HomeMy WebLinkAbout20080364.tiff OPWELD COUNTY DEPARTMENT.PUBLIC HEALTH & ENVIRONME
1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411
WEBSITE: WWW.CO.WELD.CO.US
• APPLICATION / RECEIPT
Initials: MS
Permit Number: SP-0500292 Receipt Number: HAP-05297
08-19-2005 Amount: $400.00 Payment Method: Check Notation: 1220
Owner Name: BONILLA REYNALDO
Applicant Name: BONILLA REYNALDO
Parcel Number: 130710
Location: 10009 CR 24
Account Code Description Amount
2560-41400-4221-4203 New Septic Permit $400.00
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: UVC MODULAR HOME
Commercial: (Y/N) N Residential: (Y/N) Y Acres: 29.63
Number of Persons: 5 Basement Plumbing: (Y/N) Y
Number of Bedrooms: 3 Bathrooms: Full - 3 3/4: 0 1/2: 1
•ter Public: (Y/N) N Water Supply:
ter Private: (Y/N) Y Cistern: (YIN) N Well: (Y/N) Y Well Permit Number:
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 non-transferable. 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 400 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 --(eQZ ou I `1 C)s
Owner4Applicant Date
Form: RT_HAPP
•
2008-0364
Aug-2A-05 02:I5pm From-PLAN DE SALUD 3031921511 T-358 P 03/03 F-348
COLORADO DIVISION OF WATER R CES Office Use Onl �E I4/ /2
DEPARTMENT OF NATURAL RESOD y Form GWS-44(10/2004)
it
1313 SHERMAN ST.,RM 818,DENVER,CO 80203
phone—info:(303)8883587 mein:(309)866.3581 JUL 1 8 2005
fax:(303)866-3589 http://www.water.state.co.us
.water.state.co.us
RESIDENTIAL Note:Aso use this fpm to sooty tor livestock warning WATER RESOURCES
• Water Well Permit Application STATCE
Ol01NEER
Review Instrgedons on reverse side prior to completing form.
The form must be completed In black or blue Ink or typed.
1.Applicant Information 6.Use Of Well(cheek applicable boxes)
wee.apeplmwt See instructions to determine uses for whichyou may
I=.RN24_011h RlY' ku Ause(s) ylling
Mains 0 A.Ordinary Dry ho46ehokl use n one single-fatuity dwelling
c� (no outside use)
7taro (' 15nk I w a �• - Ia B. Ordinary household use In 1 to 3 single-family dwellings;
0 Number of dwellings:fry L.te
lent L-I ttQY1 0O inioaA
Telephone e — g some garden lawn irrigation,not toexceed one acre:
( - ) 3etn- tg7g75 area Irrigated 0r sF ❑ Sq.ft.Macre
2.Type Of Application(check applicable boxes) eal Domestic animal watering—(non-commercial)
El Construct new well ❑Use existing well C.Livestock
❑Replace existing well �( watering(on farm/renchlrangNpeeture)
❑Change or inaeaw use
0 Change source(aquifer) - - —❑Reapprcatiorf(expired permit) T-Well Data(proposed} •..—. .- .._ .-
❑Dther: Merieum omen rem MASI amount to be wmorewn
3.Refer To(if applicable) 1 / Pam n1/4.1E. acre-feet
Total awe
WO porn 0 Lori-mow oleT easI-- -- (the. 1.0t
►Al11TrttF .�/AL NiUS
B.Water Supplier
bwmnesasaM omeminatlwa WO non ore
is this parcel within boundaries of a water service area?❑YESkNO
If yes.provide name of supplier
4. Location Of Proposed Well
tawny - NNW p/ - 9.Type Of Sewage System
tV aE� 'Moline �E 114
Scan Tamers Hors Range Eor W n tun ® CentralROPti absorption leech held
.C� ®0
❑® 1tt 0 system;District name:
(Or7 Io P TicVault:Location sewage to be hauled to:
Distance1(') lameatm2, llwp.tiIpn lrnls are arrow not 0re0mhljna) ❑ Q
Xen n.faa.n N❑S tot 040 04 O free❑E S W 0 Other(attach copy of engineering design and report)
Furripaamm�l wets only-Stance Ind dbeaYl lam mnmv WWI
10.Proposed Well Driller License#(optional):
o
feet direction ( P )
• wale/Won^lee,/1Won w n ergaN.) 11.Signature Of Applicant(e)Or Authorized Agent
J +�p moon y 11 l2L• z-4 The making of false statements herein constitutes perjury in the second
Optional: GPs well lonnon Intonation In UTM tunnel degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
You meet check CPS unit for rebuked=taws as follows, 244-104(131(a). I have read the statements herein,know the contents
rcnat veal be Liarthereof and state that they are tree to my knowledge.
Sae eon tea Raging
here(Gust a arrpnhregN4n) Mm
Una mull re Ras
Datum most boatels NoMNe WW1/rLJI
Jet mutt s"t ill we norN ml name Me
^/S -
•
was cps tow mused w
for se .? 0 ma Remember to sot Datum to NAPO XFtt1] 'i N.) Q—eN i t ti;—_f uAI k1
5.Parcel On Which Well Will Be Located OfffleE Use Only
- A.Ydil must check andeompieteone of the following: - 4SGs mw nww owR.map„e —'5„.5"' x^--
❑ Subdivision:Name
Lot Block Filing/Unit Receipt area only
❑ County exemption(attach copy of county approval 8 survey);
Name/e Lot it
O Paroel less than 35 acres,not in a subdivision,attach a deed with metes
and bounds description recorded prior to June 1,1972
❑ Mining dakn atua eeeeyot the ewe a Lowry Invoice 8 541147
Name/# 7/16/2005 -- 89:27:18
CISquare 40 acre parcel as described In Item 4 Cashier ID: II
El Parcel Parcel of 35 Or more acres(mach a meta elm awn aoseleta or some
II Other mama mew E Mans dwelpren w swat aw supposes awnana) WE (lack Purchase- $1121
B.a of sea.In parts( �Cm.t Naysu Me Weer M tai:war? Wit
Lek �J�2- 21 YES NO(4 no-see meevclans) puce
D.MN lnb a lneeny well oneawar? Kt YES 0 N Wna-IW Whir',Ms)
roeo
E. sumo pops me ostpell: MvtMl
_9es DIV I WO( RA MO
•
Form No. OFFICE OF TI-I.TATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOURA
818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203
(303)866-3581 LIC
• WELL PERMIT NUMBER 265349 - _
APPLICANT DIV. 1 WD2 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 NE 1/4 Section 10
REYNALDO BONILLA Township 2 N Range 65 W Sixth P.M.
PO BOX 1095 DISTANCES FROM SECTION LINES
FORT LUPTON, CO 80621- 800 Ft. from North Section Line
2940 Ft. from West Section Line
(303)356-4795 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO CONSTRUCT A WELL Easting: Northing:
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 materiai injury to existing water rights. The issuance of this permit
does not ensure 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) Approved pursuant to CRS 37-92-602(3)(b)(I)and policy of the State Engineer under the following conditions,for a
• 29.632-acre parcel, more particularly described on the attached Exhibit A.
4) The use of ground water from this well is limited to ordinary household purposes inside one(1)single family dwelling,the
watering of domestic animals,and the irrigation of not more than 1 acre of home gardens and lawns.
5) Production from this well is restricted to the Laramie-Fox Hills aquifer,which corresponds to the interval between 375 feet
and 665 feet below the ground surface. Plain casing shall be installed and grouted to prevent production from other zones.
6) The depth to the top of the Laramie-Fox Hills aquifer is approximate. To ensure the exclusion of poor quality water from
zones immediately above the aquifer, plain casing and grout shall extend through the lowermost coal and/or carbonaceous •
shale that overlies the Laramie sand portion of the aquifer.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual withdrawal of ground water from this well shall not exceed 3 acre-feet.
9) The return flow from the use of this 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.
10) This well shall be constructed not more than 200 feet from the location specified on this pen-nit.
NOTE:The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be less than
the 100 years upon which the amount of water in the aquifer is allocated,due to anticipated water level declines.
NOTE:To ensure a maximum productive life of this well, perforated casing should be set through the entire producing
interval of the approved zone or aquifer indicated above.
NOTE:This permit has been approved with a change to the annual amount to be withdrawn based on the proposed uses
and available water. You are hereby notified that you have the right to appeal the issuance of this permit, by filing a written
request with this office within sixty(60)days of the date of issuance,pursuant to the State Administrative Procedures Act.
(See Section 24-4-104 through 106, C.R.S.) N1a.) 9 l 166
etAPPROVEDJtvIW
`1A T e
State Engineer B
Receipt No.0541147 DATE ISSUED 08-30-2005 EXPI ION DATE 08-30-2007
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