HomeMy WebLinkAbout20070870.tiff orm No. OFFICE OF THE STATE ENGINEER
rt ADO DIVISION OF WATER RESOURCES LIC
818 iW 8_25 COCentennial b ldg.,1313 Sherman St.,Denver,Colorado 80203
(303)866-3561 258795 '-�
DIV. 1 WD1
." WELL PERMIT NUMBER DES. BASIN MD
l r
APPS T Lot:13-15 Block: 11 Filing
Subdiv:TOWN OF CARR �,r�
APPROVED WELL LOCATION
WELD COUNTY �`
NE 1/4 NW 114 Section
Sixth P.M.
Township 11 N Range 67 W
P O BR COMMUNITY CHURCH DISTANCES FROM Sect ion Line
P A BOX 55 1200 Ft.from North Section n in Line
CRR, CO 80612- 2000 Ft.from West
UTM COORDINATES F_astino
Northing'
(970)897-2384
PERMIT TO GONSIRUGf A WELL
OF APPROVp1
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITI
as to cause no material injury to existing water rights. The issuance of this permit
preclude another owner of a vested water right from
1) The welle sure used t isuchalloy
does not ensure that no injury will occur to another vested water right or
seeking relief in a civil court action. with the Water Well Construction Rules 2 CCR 402-2,unless approval
2) Theof a construction aacehas beenf this wl by be in compliance Installation
water
the State Board of Examiners of Water Well Construction and Pump
of a variance granted alit of the State Engineer for appropriation of ground
Contractors in cantaccot R with Rule 1(3 b I and the policy 8.
Approved the L pursuant to CRS Creek 3e which is tributary
) to the South Platte River system. other ur ose
tributary to the Lone Tree which is tributary ry facilities as described ibed in CRSor for any 602(1)(c ,o drinking and 4) The use of ground water from ater from thisis well is 1wellted tshalll not be used for lawn or landscape for a commercial business. structure. gallons).
outside the business building 108,600
5) The pumping rate of this well shall not exceed 15 GPMhIs well shall not exceed 1f,a4,cre-foot
block 11,Town of Carr,Weld
well on a tract of land of 1.00 acre(s)described as lots 13,
5) The annual amount of ground water to be diverted by
7) Approved as the onlydisposal the
County,reference attached exhibit"A".
system in water s the well systemis e of th
good working nw order. Permanent records of all
8) The return flow framthe here the water ilsnretumed to the same stream ust be through an )sy waste
ed.
non-evaporative type
9) gversions flow e meter must bemaintained
installed yewell this well and sm at leastned
in
)ions must be ma!na!ned by the owner(recorded at least annually)
on this permit the Division Engineer upon
diverspecifiedill g _ 20'2 OOFI\
request. f
10) This well shall be constructed not more than 200 feet from the location
• pSe
A
APPROVED By
XPIRATION DATE 08-20-2006
PAT State Engineer 08-20-2004
DATE ISSUED
�acei t No.0525910
2007-0870
FORM NO. WELL CONSTRUCTION AND TEST REPORT For Office Use Only
GWS-31 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER
02/2005 1313 Sherman St,Room 818,Denver,CO 80203
Phone—Info(303)866-3587 Main (303)866-3581
Fax(303)866-3589 http:/Nnww.water.state.co.us
1. WELL PERMIT NUMBER:258795
2. WELL OWNER INFORMATION
NAME OF WELL OWNER: Carr Community Church
MAILING ADDRESS: PO Box 55
CITY: Carr STATE:CO ZIP CODE: 80612
TELEPHONE NUMBER:(970)897-2384
3. WELL LOCATION AS DRILLED: NE1/4, NW1/4, Sec.27, Twp. 11 ® N or O S, Range 67 O E or®W
DISTANCES FROM SEC. LINES: 1200 ft from ®N or O S section line and 2000 ft.from O E or OW section line.
SUBDIVISION: Town Of Carr , LOT 13-15, BLOCK 11, FILING(UNIT)
Optional GPS Location:GPS Unit must use the following settings: Format must be UTM,Units must Owners Well Designation:
be meters,Datum must be NAD83,Unit must beset to true N, O Zone 12 or O Zone 13 En9
STREET ADDRESS AT WELL LOCATION: Northing:
4. GROUND SURFACE ELEVATION feet DRILLING METHOD
DATE COMPLETED 3/8/2005 TOTAL DEPTH 250 feet DEPTH COMPLETED 250 feet
5. GEOLOGIC LOG: 6. HOLE DIAM(in.) From(ft) To(ft)
Depth Type Grain Size Color Water Loc. 10" 0 44
0-16 Gravel Large Brown 6" 44 250
16-41 Bentonite Brown
41-92 Shale Tan 7. PLAIN CASING:
92-212 Shale Dk Grey OD(in) Kind Wall Size(in) From(ft) To(ft)
212-250 Sandstone Fine Lt Grey 212-250 6.625 Steel .188 +1 44
4.5 PVC 25 10' 210
PERFORATED CASING: Screen Slot Size(in):
4.5 PVC .25 210 250
8. FILTER PACK: 9. PACKER PLACEMENT:
Material Type Formation
Size
Interval Depth 210
10. GROUTING RECORD
Material Amount Density Interval Placement
Remarks: Cement 8 bags 6 cal. 10-44 Poured
11. DISINFECTION: Type CAHCL I Amt Used 1.5 Cups
12. WELL TEST DATA: ❑ Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test.
TESTING METHOD Air Lift
Static Level 20 ft. DateTme measured:3108/05 Production Rate 70
Pumping Level 250 ft. DateT Test Length(hrs).2
me measured 3/08/05 9Pm.
Remarks:
.
13. I have read the statements made herein and know the contents thereof,and they are true to my knowledge. This document is signed and
cer'^'in accordance with Rule 17.4 of the Water Well Construction Rules,2 CCR 402-2. [The filing of a document that contains false
stat ants is a violation of section 37-91-108(1xe),C.R.S.,and is punishable by fines up to$5000 and/or revocation of the contracting license.)
Company Name: Phone: I License Number:
Pro Well&Pu p Service, LLC (970)881-3826 1299
Mailing Addr tDeadmr
FeatherLekes CO 80545 C s>�ou �.V
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N 17TH AVE
.-. 114(TH GREELELEY, CO 80631631' WEBSITE: www.co.weld.co.us
ADMINISTRATION (970)304-6410
FAX (970) 304-6412
PUBLIC HEALTH EDUCATION AND NURSING (970)304-6420
O FAX (970) 304-6416
• ENVIRONMENTAL HEALTH SERVICES (970) 304-6415
COLORADO FAX (970) 304-6411
June 29, 2005
Kenneth Gunter
Can Community Church
Post Office Box 55
Can, Colorado 80612
RE: Individual Sewage Disposal System Permit No.: SP-0500183
Location: 9433 Grey Avenue, Car
Dear Mr. Gunter:
This is to inform you that your Engineer Designed Septic System has been reviewed by the Weld
County Board of Health and approved.
A copy of the Weld County Board of Health I.S.D.S. Review Form and your
I.S.D.S. Permit are enclosed. PLEASE NOTE THAT THE SYSTEM MUST BE
INSPECTED BY A REPRESENTATIVE OF THIS DEPARTMENT AND BY
THE DESIGNING ENGINEER, BEFORE THE SYSTEM CAN BE APPROVED
FOR OPERATION. THE ENGINEER MUST CERTIFY TO THIS
DEPARTMENT, IN WRITING, THAT THE SYSTEM HAS BEEN
INSTALLED ACCORDING TO HIS/HER SPECIFICATIONS.
Should you have any questions regarding your septic system, please contact this office at your
earliest convenience at (970) 304-6415.
Sincerely,
OPNWANA
Pam Smith
ISDS Program Coordinator
PS/ms
cc: Laube Engineering, LLC Engineer Job No.: 253
WELD COUNTY BOARD OF HEALTH
ENGINEER DESIGNED SYSTEM REVIEW
PROPERTY OWNER: Carr Community Church PERMIT NO.: SP-0500183 (New)
LEGAL DESCRIPTION: PT: SECTION: 27 TOWNSHIP: 11 RANGE: 67
SUBDIVISION: Carr LOT: 13,14,14 BLOCK: 11 FILING:
SITE ADDRESS: 9433 Grey Ave., Carr
FACILITY: Fellowship Hall for 40 people ACRES: 0.5
PERC RATE: 20 SOIL: Unsuitable WATER SUPPLY: well
LIMITING ZONE: 3 feet, gravel
XXX ENGINEER DESIGN (3.5) EXPERIMENTAL DESIGN (3.14)
ENGINEER: Laube Engineering
ADDRESS:
ESTIMATED FLOW: G.P.D. 300
PRIMARY TREATMENT: Standard tank CAPACITY: 1000 gallons
DISPOSAL METHOD: Absorption bed SIZE: 498 square feet
REQUEST FOR VARIANCE:
STAFF COMMENTS: The system is adequately sized for the proposed load. The gravel
soils will be removed and replaced with suitable soil. A 10 MIL PVC
Perimeter liner will be installed.
STAFF RECOMMENDATION: Approval
ENVIRONMENTAL PROTECTION SPECIALIST: Deborah Blandin
REVIEWED BY BOARD: June 28, 2005
B.O.H. DECISION: APPROVED: ✓ DENIED: TABLED:
Chairma
Weld County Board of Health
O.\PAM\Isds Shells\bon engineer review.doc
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