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Home My WebLink About20092983.tiff I 'D -' WRJ.SRey.76; ' COL• >�ADO DIVISION OF WATER RESOURC - 818 Centennial Bldg.,1313 Sherman St.,Denver,Colorado 80203 PERMIT APPLICATION FORM RECFIVFD pliplion must itcomplete where (7(I A PERMIT TO USE GROUND WATER mAR 06 95 livable.Type or i X) A PERMIT TO CONSTRUCT A WELL print in BLACK FOR: 1)c) A PERMIT TO INSTALL A PUMP �� INK.No overstrikes 1otaTvAIER RELU41 r / is�/ rtaTE En5tt! ' /11(tCO- J or erasures unless ( ) REPLACEMENT FOR NO. �(10(J initialed. i )OTHER WATER COURT CASE NO. (1) APPLI//CANT1J- mailing address a FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN � p NAME L/pt} ff Ir Pant% p Receipt No. 382 / U(�- STREETpp )1 s0! f 1 1I o'- d a l( IPfi Basin Dist. CITY P✓1 g' h fom 6U gin,0 IState) (DinCONDITIONS OF APPROVAL TELEPHONE NO. C51-1 ` 64)- 03 This well shall be used in such a way as to cause no material injury to existing water rights. The (2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant tri hat no injury wilt occur to an waght or preclude another owner ofother a vested vested water ter County Weright from seeking relief in a civil court action. caner))ry 5 t % of the NE %.Section 3/ CA 246\1 ,L' W t i/ P "4-04 Twp. & a ,Rng..� 4 P.M. Z3 4*t,el} 04,81 lE.w) ',b00-N 4,r ill"' (3) WATER USE AND WELL DATA 30s-B Kkf CO-111 a_f c.ss *t posed maximum pumping rate Wpm) l.S ii57( woo', -'ICI Average annual amount of ground water / to be appropriated (acre-feet): �� Number of acres to be irrigated: / Mvial).'Illy so ^" .frw I ,)145 rtur`kk Proposed total depth (feet): VOD Aquifer ground water is to be obtained from: fox btf'11 Owner's well designation GROUND WATER TO BE USED FOR: I ) HOUSEHOLD USE ONLY-no irrigation (0) (x) DOMESTIC (1) ( ) INDUSTRIAL (51 I ) LIVESTOCK (21 ( 1 IRRIGATION (6) ( ) COMMERCIAL 14) ( 1 MUNICIPAL (8) ( I OTHER (91 APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) PERMIT NUMBER (4) ¢RiLLER f DATE ISSUED Name ii c ens cc! EXPIRATION DATE ' CHECKS TR6362025 030695 60.00 Street DIV OF HATER RESOURCES •ty (STATE ENGINEER) (State) (zip) BY Telephone No. Lic.No. 1.D. / COUNTY Z e_ of 2009-2983 (5) THE LOCATION OF TH•ROPOSED WELL and the area on (6) TitWELL MUST BE LOCATED BE1 0W which the water will be used must be indicated on the diagram below. by distances from section lines. Use the CENTER SECTION f1 section, 640 acres)for the well location. + — -r — -)- — + — _l_. — + — -+ — + — T - 4900 ft.from N0 Y- sec.line (norm or soutnl • I !4--.-;--1 MILE,52964EET---Iii I 310 ft.from ea 51 sec.tine !east a want 1- + -I- + + . + + + ± LOT BLOCK FILING r I + — _4_ _ . NORTH SECTION LINE I _ + _ SUBDIVISION Subd►Ulalin E)<QwIrJ1!/t!Y I I I (7) TRACT ON WHICH WELL WILL BE thy L I I LOCATED Owner. y d 4nd T +' NORTH+ z — + - - + .�.y No.of acres 4,5- . Will this be I z I • I O I m ' the only well on this tract?_y (5 T ± 2 4 — f �ZaI H I ( Z (8) PROPOSED CASING PROGRAM I I Plain Casing 4_ +- 11 - + -. - 4- - i + (:, in.from 0 ft. to a b° ft. I I I I y in.from 200 ft.to 7•SO tt + - SOUTH SECTI. LINE , — -I'" - J.� Perforated casing I I I I / in.from 7.5-1) ft.to 20 0 ft. + T + 4 4 4 + + in from ft.to ft. I I I I I (9) FOR REPLACEMENT WELLS givedistance + - --- I and direction from old well and plans for plugging it: The scale of the diagram is 2 inches= 1 mile Each small square represents 40 acres. • WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot coven 1 acre of land 1 foot deep 1 cybie foot per second iris)...419 gallons per minute(gpml A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot...43.560 cubic feet...325,900 gallons. 1,000 gpm oumped continuously for one day produces 4.42 acre-feet. (10) LAND ON WHICH GROUND WATER WILL BE USED: Owner(s): 4'tY d Lr £a n O 1 No.of acres: 4.5- Legal description: Ste Ia d►Vr's/ari Exewtml:yt4&1 (11) PETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system mbe used. HokS< bo { � / /awb% afar devita eI'wsal, 5ephc. Tent!- eV% A leach {'/'e /d Wi a y/rn a .,. II--r t era fo ri a /04 w e c( cis s,. anther* / le der)A, (12) OTHER WATER RIGHTS used/on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for(purpose) Description of land on which used flu sate (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SICNATs OF LICANTIS) jai • Use additional sheets of paper if more mace is required. Form No, OFFICE OF THE STATE ENGINEER GVu'925 . COLORADO DOION OF WATER RESOURCES • • 818 Centennial Bldg.,1313 Sherman St,Denver,Colorado 80203 (303)8663561 UC • WELL PERMrr NUMBER 'EA6153 - -- APPLICANT DIV. 1 CNTY. 62 WD 1 DES. BASIN MD Lot Block: Filing: Subdly: APPROVED WELL LOCATION WELD COUNTY LLOYD L LAND SE 1/4 NE 1/4 Section 31 12501 RIVEtDALE RD Twp 2 N RANGE 64 W 6th P.M. BRIGHTON CO 80601 DISTANCES FROM SECTION LINES (303)654-0203 2600 Ft.from North Section Line 300 Ft from East Section Line PERMIT TO CONSTRUCT A WELL CONDRIONS 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)(I) and policy of the State Engineer under the following conditions. • 4) The use of ground water from this well is limited to ordinary household purposes inside one single family dwelling, the watering of not more than four(4)large,non-commercial domestic animals,and the Irrigation of not more than 4,000 square feet of home gardens and lawns. 5) Production from this well is restricted to the Laramie-Fox Hills aquifer which corresponds to the interval between 660 feet and 945 feet below ground surface. Plain casing shall be installed and sealed to prevent production from other zones. 6) The maximum pumping rate shall not exceed 15 GPM. 7) The annual amount of ground water to be withdrawn shall not exceed 0.55 acre-feet 8) The return flow from the use of the well must be through an individual waste water disposal system of the type so that not less than 2%of the total amount of water withdrawn is returned to the same stream system in which the well Is located. 9) This well shall be constructed not more than 200 feet from the location specs ied on this pent*.q�\ Note: To insure a maximum productive rife of this well, perforated casing should be•set through the entire producing interval of the approved zone or aquifer indicated above. APPROVED /� D p C �Q RAN <`(-J '/..J'�..rr _ 'V ` ' ` .54^^' BF • Receipt No. 0382025 DATE ISSUED APR 1 7 1995 EXPIRATION DATE APR 1 7 1997 "" " V \NEIL CONS CTION AND TEST REPORT far u t(+t1�o�yVED GuS•31 net, STATE OF COLORA FFICE OF THE STATE ENGINEER • 1' WELL PERMIT NUMBER 1R61.51 0CT 18 1995 2. OWNER NAME(S) LLOYD LAND_ Malting Address 12501 RLVBRDLLF RD. WATER RESOURCES STATE ENGaIEEq • city. St. Zip BRIGHTON, CO. 80601 Phone ( 303 ) 288--5474 Coto 3. WELL LOCATION AS DRILLED: _x_1/4 MP 1/4, Sec.__LL__.Twp. 2 _41_,Range - 64 __N_^, DISTANCES FROM SEC. LINES: 2600 It. from N Sec. line. and 100 ft from 1? Sec. fine. OR Math 0€south) pr of*mg SUBDIVISION: LOT BLOCK FIUNG(UNfn STREET ADDRESS AT WELL LOCATION: 4. GROUND SURFACE ELEVATION ft DRILLING METHOD ROTARY DATE COMPLETED 10-4-45 . TOTAL DEPTH.aft DEPTH COMPLETED Ron n. 5. GEOLOGIC LOG: 6. HOLE DIAM. (In.) From (ft) To (ft) On. . Description a Wiwi&(Typ:.8iaa. color,War Lacrfnq 978 n 0 - 30 n_ 5 topsoil 532-535 shale 7/ 30 so 5- 15 sandy clay 535-550 coal 5 Ft" 50 ROO 15- 50 clay 550-560 shale 50-110 shale 560-565 sand - T. PLAIN CASING 110-112 rock candatnna ' 565-570 shale OD (in) Kind Wall Size From(ft) To(ft) 112-271 shale 570-580 sand 65 n „foal a 271-272 rock 580-600 sb le „ 16 0 80 272-285 shale 600-610 �'`— staP1 188 40 _ fi80` solo >ro(:k 285-287 rock 610-625 shale l ' 287-310 shale 625-629 siltysand PERF. CASING: Screen Slot Size: 310-312 rock '629-630 shale 312-400 shale . 630-640 sand __4_,3/4,z `tael pas Fan Rnn 400-405 cnal shale 640-654 shale 405-419 shale -654-658 coal 419-42-1- ^I, 65R-679 sha 8 FILTER PACK 9. PACKER PLACEMENT: 421 435 shale -A74-ARn0SR e 43-5—^^^ RR0_6RS ci1tjd Materiel _ Type 440-480 shah. SRS-770 sand X Size 480 190 wl 770-800 shat w Interval Depth 490-502 she le 10. GROUTING RECORD: 502-504 rock #44.,:r4.97frinyeEtrit Material Amount Density Interval Placement 509=5'1-0- ohalo cement40sacks 14.5 0-675 pumped 510 511 rock 511-R2R ghA1a 2 - 2 coal I. DISINFECTION: Type HTH Ant Used (� 31bs. 2 WELL TEST DATA: l l Check box d Test Data is submitted on Su TESTING METHOD . AIRLIFT Supplemental F0rtn. Static Level 380 ft. Date/Time measured 10-9..95 1 nnM_1 ants , Production Rate 15 gpm. + Pumping level _450 ft. Date/frne measured 10-9.95 1011,M-1 2PM . Test Remarks _. length mom) 7hre 3. I have.eed IM summing mock lief*in and Mnaw es Gamuts duraal,and la May M WS b olr •n�.uwe uwnmano:(lawn Commutespapvy in Innsecond bs0 nii Manuel b*Mon 2N-1 W(i�W c.RA.Me milking daptaa a/4 lo punishable r•clan 1 aaaaantarta,] CONTRACTORROGER SCHOCKE WELL DRILLING INC Phone ( 304 288-5474 tic. No. 403 Moiling Address me/Title (Please type or print) Signature�(/!��I��r�� /// / ROGER SCHOCKE PRES. -L� 7 �d21�L rDa1 10-16-95 • EXEMPT WELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: LAND RECEIPT NO. 382025 LOCATION: SE1/4 OF NE1/4 OF SEC. 31, T.2N., R.64W. (2600 NSL, 300 ESL) PROPOSED AQUIFER: LARAMIE-FOX HILLS SURFACE ELEVATION: 4975 NUMBER Of ACRES IN TRACT: 2.5 IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY 5.B.5 CONSENT NAPS? NO YES IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS ,DIV. IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY TIE WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS: evaluated by RAN on APRIL 13, 1995 ELEVATION DEPTH TO ANNUAL NET APPRCP STATUS AQUIFER NOT. TOP SAND HOT. TOP A-F UPPER DAWSOI LOWER DAMSON ____ ____ ____ ____ ____ ____ --- DENVER ____ ____ ____ ____ ____ ____ UPPER ARAPAHOS ____ ____ ____ ____ ____ ____ LOWER ARAPAHOE 4678 4898 92 297 77 0.387 NNT *LARAMIE-FOX HILLS 4031 4313 147 944 662 0.551 NT note: E indicates location is at aquifer boundary and valor may be more approximate. • indicates the proposed aquifer. • All values are interpolated from the 5.8.5 data base asseobled in November of 1986. '-,9W 1i su tF d rn.t� ' l% O'ti_�`l a 2/J A,'" INSTRUCTSS FOR WELL CONSTRUCTION AND TES.ERORT The report must be typed or printed in BLACK INK All changes on the form must be initialed and dated!. Attach additional sheets if more space is required. Each addNional sheet must be identified at the top by the well owner's name, the permit number, form name/number and a sequential page number. Report depths in feet below ground oudace. This form may be reproduced by photocopy methods, or by computer generation with prior approval by the State Engineer. The original and one copy of this form must be subnated to the Stets Engineer's Office within 60 days after completing the well w 7 days after the permit expiration ae, Wridlsver le eels. Another copy of the form must be provided to me well owner t. Complete the Well Permit Number in rut 2. Fill in Name and Mailing Address of Wei Owner where correspondence should be sent. 3. Complete the blocks for the actual location of the well where drilled. If the owner has more than one well _ serving,this property,provide the identification (Oranges Designation) for,t•t3 wet DO NOT USE THE OWNER St UPPUED LOCATION unless a survey has been provided. For wars located In subdivtsioni the lot, block and subdivision information must also be provided. 4. Report the ground surface elevation in feet above sea level if available. This value may be obtained from a topographic map. Describe the drilling method used to construct the well and the date completed. Indicate the total depth drilled and the actual completed depth of the wet 5. Fully describe the materials encountered in drilling. Do not the formation names unless they are in conjunction with a description of materials. Examples of descriptive terms include: - Gran sae-Boulders. gravel, sand, ail, clay. Hardness-Loose, suit, tight, hard, very hard . . • Color--M materials. Most critical n sedimentary rock - Depth when water is encountered Of it can be determined). • O. Provide the diameters of the drilled bore hole. 7 The outside diameter, kind, wall thickness and Interval of casing lengths must be indicated. 8. Indicate the type and size of filter (graven pack and the interval where placed.- _�,9 tndis ate the_type_and setting.depth.foc,anypackers installed__�- 10. The density of the grout slurry must be repotted and may be indicated as pounds per gallon, gallons of water per sack, total gallons of water and number of sacks used,etc. Specify the grout placement method. i.e.tremie pipe or positive displacement. The percentage of additives mixed with the grout should be reported under remarks. 1 t. Record the type and the amount of disinfection used, how placed and the length of time left in the hole. 12. Report well test data as required by Rule 10.7. Spaces are provided to report all measurements made during die test. The report should show that the test compled with the previsions of the rules. II a test was not performed explain when it will be done. If available, report clock time when measurements were taken. 13. Fill in Company Name and Addrete of Ccntrmctor who constructed the well. The report must be signed by the licensed contractor responsible for the construction of the welt. • / - • • '` `� JUN 1 '78 COLORADO DIVISION OF WATER RESOURCES 3 p r PE 'OR' �j 818 Centennial Bldg., 1313 Sherman St. Cyi-C t1Jl 'INT IN ;,LACK INK. WATER RESDURCE^i IA in MAILED COLO.ACCETED Denver, Colorado 80203 _ STATE ENGINEER 1. I EST. STATE OF COLORADO If S '2� SS. AFFIDAVIT COUNTY OF Weld wAla RES°I SIpTE Etta alt / . STATEMENT OF BENEFICIAL USE OF GROUND WATER X AMENDMENT OF EXISTING RECORD - • DLt'yCX�E© LATE REGISTRATION L� Os l� • PERMIT NUMBER 30875 LOCATION OF WELLco i W tw- C.513 a tE AFFIANT(S) Rolanda Feeds Incorporated county Weld SSP�tptp, lose mailingailing 6509 Weld Cisounty Road 51 SE NE y. of the Z. Section 3 Keenesbur Colorado+y &t 80643 T F. 2 N Rng. 64 W 6th P went] wp) IN OP $1 tE on v., ing duly sworn upon oath, deposes and says that a(the'y)XX(ore) the owner(s) of the well described hereon; the well i toted as described above, •ot distances of 2540 feet from the North section line and 600 feet from ti (Nonni Oo souse) 1St section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the a O. wta•! y of July , 19 77 ;; the maximum sustained pumping rate of the well is 40 , gallons per minute, the pumpir tamed hereby is _15!' gallons per minute; the total depth of the well is 793 feet; the average onnuol amour water to be diverted is /5 acre-feet; for which claim'is hereby mode for Commercial Use purpose(s); the legal description of the land on which the water from this well is used i See Attached Legal Description n/c of whic acres Irrigated -yls etetirnigated and which is illustrated on the map on the reverse side of this form; that this well was completed i Impliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; f ley) has (have) read the statements made hereon; knows the content thereof; and that the same ore true of his (their) knowledg (� v�n �j`y�� (COMPLETE REVERSE SIDE OF THIS FORM) gnat ure(s) ` Qati444�� 6- bscribed and sworn �' FOR OFFICE USE ONLY before me on this 25th day of August , 1977 Court Case No. • / Commission expires: January 20, 1980 mu.r ( d 1 • - Prior. Mo. Doy, Y./• .,or.oy rustic Div. Cry. Il} afar.. CEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO JRSUANT TO THE FOLLOWING CONDITIONS: Sec. /Jy X. r. %. Well Use f • Dist.A Bosin Mon Dra • -- r+.+c cucwcco AT • • • kC Well drilled by Kenneth L. Rutt Lic. No. 1.:'• IIIPermanent Pump installed by Spain Ping Lic. No. r Meter Serial No. ❑ Flow Meter Date Installed Owner of land on which water is being used Rolanda Feeds Incorporated THE LOCATION OF THE WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW. This diagram represents nine (9) sections. Use the CENTER SQUARE (one section) to indicate the location of the well, if possible. 1 I I I I I - + - + + - + - .+. - + I I 1 I I I • - + - + -- -+ - + + -- 1- - I NORTH SECTION LINE 1 ORTH 4 N � !71 I -� • Z g� I . C a � I UP •__ O U Z w elw } I SOUIIH SECTION LIFE I I - i - + - + __._ + _ + + - + _ • I I I H I - f • THE SCALE OF THE DIAGRAM IS TWO INCHES E UALS ONE-MIL E . - + - + ----- -I- -- ± -I- - 1- - --1 Mile--4- I I 1 i I I WATER EQUIVALENTS TABLE (Rounded Figures) ii An acre-foot covers 1 acre of land 1 foot deep. 1 cubic foot per second(cfs) . . 449 gallons per minute (gpm). 1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. 100 gpm pumped continuously for one year produces 160 acre-feet. (WHITE AND PINK COPY TO BE FILED WITH THE STATE,ENGINEER PINK COPY WILL BE RETURNED TO OWNER) COLORADO DIVISION OF WATER RESOURCES AS FORM MOST BE SUBMITTED 300 Columbine Bldg., 1845 Sherman St. ' • ITHIN 60 DhYS OF COMPLETION 1 i Denver, Colorado 80203 p�Sr d9 F THE WORK DESCRIBED HERE- t/ NNE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT Ciki WATER ROR GIRT at 0 PERMIT NUMBER 90375 i A G000. 'ELL OWNER Rolenda Feeds, Inc. C7 /.of the r" Y.of Sec_ 31 6509 .leld Co. Rd. 51 DDRESS Keensbur' Colo. 80643 T. 2 N R 64 11 6 ATE COMPLETED 14? —t , 1�!n/ HOLE DIAMETER �C L,MV1: WELL LOG / R in. from 0 to 6 ft_ Water s 4` OO From To Type and Color of Material Loc. /9 in. from F�l to 70. ft. �pU' 0 23 Sandy clay Co Sand Vthlt, 001 23 69 Weathered shale in. from to ft. � SFIQ 69 27% Dark s el DRILLING METHOD Rotar,•r 202 221 Grey rock CASING RECORD: Plain Casing = ' 7h.l. Shale Size 6 5/8 & kindsteel! from 0 to AM L .6_. Grey rock VS 4P.3 Shale zS 49 Coal Size & kind from to 1`94 5;5 Shale _' 0 Coal Size & kind from to 54 335 550 343 Shale 5' 5 :=/-13 Coal Perforated Casing =1 7- Shah 5 5S0 Sand Size 4 -.1s- & kind steal from 'R1 to 793 58 623 Shale • 623 `25 Coal Size - & kind from - to == /;"n Shale Size & kind from to c50 6)5 Sandy clay . . 6;.5 6=7 Shale 6;77 66O Goal GROUTING RECORD 660 Soc Shale 635 633 Sandroetc Material Car_ent 6a8 776 Sand XIntervals 0--695 776 795 Shale. Placement Method Halliburton GRAVEL PACK: Size • Interval TEST DATA Date Tested Ju t z, 23, 1977 , 19 Static Water Level Prior to Test ='00 -' Type of Test Pump Ai r1i"t • -Length of Test 2 Frs. ` .Sustained Yield (Metered} 40 GP?! TOTAL DEPTH 79,' . x' Use additional pages necessary to complete log. 'FitraIiPumping Water Level Jet set at 510' • S A- ata imp Make • .. :.. i_r c -. )wered by HP %` - imp Serial No. 1-i - a WATER otor Serial No. TABLE m ate Installed" - <J cc to imp Intake Depth " 's emarks - : z i ` • a r • ''' • i • i • w , `•• ,,` 1F- • y ' ELL•TEST DATA WITH PERMANENT PUMP a — Y` c .. - ILI o Fes- '+ ate Tested ,� x e= CONE.o :atic Water Level Prior to Test o o DEPRESSIC errf Test Hours -- ` .1/4 istained yield (Metered) GPM • ' imping Water Level ,, ; + - emarks - le -': . r. • ri CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation describ d hereon; that he has re.: t e statement made hereon; knows the content _ thereof, and that the is true of is-own k wl dg . i/ . Signature -7t , �L97� License No. . State of Colorado, County of _i SS • Subscribed and sworn to before me this 9 %jay Of i9 77 My Commission expire h1YConlmsslun ExpiresFeb,22,198}9 l ' Notary Public ;�i-= - FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. Vhn TC nMn roccM ..........o..l..I:I.A._.;.ka, c.ar.F....:..... OINK rnpv:.!n.•6an.-...u.-..A vcrInc4 r•nnv 1 s....As n-al-. • • / PERMIT APPLICATION FORM 01'1 A;)pl:,:ition must complete where ( ) A PERMIT TO USE GROUND WATER 'plicable. Type or (X) A PERMIT T O CONSTRUCT A WELL int in BLACK FOR: (X) A PERMIT TO INSTALL A PUMP INK.No overstrikes or erasures unless ( ) REPLACEMENT FOR NO. *Ate initialed. ( I OTHER S't ;*v. WATER COURT CASE NO. (1)) APPLICANT- mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUM NAME Ro`aAkCL --et'Ct`, Ir\C . Receipt No. eD6`'�',..5"-i i7 STREET/ (05O9 \�vELc . et'�• ---01,2. -51-511- Basin Dist. CITY ke t-'11-Q 41'3;✓LY,J (stateO/fi U-O O(n 1 L.3 J ) (Zip) CONDITIONS OF APPROVAL TELEPHONE NO- 511— i 1 0.L This well shall be used in such a way as to cause no material injury to existing water rights. The '(2) LOCATION OF PROPOSED WELL 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 County �f� right from seeking relief in a civil court action. S E '/. of the %,Section 3 IAPPROVED AS THE ONLY WELL ON 78 ACRES IN Ti Twp. -J A+ , Rng. (2 LI ia.1 oh P.M. E 1/2 OF THE NE 1/4 OF SECTION 31, 1.5N., 'N,S) IE.WI R. 46W. , OF THE 6TH P.M. (3) WATER USE AND WELL DATA IrD THIS WELL IS APPROVED FOR DOMESTIC USE, INCLUDING DRINKING AND SANITARY FACILITIES oposed maximum pumping rate(gpm) � IN AN ASSOCIATED SMALL OFFICE. /jc4- Average annual amount of ground water I to be appropriated (acre-feet): d. i} )4 Number of acres to be irrigated: Proposed total depth (feet): p 1 1 t0 D Aquifer ground water is to be obtained from: L r�alra_x .e, VIAL 14 t l 1 c Owner's well designation GROUND WATER TO BE USED FOR: ( I HOUSEHOLD USE ONLY -no irrigation (0) • ( ) DOMESTIC (1) ( ) INDUSTRIAL (5) (�} LIVESTOCK (2) ( ) IRRIGATION (6) ( i COMMERCIAL (4) ( I MUNICIPAL (8) - I I OTHER (91 APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) C PERMIT NUMBER t 9085'7 (4) DRILLER DATE ISSUED JUN 0 9 1977 e 1` ,..,,..-\+-___. EXPIRATI TE JUN 09 9 reet _ ^ � V� • / City if' 'iSTA ' NGIN . R) (state) (Zip) Telephone No. Lic.No. 7 BY I.D. / - C .• COUNTY 6 %Of I in_ L I VIII. •l • , •• ' L vwL U L an t,,cu, t,,• 1..,/ ' •- •••,,,,. r which the water will be used must be indicated on the diagram below. by distances from section lines. Use the CENTER SECTION (1 section, 640 acres) for the well location. T — t — + — ± — _l___ -1-- — -+ — ± — ___I... K 4 Q ft.from C`(nortt% h)TN Sec.lin •I 1 MILE.5280 FEET-j I too ft.from L=- -. T sec.lin + + + -� + f i 1 (east or west) LOT BLOCK FILING u SUBDIVISION + - - 1 NORTH SECTION LINE - + _ 1 y (7) TRACT ON WHICH WELL WILL BE ,NORTH+ in — —I I — LOCATED Ownergr k a-�c`Q cts S z I w + + No-of acres 78 -RI: ill this b� J y o I �m the only well on this tract? 1�� w I W o _ 4-.1 (8) PROPOSED CASING PROGM N _ I' r I Plain Casing N - Z J -)- 3 -- -�- - m + f G'Ci in,from Cl ft to -Z-) ft. I I I 1 9 in.from 2t ft-to 4-0 O ft. — + SOUTH SECTION LINE — — --I- Perforated casing CI in.from goo ft.to 9(?0 ft. -4- t + -I- + 4 + -I- in.from ft.to ft. I I I I I (9) FOR REPLACEMENT WELLS givedistance and direction from old well and plans for plugging • +- - -(- - + - 4- - ± - + — + - 4_ - 4_ it: { • The scale of the diagram is 2 inches= 1 mile �II' Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second(cis):..449 gallons per minute(gum) A family of 5 will require approximately 1.acre-foot of water per year. 1 acre-foot.. .43,560 cubic feet...325.900 gallons. 1000 gpm pumped continuously for one day produces 4.42 acre-feet. (10) LAND ON WHICH GROUND WATER WILL BE USED: Owneris):Nz(f lf ttOVertklrcv&Nc 4'N RA-1kt-.�r-1.1,. ) No.of acres: TC/' Legal description: 1 0c Ili C lcf LL C_ t 7 -f t 5 tc: k b - \AJ ` e & 4rt.L+- +.01)tagt t (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of dispose system to be used. Air y �h tel ie Q . OA tic d inknik hcutse strkic, --\-nkink ,4 1e.o c_h -Qke A (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. • Type or right Used for (purpose) Description of land on which used 1 iuc,ri 1_Q.-- (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS • TRUE TO THE BEST OF HIS KNOWLEDGE. ID ..".y --0, ct Q SIGYATURE Of/APPLICANT(S) Ilse additional sheerc of Dauer if more space is required. D COON R Y DEPARTMENT OF PUBLIC. SOEt( LhU' ')e.O LTH AND ENVIONMENT ORG PERMIT# 1555 N.17m AVENUE REPAIR* GREELEY,COLORADO 80631 LOAN It JuDe PHONE:AX: () 304-64.6415 ISDS.# Oil031 FAX: ( 304bt11-6 COLORADO STATEMENT OF EXISTING FOR SEPTIC SYSTEM (PLEASE FILL OUT IN BLACK INK ONLY) PARCEL NO. 13 ©Sf [m 60 2- 7 PROPERTY OWNER L I eni rd- La-n (4 PHONE NO. (563) SL3 C °V/a> MAILING ADDRESS I .2.5 o ( (� u crtict t 12-grai effridic. rG Pa Cn 7 City n State / Zip DESCRIPTION OF BUILDING(ex. house,mobile/modular hom shop,offi ) -Pa rm o#i-PG SITE/LOCATIONADDRESS .GS/ ( LtrGR 6 r &bCtj'3 City State 'Zip LEGAL DESCRIPTION PTA PT /VE4 SECTION 3 1 TOWNSHIP /!r RANGE S SUBDIVISION - LOT BLOCK FILING CENCUS TRACT LOT SIZFJACRES /6 A-c t COMMERCIAL YES RESIDENTIAL NUMBER OF PERSONS A BASEMENT PLUMBING YES I BEDROOMS 0 BATHROOMS-FULL M/- 3/41A- I/2451' *ATER SUPPLY-PUBLIC YES leis NAME PRIVATE ') 'NO WELL rT! O CISTERN YES/NO " .I !CISTERN# SYSTEM SIZE: Septic tank material is constructed of to-r-c"- -te and has 10-0-c gallons capacity. FIELD: Trench Cf 00 square feet or Bed square feet YEAR INSTALLED /9V g - You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate location,length,width,and distance from the dwelling: The undersigned property owner hereby certifies that the above described septic system is intact installed,as described,and exists at this time on the parcel of ground identified by the above legal d- ption and further states that the systemattaps in good working order and to the best o er knowledge to function properly �h ge „�. n, i, � I further understand that any falsification or misrepresentation may result in revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. C7" - 9 ci{ DATE OWNER SIGNATURE Subscribed and sworn to before me this C&+T day of lQNJ , 20(I , By L\rxe. Witness my hand t $S1fIsa My commission expires a -6b*O —Z _ ARV PUBLIC 3TATC Dr COLORADO ATE NOTARY P My Commission Expires 9-26-2004 STATEMENT OF EXISTING INSPECTED&REVIEWED BY -sir „.0 t aippl DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT • (AIP 1555 N 17TH AVE GREELEY,CO:80631 WEBSITE: www co wetd.co us ADMINISTRATION (970)304-6410 O FAX(970)304-6412 • PUBLC HEALTH EDUCATION AND NURSING (970)°304-6420, COLORADO 1=A�c 97O 404 6446 . ENVIROaNIMENTAL HEALTH SERVIC (970)4u4-4,41‘ -t FA'X:(9` 0"3d4-6411 March 26,2004 Lloyd Land 12501 Riverdale Road - Brighton,Colorado 80602 RE:Lloyd Land ISDS No.:04031 Permit No.: SE-0400036 Dear Mr.Land: On March 25,2004 an evaluation of the existing individual septic disposal system at: dj 6511 County Road 51,Keenesburg Section 31,Township 1 North,Range 65 West, • was conducted by Stephen J.Wiatrowski,an Environmental Specialist of this department. The existing individual septic disposal system is of sufficient size and capacity to adequately handle the proposed load.This evaluation is based on a final treatment capacity for an office. Be advised,neither the County of Weld nor any of its agents or employees undertake or assume my liability to the owner of the above property,to any purchaser of the above paupcity or to any lending agency making a loan on the above property or in the report- This inspection was conducted for the purpose of determining compliance with current regulations and for detecting health hazards observable at the time of inspection. This does not constitute a warranty that the system is without flaw or that it will continue to ftniction in the 8tture. Inspections requested during periods of snow cover and high soul saturation may be of questionable value to potential bu3trs due{o adverse conditions. Evaluations based on Statements of Existing(S.O.E.)relies on intonation-the''r property owner provides,under oath,indicating current status of the system and representing td the hest of his/her knowledge the system is not failing to function properly. .. • If we can be of any further assistance,please contact our office at(970)304-6415. j Sincerely, Stephen J.Wiatrowski • Environmental Health Specialist 000Parrna man1Ss rmutai.stun JE6VAA..GO r R awuu, e }517 26th Avenue,Court `sMl1l it ISDS t GI 3 -9S Greeley, Colorado 80631 REPAIR p 303)353-0635 weld � Department mono 9 S OD 4.ec • STATEMENT OF EXISTING FOR SEPTIC SYSTEM /l(PLEASE FILL OUT IN BLACK INK ONLY) OWNER OF RECORD: L G d h_. L. a-41 ci PHONE: 66-y 0 20 j MAILING ADDRESS: ./ 2 5-'O / R A„..,-;:<-4ak RAJ, !3 A j. C-a 'G 6-c/ City✓ State Zip (p co SITE ADDRESS: /q cc,e. R CI / 8.z7 Ff,-)G 53 City State Zip LEGAL DESCRIPTION: PT: PT: SECTION: 3 (( TOWNSHIP: .2.41 RANGE: 691c) SUBDIVISION,: LOT: (? BLOCK:_ FILING: NUMBER OF PEOPLE: / BATHROOMS: / LOT SIZE: /L A-C7A.- BEDROOMS: ,M, or COMMERCIAL BASEMENT PLUMBII�NG:. Yes cg) WATER SUPPLY: W a( SYSTEM SIZE: Tank is constructed of @)yt A.zA and has / OOO941 gallons capacity (material) FIELD: Bed /O.572 sq. ft. or Trench sq. ft. DATE SYSTEM INSTALLED: 1? C78-- • You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate location, length, width, and distance from the dwelling. The undersigned property owner hereby certifies that the above described septic system is in fact installed, as described, and exists at this time on the parcel of ground identified by the above legal description and further states that the system is in good working order and to the best of his/her knowledge is not failing to function properly. I further understand that any falsification or misrepresentation may result in revocation of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. - , Date Owner Subscribed and sworn to b for me s el day of /Tam (�G 199 "_ by (/// Witness my hand d fficial seal. commission i es: /o ) 3 ilfr AZT alit, ate Notary Public •STATEMENT OF EXISTING REVIEWED BY: onmental Protection Specialist • • l louSc , ( 17 ' 0 • 1/ . let 77 1 ) 77 { 7 • • v y WELD COUNTY HEALTH DEPARTMENT• ,-li 4t i r I O 1555 17th Avenue { Greeley, Colorado r' Iii© 9 Ph. 353-0540 RECEIPT NOTI fey plicatio• ppermit Install., Construct, Alter, or Repair an Individual Sewag posal System. • . Owner. 4 � L /K� Address hone 2_,999/ Direct to Site jaYr -� �� r,... tot./ Legal Description General Information Dept. Use Only No. Bedrooms No. Persons 3- Pere. Rate (Avg.g of 3) /S No. Baths / Basement Plumbing -s) Soil Type .LG'a9/1/4"` 1 Size of Lot /!s0 /9—.—s H.0 Table Depth , 7 H,0 supply (if well give depth) 7, tiefiG t Grade 577; I� Type of sewage dieral requested: Requires Engineer Design_Yes A No Septic tank Privy Other If yes — reason Comments: Installation Instructions: jlil Septic Tank /00O Gals. Absorption Field WO(o0Sq. Ft. Other Seepage bed � 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 0 days after its issuance, if construction has not been commenced. Date: 2, /9 7 Owner: [P _. Applicant: The plans d specifications as shown are approved pending payment of permit fee. Date: ',. 171- 1 -- 7 1 . Sanitarian: 2241 The above system inspected and found to comply with plan and descript-on. 7 e,,Systems Contractor: ,i4vf1J /� . -6 1 _;n, Date: <, 75/ Sanitarian: �/� } A t--: _'Y'_ G sic Engineer Review: (Date) (Signature) •ermit Fee: $ 8 S O D Received by: t((•.�� ate: /1 49 — 2 9 • -460111'n INDIVIDUAL SEWAGE DISPOSAL SYSTEM PE V , . WELD COUNT\ HEALTH DEPART=1FN-:- ENVIRONMENTAL HEALTH SEFtr.'1 •:Y,-., 1517 16TH AVENUE COURT. GREELE' 353 06's E'T.222 ?WNE.`: L.�ND. LLOYD /��////�� .�.� �DF)E�.�. ;•- RIVER DALE .-. ^ JJ 111/// S 1 501 RIVER �D BRIGHTON ADDRESS OF PROPOSED SYSTEM WCR 51 �r 8_:r.,: 1 KEENESBURG Co 80643 LEGAL DESCRIPTION OF SITE: SEC 31 TWP 2 RNG 64 SUBDIVISION: USE TYPE: RESIDENTIAL HOUSE LOT 0 BLOCK `` F 1LIP1r SERVICES: PERSONS I BATHROOMS 1.00 LOT SIZE 16.0c_; ACRES BEDROOMS 2 BASEMENT PLUMBING NO WATER SUP'P'LY PWELL APPLICATION FEE $15�i.00 REC'D BY CHAD YOUNG SIGNED BY LLOYL? LAND DATE 02/21/95 nATFes, 02/21/9 r r PERCOLATION RATE 10.0 MIN PER INCH SOIL TYPE SUITABLE LIMITING ZONE d ;=EE; PERCENT GROUND SLOPE 0 DIRE:I-TI:J N REQUIRES ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN FROM THE APPLICATION INFORMATION SUPPLIED AND THE ON--SITE SOIL. THE FOLLOWING MINIMUM INSTALLATION T .. "ED " +` SPECIFICATIONS ARE REQUIRED: .,.- . SEPTIC TANK 1000 GALLONS. ABSORPTION TRENCH 34=: SQ. r , OR ABSORPTION BED 474 2n. T. ADDITION, THIS PERMIT IS SUBJECT TO THE FOLLOWING ADDITIONAL TERMS bl7GCD-CO�tC �- �•11A.1f_=AEtr1a. 1.!r ".t:/Tcr THIS PERMIT IS GRAMTED TEM ORARILY TO ALLOW CONSTRUCTION TO MAY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR. •= _ FORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM.REGULATIOW:FAILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPOPAP APPROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTic;3 - DEPARTMENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR _INAL.E t. AC Y SEWAGE DISPOSAL SYSTEM. rn �' KELLY LIED�TKE —� y—Pi-14 ENVIF:Ohs lEi'JTr • .._ � THIS: PERMIT IS NOT TRANSFERABLE AND SHALL BECOME VOID IF SYSTEM tOT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING -:HIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE F.'I+.:FT�i;� ' � r rk', TION AL TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CON ;_ . .: 5I5. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTItrJ OF f. PLETED SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. SYSTEM INSTALLER iithkild Arpti SYSTEM ENGINEER �.� - - FINAL IIJSPE r y2t{L/a5 TYPE OF SYSTEM IN87ALLED - APPROVAL THE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER - OR LOCAL REGULATORY OR BUILDING REQUIREMENTS, S L'IT Aar SUBJECT SYSTEM WILL OPERATE IN COMPLIANCE WITH APPLIC:A;�,LE AL REGULATIONS ADOPTED PERSUANT T AR TI IT • EY,CEPT FOR TO CLE 1.C:. TITLE ;^-:. r-c : . THE PURPOSE OF ESTABLISHING FINAL -' - OF ALOCAL _ _ - ISSUANCE OCCUPANCY APPROVAL�.i_ F rOCCUPAN•C PERMIT 'r �" PURSUANT IAN'' '- ((.P `. • — ,,,.,,ears t—DR ARTMENT OP PUBLIC HEALTH AND BNVIRONMBNT 1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE (970) 304-6415 FAX (970) 304-6411 Fhialed Permit # : SP-9900303 Sec/Twn/Rage 31 02 64 Status: I8' 3'ED Permit Type: RVLT Cecommercial, R.residential + NEW, REPair, vauLT Applied: 06/22/1999 Parcel No: 1305 31 000026 Issued: 06/22/1999 Finaled: (p • Location: 6513 51 CR KEENESBURG Legal Desc : 8717-C PT E2 31 2 64 BEG NE COR SEC 52391 . 05' T 6513 51 CR KEENESBURG APPLICANT GOBLE KIRK OWNER HUNTER GREGORY S & TINA M 6513 WELD CO RD 51, KEENESBURG CO 80643 Description: HOUSE Commercial (Y/N) : N Residential (Y/N) : Y Acres : 2 . 50 r Number of Persons : 2 Basement Plumbing (Y/N) : N "Number of Bedrooms: 2 Bathrooms-> Full: 1 3/4 : 1/2 : Water Public (Y/N) : N Utility Name : Cistern (Y/N) : N Well (Y/N) : Y Water Private (Y/N) : Y 40 Water Permit No: Percolation Rate : . 0 Limiting Zone: 00 ft 00 in Desc: s Ground Slope: Dir: Soil Suitable (Y/N) : Engineer Design Req'd (Y/N) : In 100 Yr Flood Plain (Y/N) : Minimum Installation septic Tank: 1000 gal Absorption Trench: sq. ft . Absorption Bed: sq. ft . Actual Installation Septic Tank: boo gal Absorption Trench: sq. ft . Absorption Bed: sq. ft . Design Type : NOTICE • The issuance of:this permit does not imply compliance with other state, county or local regulatory or building requirements, nom 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 condition.s 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. • X �- ' LCsK-W�y^3 4"cif) • Envir nmental Specialist Date Hello