The URL can be used to link to this page

Browse Search

Home My WebLink About20071036.tiff rn DCART. T :r _> . SCE ( C-y- YO-s na'G loo S...VICES ,� , �, [.�,,,i l" LOAN ►00631 Yi++++ ilMtue/ ISDS I ld Cunty Heahh Department STATEMENT OF EXISTING FOR SEPTIC SYSTEM(PLEASIc FILL O((IT� IN BLACK INK ONLY) etreat-4_Retreat-4_ . C�i� t5pi1A 7 / Cid� ?P PHONE:4 Xi) 7 f5it. 6-/'r-I l ( O49 / City State Zip /2/ I' City State Zip LEGAL DESCRIPTION: PT 41.4 PT:MS'S-( SECTION: ,3 y TOWNSHIP: /ffp RANGE:`jj7p SUBDIVISION: LOT: BLOCK:_ FILING: NUMBER OF PEOPLE: 2, BATHROOMS: 3 LOT SIZE: f-rrrr,, p BEDROOMS: ,! SIDENTIAL or COMMERCIAL BASEMENT PLUMBING: Yes to WATER SUPPLY:(/JP,/ SYSTEM SIZE: Tank is constructed of (cjoin.fp so and has /C 67 ) ' gallons capacity (material) FIELD: Bed sq. ft. or Trench '34 sq. ft. DATE SYSTEM INSTALLED: ///f`,' 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. aZ41722,& CXA:I; /9 '.?9/ Cl.kj Date er / Sub= ribei and sworn to before me this //2day of Sin , 199 (� , by 3;M Witness my nd nd official seal My commission ex i es: 6 94 ftA '- Date Notary Pub c STATEMENT OF EXISTING REVIEWED BY: d�-✓sue/t U Environmental otection Specialist 2007-1036 •L-pee 4 Fi r- /I A $LACK INK': ONRs xg Kt/ l 6a 5.4 Coarp r ,r tom( L- \ et, k we �� ® 14 ,7, 2 , < ,?a yO fr cc ,_-___- 1 ,&a w( - my), S J , ------5-ri .-/C, lr:- — F 21, _ Form No. ' OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg.,1313 Sherman St,Denver,Colorado 80203 (303)e863581 LR WELL PERMIT NUMBER 113922.5 - -_ APPLICANT DIV. 1 CNTY. 62 WD 3 DES. BASIN MD Lot: A Block: Filing: Subdlv:80534 -RE-W APPROVED WELL LOCATION WELD COUNTY KEITH A& BARBARA K MCINTYRE SE 1/4 SE 1/4 Section 34 4804 F STREET Twp 6 N RANGE 66 W 6th P.M. GREELEY CO 80631- DISTANCES FROM SECTION LINES (970)352-4786 1275 Ft.from South Section Line REGISTRATION OF EXISTING WELL 502 Ft.from East Section Line ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDITIONS 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 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 18. 3) This well is recorded, and permit approved, in accordance with CRS 37-92-602(5) for historic use as Indicated herein and described in CRS 37-92-602(1)(b), being a well producing 15 GPM and used for ordinary household purposes inside one single family dwelling(s), fire protection, the watering of domestic animals and poultry, the watering of livestock on a farm or ranch, and the irrigation of not more than 21,000 sq. ft. of home gardens and lawns. 4) The average annual amount of ground water to be withdrawn shall not exceed 1 acre-foot. a�D a- 9-9r • APPROVED OLD ,?� . .4 - //'l pr-y.,, Receipt No. 0387525E DATE ISSUED AU6 1 1 1995 EXPIRATION DATE 4�ei/iT awalsplM • , - COLORADO DMSION OF NW7ER RESOURCES f791)INSPECTION REPORT Plane complete this tmm in adC aPPL=aim no(s)- e -.v 1 WD 3 DATE OF INSPECTION: June 17 , 1995 PURPOSE OF INSPECTION:LATE REG. X X OTHER APPLICANT: Keith & Barbara McIncyre poison corttaaedi not appEcent Kelly McIntyre ADORES& 4804 F Street WC,11emedpllatee: George Varra Greeley . CO 80631 484-1628 • phone: (970) 352-4786 EXJSiWG WELL LOCATION: SE 1/s, SE 114,Sec. 34 ,tip. 6N ,Rtg. 66W , 6 *JA. Dm 1250 from amne, 875 - . 1:1)isecke;Canty Larimer (ftfi/d) ("rept,giro first 6 dr.to f wet site— ) cede type of misting well: DRILLED HAND DUG,-SPRING W81, GALLERY WELL, GRAVEL PTT, OTitt any otheniefls we loosed on Dtga,..at?fres)Mw.ry- NO . (no);prittrarsatist EST.DATEWELLCOfb7RI/CTED 1950 DATE OF NAST USE 1950 EST.PUNPINGRATE 15 glom TOTAL*OF ACRES 04 mg TRACT/PARCEL 31 ACRES • ""drossdproperty(I fhrtappicented ress): add sobered Ida: *acres hlgated(non•esenpth op fir.) --- NAME OPALS.PLAN?..- USE OF WELL: Yes household use In(indicate how in )a single ft*dwelling(*) XX watering d podgy andfa domestic animals rdontMac'Nevis'world Induce a-ft cows,horses,etc.) waeerhn°of livestock on a htnt a ranch—ggAnat how many heed? is Dis a Axed let? ._ _- - :fair /Wed? XX Gass to spedy eslrmt14 deg&Itwm wden hr.)h. 21 ,300 Ewers Are e of lawn and/or garden X X Aire proeecr7on - - commercial—drinking&son,arty?(Wife deals in'commnW section) other(twits debt in'comments'secton) • no WERE THE USES CHECKED ABOVE INITIATED PRIOR TO AMY 8, 1972? NOTE:F ANY 0WISE IN THE t talc( E of 778! Wfe Hey$OCC*nWJ#VCE MAY 8. 182 please Ordure the*Ws)the yid ilt3ras . tp this do aelend&cr� toMaralon ofthe ct nerxlaproposed use binsnts'sectfor►d aria arm (if completing for NONE X1PT USES,use comments section below(include case 0, 0 acres h:X+pplceble,ale)) signed: ft il�� detect 1_117 j 95 additional comments aad)ahlomtaa= Well sits just east of the house . more room%ar continents on the beck Form STATE OF COLORADO For Office Use Only No. OFFICE OF THE STATE ENGINEER )-GWS-11 818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 2005 Phone—Info: (303)866-3587 Main: (303) 866-3581 Fax: (303) 866-3589 http://www.water.state.co.us CHANGE IN OWNERSHIP/ADDRESS • CORRECTION OF THE WELL LOCATION Review instructions on the reverse side prior to completing the form. Name, address and phone of' the t person claiming ownership of the well: NAME(S): TUS}In t - Wecidki �Cl�A1 Mailing Address: 4gou F S f, city, st. Zip: 6 ape c1 (- ©' (.)6 3 4j Phone ( S70) S- (3 �f This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above. This filing is made pursuant to C.R.S. 37-90-143. WELL LOCATION: Weil Permit Number i s' cj � S Receipt Number bN County ( . \ Co Well Designation 48 o 4 F S+. ( (F \ (Ad ess) / (City) (State) (Zip) SE 1/4 of the-SE 1/4, Sec. 3`I , Twp. N, or❑ S., Range 66 ❑ E. orb/., P.M. ^istance from Section Lines: Ft. From Of N. or❑ S., Ft. From ❑ E. or❑W. Line. Subdivision Name Lot , Block , Filing/Unit The above listed owner(s)say(s)that he, she(they) own the well described herein. The existing record is being amended for tllowing reasons: hange in name of owner❑ Change in mailing address 0 Correction of location for exempt wells permitted prior to May 1972 and non-exempt wells permitted before May 17, 1965. Please see the reverse side for further information regarding correction of the well location. I (we)claim and say that I (we) (are)the owner(s)of the well described above, know the contents of the statements made herein, and state that they are true to my(our)knowledge. Si ature(s)of the new-owner Please TT print the Signer's Name&Title DateG -- G Zt 1,N MAr1', l,,r} -a+ I.-"W 'tr.' O - I 1 -O 6 It is the responsibility of the new owner of this well to complete and sign the form. Signatures of agents are acceptable if an original letter of agency signed by the owner is attached to the form upon its receipt. For Office Use Only State Engineer By Date Hello