t Aft wain APS or DATE JUL 1.110 ;Ls Driller Nadaa_k.:1".' ua N°'—L.- O Addrsss _..FP7spade tea,SATIBPACTORY COMPLETION REWIRED FOR APPROVAL OF APPLICATION II i-i JAN-05-01 11:52AM FROM-DIVISION 0 ATER RESOURCES 3035662223 T-051 P.03/04:r F-}465 r I ..t • I � . 1 • LOG OP WELL (ADD. SPACES AS NZEDItD) From-.-41-it. .aa" # Clay to-15.-X. Clay *ma, -- —� 6o--eft' Oka TO 7! er w . s0 c • • • • • • • • • • • r: WELD COUNTY DEPARTME'f lF PUBLIC HEALTH & ENVIROF 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411 APPLICATION /RECEIPT Initials: BM Permit Number: SP-0100068 Receipt Number: HAP-01068 02-12-2001 Amount: $315.00 Payment Method: Check Notation: 1290 Owner Name: FOUR WAY BAPTIST CHURCH Applicant Name: AGPRO ENVIRONMENTAL SERVICES Parcel Number: 1307-16-0-00-027 Site Address: Location: 9966 WCR 41 16-02-65 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 WITH CHURCH Commercial: (Y/N) Y Residential: (Y/N) N Acres: 6 Number of Persons: 300 Basement Plumbing: (Y/N) Y Number of Bedrooms: 4 Bathrooms: Full - 6 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: 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.•X I -,I .. / �T-2• �" Owner/App leant� Date Form: RT IAPP WELD COUNTY HEALTH DEPARTMENT 1517 15TH AVENUE COURT, GREELEY, CO 80631 (970) 353-0635 EXT 2225 FAX (970) 356-4966 Permit # : SP-9600257 Sec/Twn/Rng: 16 02 65 Status : !93UED Permit Type : RREP C=commercial, R=residential + NEW, REPair, VauLT Applied: 05/10/1996 Parcel No : 1307 16 000027 Issued: 05/22/1996 Finaled: �1a1 ' iG/'?'/_ Location: 9966 WCR 41 FT LUPTON CO 80621 }� Legal Desc : 11320-C PT NW4NW4 16 2 65 BEG NW COR OF SEC APPLICANT ASHLIMAN MONTY G Phone : 303-659-4786 1372 WCR 41, HUDSON, CO 80642 OWNER FOUR-WAY BAPTIST CHURCH 9966 WELD CO RD 41, FT LUPTON CO 80621 Description: HOUSE EAST OF CHURCH Commercial (Y/N) : N Residential (Y/N) : Y Acres : 5 . 00 Number of Persons : 4 Basement Plumbing (Y/N) : Y Number of Bedrooms : 4 Bathrooms-> Full : 1 3/4 : 1/2 : 1 Water Public (Y/N) : N Utility Name : e-ter Private (Y/N) : Y Cistern (Y/N) : N Well (Y/N) : Y Water Permit No: Percolation Rate : 43 . 2 Limiting Zone : >08 ft 00 in Desc : % Ground Slope : Dir: Soil Suitable (Y/N) : Y Engineer Design Req' d (Y/N) : N In 100 Yr Flood Plain (Y/N) : N Minimum Installation Septic Tank: 1250 gal Absorption Trench: 1232 sq. ft . Absorption Bed: 1588 sq. ft . Actual Installation Septic Tank: p,S) gal Absorption Trench: sq. ft . Absorption Bed: RI:4) -- sq. ft . NOTICE The issuance of this permit 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 persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2) . This permit is not transferable. The Weld County Health Department reserves the right to impose additional terms and ccnditions required to meet our regulations on a continuing basis. Final permit approval was contingent upon the final inspection of the completed system by the Weld County Health Department.\9\1t)\L r Xfi h mnv4l,jy c/ / Environmental Specialist Date 130-.. ' z WELD COUNTY HEALTH DEPARTMENT / t/ 1555 17th! Ave, � ' RP. No. \ •---- Greeley, Colorado Ph. 353-0540 M.H. No. Application for Permit to Install, Construct, Alter or Repair Individual Sewage Disposal System. Owner /� ) eh sr Address ,/� Phone it.„,..•/Oopei:' re (Jcvf/ssl0 '/Jk'dJJoh, C1o4r4do £4' de t• lennirec; 1 - Jeoe 11 - 7- --Q "! lei. 4. ri. °o len 3 —9,rihega Direction Legal Description � 'l 9h c/-v r, �4-0 General Information Septic ank • 1. Living Units gad'/'u' 90 CA Await 1: Liquid Capacity / D _ Gallons 2. No. of Bedrooms — 2. Dimensions' W L D 3. No. of Baths 7 �dJ' /inlet- 44404 - '3. Material 4. Basement Drain --- `f larva'/awe4. Type Inlet 5. Automatic Dishwasher — Type Outlet 6. Garbage Disposal elsSecondary Treatment 7. Automatic Laundry 8. Size of Lot a x '12 3 S ' 9. Type of Soil `Jer•V ' y Q/ ry Field Bed 10. Percolation Test 4!/ 5 f ✓ 1. No.of distribution lines �� 11. Water Supply eLL- 2. Trench: Width —Q ngt L2. Lot Grade 3. Type Filler Material / 13. Water Table Depth 14. Depth of Filler Mat5Tiial 14. Other 5. Gravel Size lI 6. Type Tile • 7. Depth of Cover 1 IS. Other I The Permit is to remain in full force and effect for six (6) months from date, until revoked for non-compliance. X This system will be constructed in accordance with the above specifications and regulations governing non- municipal sewage disposal systems, in accordance with Regulation No. 1 of the Weld County Health De- partment. Owner cannot transfer permit. Owner ->h- 7 Date: �y �?/ l9.C3 Applicant:.,`/ i. • ! The plans and specifications as shown are approved, pending pay�t of permit. ee. Sanitarian: ja7Date: / i 2 The above system i spected and.421 to comply with the plan and description. D e: Installed by --I I Sanitarian: r PERMIT FEE $ /� ,c7 Received by A te.� • ,:` Date ` Please use reverse side for Plot Plan or use separate laheet of, paper. Hello