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Home My WebLink About20070756.tiff Form No. OFFICE OF THE STATE ENGINEER -ovys-25 ' COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg.,1313 Sharman St.,Denver,Colorado 80203 (303)886.3581 uc WELL PERMIT NUMBER �L6R hS _APPLICANT DIV.DIV. 1 CNTY. 62 WO 2 DES. BASIN MD Lot: Block: Filing: Subdtv: APPROVED WELL LOCATION WELD COUNTY STEPHEN KORAS NW 1/4 NW 1/4 Section 21 2837 MATHER Twp 1 N RANGE 65 W 6th P.M. BRIGHTON CO 80601 DISTANCES FROM SECTION LINES (303)659-8859 1300 Ft. from North Section Line PERMIT TO CONSTRUCT A WELL 300 Ft. from West Section Line ISSUANCE OF This PERMIT DOES NOT CONFER A WATER RIGHT CONDmONS 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 domestic animals, and the irrigation of not more than 13,000 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 805 feet and 1,085 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from other zones. 6) The maximum pumping rate shall not exceed 15 GPM. 7) The annual amount of ground water to be withdrawn shall not exceed 1 acre-foot. 8) The return flow from the use of the well must be through an Individual waste water disposal system of the type so that not less than 2%of the total amount of water withdrawn is returned to the same stream system in which the well is located. 9) This well shall be constructed not more than 200 feet from the location specified on this permit Note: To insure 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. �UF3 . 10473 APPROVED /� o JWB Receipt No. 0340269 DATE ISSUED APR 14 1993 RATION DATE A714 1995 FORM NO.-7' WELL CON .^ ~ �,.,ON AND TEST REPORT For odke Use only `� cus•31 ' STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 11/90 ^1. WE'LL PERMIT- NUMBER ,Itrents- , RECEIVED :. OWNER NAME(S) $7`opAQ.y /r ro , -S DEC 1. 0 '93 Mailing Address a 3 7 /I a e7.. City, st Zip gA.10,1h sl Co 3n(Po I WATEtt Phone (361 ) iris?, reel' STATE MO 3. WELL LOCATION AS DRILLED' NW 1/4 My 1/4,Sec. 4I Twp. _rye, Range /,S co . DISTANCES FROM SEC. LINES: kip d ft. from No?-1X Sec. line. and 30 D ft. from W esnc Sec. line. OR (north of south) (east or west) SUBDIVISION: �- --LOT_BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: .7'n a Lv (+ RG y/ n ds d 's, 0a A it 8aGya- 4. GROUND SURFACE ELEVATION ft. DRILLING METHOD nj ola), y • DATE COMPLETED O Gf 45°. 73 . TOTAL DEPTH _9°? _ft. DEPTH COMPLETED ft. 5. GEOLOGIC LOG: 6. HOLE DIAM. (In.) From (ft) To (tt) Depth Description of Material(Type, Size. Color, Moor Location) S ?IS' d _ 907 o JO laic s>,1+ -,C.4-4..y /n--3a CIA.1 4) —ya ,acz".J / 4in./9a 4 Aso t{ n A0lr.e 7. PLAIN CASING /Vs .11.7 ao-vh I OD (in) Kind Wall Size From(ft) To(ft) /9a j117 6I,e1.Frt 2 31.4.411 ,j re r- R/7 tri . Avg S An,d# stoat .4.ay.. .1.7a A,4a4 C 'la -.)90 ye-Nei '. S.(Tc(y Ski4L, --min. 4s1. SA4(.,c PERF. CASING: Screen Slot Size: j'/a.' Eyr-AP/ Cswka anke 3fed. JOT .P/7 `?O) 'IV- yrn icAe./. VI 46P•9415 Pac,k _ a/e5-Svc Ca q in-el kg 4.• Cdr -14a sX44 . ' tams-laC .c"„c1y sif4 r j Caa.(/ a .CJT,JICd a 8. FILTER PACK: 9. PACKER PLACEMENT: la L •)Sr ,T44 kg Material Type 7 et- 790 0-4.7.J 4 SW s14✓ alai e _ Size 79a .Q/t .s4•4c y[ _ Interval Depth eti -810 s"-'e.d F9a- 'Ts7 a-A 4T(. . 10. GROUTING RECORD: Material Amount Density Interval Placement REMARKS: 1+3 RJAnw1�/aoosh Soso 8'/) As.%e 1'b 11. DISINFECTION: Type J4 F h 4__. Amt. Used .G.4J)A 12. WELL TEST DATA: ECheck box if Test Data is submitted on Supplemental Form. TESTING METHOD 31,P /6 541 So b >...b7. s /iht-fa • Static Level aim it.DateTme measured /b ...y.-f3 9nr.3arAATMProduction Rate /S gpm. Pumping level q..a ri ft. Date/Time measured 1 '-n 90r in t k,$M Test length (hrs.) /O A ,-S . Remarks _ 13. than red the sfatsmeb made herein and know the contents thereof,and that they an true to my knowledge.(Pursuant to Section 24.1.104(13)(s)CAS..the mallet, of tabs ewemenb herein constitutes perjury In the second degree and I.punlahads as a class I misdemeanor.) ^—ciONTRACTOR 6)ov c'-'s /7),.Iilvlr/ Phone `303) 9-51 -Awl/ Llc. No. V. oiling Address 2a 4/..1 B 11 f. 3/ .77-.,u a-, l a cote LI' Name/TItle (Please type or print) Signature Date 46-.4144.-1 Pita o-ves. -Th.-fx4--)+ >-j l ),:1-1. -93 1 roan No. PUMP INSTAL ^.t .1 AND TEST REPORT For Office u.o only Gus-32 11190 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED t_ WELL PERMIT NUMBER ,. `69485 /6 .1fikt5""- thEci o esa 2 OWNER NAME(S) 5/O14A-eh /ro?.45 w Mailing Address it 37 )11.1 e 1'- STATE City, St. Zip /hrib3on q..oP r04o/ Phone ( 20 ) (gc9-. 8 9 3. WELL LOCATION AS DRILLED: Nt 1/4 NA/ 1/4,Sec. o)/ Twp. / /f/ , Range 1,5 ___. DISTANCES FROM SEC. UNES: 13oa ft. from No-MA Sec. line. and a o a ft. from Aids 7` Sec. line. (north or mouth) (Seat o,wen) SUBDIVISION: LOT 7--BLOCK FILING(UNIT) . STREET ADDRESS AT WELL LOCATION: ,.3 V w/+larf A/, v rl rC I -r, rrn 4.0 'rot, y a • 4. PUMP DATA:Type .5a6 771 t 1.510 c Installation Completed 1- g-_9,? • Pump Manufacturer Go v6 d 5 Pump Model No. /oA-J , Design GPM /0 at RPM , HP 3 , Volts -73 t , Full Load Amps Pump Intake Depth ,fi93 Feet, Drop/Column Pipe Size /3,, Inches, Kind CA- J,r u fit-p ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM; TURBINE DRIVER TYPE: O Electric D Engine ❑Other Design Head feet, Number of Stages , Shaft size inches. 5. OTHER EQUIPMENT: Airline Installed O Yes a-No, Orifice Depth ft. . Monitor Tube Installed O Yes No, Depth ft. Flow Meter Mfg. Meter Serial No. ^ Meter Readout O Gallons., O Thousand Gallons, O Acre feet, O Beginning Reading 6. TEST DATA: ®Check box if Test data is submitted on Supplemental Form. Date S'd Total Well Depth 90 Time • Static Level 'be) Rate (GPM) /Stiff 4 Date Measured /yr) g-a.', Pumping Lvl. 4,1n 7. DISINFECTION: Type Al-), 3tril•-Z Amt. Used 4 h is 8. Water Quality analysis available. O Yes ® No 9. Remarks 10. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. [Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.]CONTRACTOR C(4011 a k- ,5 Di./,f.W/N Y Phone 003) jyS2-,-]a/,// tic. Nolan . Mailing Address .-Namefrrtle (Please type or print) ' Signature p Date Idle malla.),"J/.gA Oil Cr cifil edF...ern r0" fd -a • 93 Form STATE OF COLORA.,v Foi voice Use Only No. OFFICE OF THE STATE ENGINEER GWS-1't 818 Centennial Bldg., 1313 Sherman St.,Denver,CO 80203 06/00 (303)866-3581 Fax(303)866-3589 . CHANGE IN OWNERSHIP/ADDRESS CORRECTION OF THE WELL LOCATION RECEIVE? Insert the Well Permit Number JUL 0 2 2002 Name address and phone of the person claiming ownership of the well: O g,t r�1 w�rtn ru: NAMES) �� \ ' < - --_ (FO'7Tt/21D��rrEW,tik Efi Mailing Address �� \C� If your well has an absolute water right,decreed \ /� by the court and the well is not registered with the CO � /j\ Z State Engineer,enter the Water Court Case City,St.Zip � Number/Civil Action Number and well number as decreed. Phonet---_) ��o- 4—l�� - - - . --- -- This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above. This Mina is made pursuant to C.R.S. 37-90-143. WELL LOCATION: County \13 Owner's Well Designation (Address) (City) (State) (Zip) N 4J 1/4of the N1rd 1/4, Sec.&l , Twp. I )C N. or❑S., Range (0S E. or )( W., P.M. istance from Section Lines 1300 Ft. From El N. or❑S., 300 Ft. From❑E. or OW. Line. Subdivision Name Lot , Block , Filing/Unit The above listed owner(s) say(s)that h she (they)own the well described herein. The existing record is being amended for the following reasons: Change in name of owner ❑Change in mailing address ❑Correction of location for exempt wells permitted prior to May 8, 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 and that the commencement of extraction of ground water from this well, lawfully-made'underthe well permit, occurred on the data indicated,and that the statements made herein are true to my(our)knowledge. çtesi9Nn&me Sign e )of then er. Date c)cs 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 ACCEPAND/ORMAILING ADDRESS.Id IA a OWNERSHIP 4740,^ State Engineer By Date STATE OF COLORADO OFFICE OF THE STATE ENGINEER pt nf of Na urResourceslesoae Department of Natural Resources 1313 Sherman Street,Room 818 -4 476 Denver,Colorado 80203 Phone 13031866-3581 FAX(303)866-3589 Gov G Romer Governor Ken Salazar Execodve Director Hal D.Simpson Slat,'Engineer TO: Stephen Koras FROM: John W. Bilisoly RECEIPT NO.: 340269 DATE: October 2, 1992 Your application for a permit to construct a well is being returned for the reason(s) listed below. The amendments and/or additional information or documentation requested is required before we can proceed with the evaluation of your application. All amendments made to the application must be typed or printed in BLACK INK. Please initial and date all amendments made then return the application and all attachments to this office. If you have any questions, feel free to contact this office. In our correspondence dated July 1, 1992 (copy enclosed), we asked for information regarding the creation of your 5.002 acre parcel. This was not provided. Until this information is provided, we cannot continue the evaluation of your application. -•.r- • EXEMPT WELL DATA SHEET - DENVER BASIN, COLORADO APPLICANT: KORAS RECEIPT NO. 340269 LOCATION: NW1/4 OF N111/4 OF SEC. 21, T.1N., R.65W. (1300 NSL, 300 WSL) PROPOSED AQUIFER: SURFACE ELEVATION: 4985 NUMBER OF ACRES IN TRACT: 5.002 J" IS PROPERTY WITHIN SERVICE BOUNDARIES OF MUNICIPALITY S.B.5 CONSENT MAPS? NO YES_ IF SUBDIVISION IS UNDER AUGMENTATION PLAN, CASE NO. IS ,DIV. IF SUBDIVISION WAS RECOMMENDED FOR APPROVAL BY THE WATER MANAGEMENT BRANCH, DATE OF LETTER IS INFORMATION ON SUBDIVISION OR TRACT OF LAND/SPECIAL RESTRICTIONS: evaluated by JWB on JULY 1, 1992 ELEVATION DEPTH TO ANNUAL NET APPROP STATUS AQUIFER ROT. TOP SAND BOT. TOP A-F 'UPPER DAWSON LOWER DAWSON ____ ____ ____ ____ _--_ DENVER .... .... .... .... .... .... ... PER RAPAHOE 2 4902 16 83 0.128 D�E�NVR AARAPAHOE 4553 4794 73 123 191 0.612E XNT ` y�f.�/�_��///f/ Qa c'tARAMIE-FOX HILLS ) 3901 4181 162 084 (9 �1 NT ti/LAV/ note: E indicates location is at aquifer boundary and values may be more approximate. 6" ' indicates the proposed aquifer_ O. oS — escp; izo ALL values are interpolated from the S.B.5 data base assembled in November of 1986. 0.6 S - 9R-P-4iJA- e 0.050//oa2 a NOr.CS : - 3/0GY1aM4 , •7/'/9z — J/�e�rwm.er�/ 4 J .4.114,2,74/ APE - /398. fat ,�C •.4, oat,/ 9//92. . .1 :0 ,ter/ear c, 4 ,aj�Cf A& 3/. 977 eze . #4:4 Z 04, ox ?o. 9z7a<. 9e //-one, aett . .Lt dc21a•r1` tae. Air S • ac2 zoce iue. Al' 1 Qest COPY Ava Iakle CV - - RECEIVED 1 Wii 30'93 • STATE INGINUER Mr).cot wee COLO 4.�N,I es to �y.__y N •1/'N•V•y.t1• N.frA. seer ..: __ ``µ M. f- - y' �_ i ram • 1r ti•18•••..-,... • i A.r• a 1 1 1 N'f / 1 jy y.w N I l w 1 LOT D !1.927 Acme • = 'a.s• I ;r I . 1 • 1 •• 1 4.Vile'• 1 •i../ sAr 1 NLt-N Kf 1 i I NOT on nag 1N.N•, ler I 5.001. 11•••• �T....f 111 . f �. • 1 Lora NJr.74./1•. • TIt.M ` miss ea' f •w.1..If 'Mtg. f 1 Nel•ell it Am f.7• rl, 5 1' LorA as soot 4 I' Lor '8f 3I.121 his • _ hngL sc.12 I seas 4 a y�Y 4.I 1 iemelt• 1 • 1 St.... \. I /••zoos' . I L.yrw MM X _ - 1 .. • RECORDED EAEMPT1oiv Mo. Best Copy Available RECEWED ----- ' JUN 16'92 WAT_s .:MOLES ]TAIL ENO NI; F ot, tee.y7 - No.er./ L..Ji,Sec 27 ii 45O �,y ''� • ••air s0 W t4(.2.0” _ _1t_ Co,QJ. a H. -_ - _ _. • . va No*az' ' a 1 u I it I *WIG 20.�•� -• I bee. X V N 1 0' N 1 4 LOT B 3!.927 /stags 1,.3e0• . I .0• I • t.W J ' c I• ; n 1 Pi Le, q to 1 (I GO- '41'4.4 111.n. 1 1 0 . 1 t 1.1P/1R17 q 4117-KJ-ecS (� V .p 9 NY9'es O ...711.ca•• y17 1 Ha 2791.8' a•CAI-L: J ,1 $.002 AC'S] "...eta ehi� 139.61' 1'•• 300' IS n ) 4? 4/33.34'43"E • e LerA . iv woe asv e _'li• 'nt.'s, 7 NBe 63'le,e PIA/ Scr tilN , h i� LorAIs ' Loot 4CAEs ia I Lor "8" 31 . 1 2-[ AGES , IOTA L x 1.. dG • 4x4 "LES 1 14 4Y C Aa 4.n1 , 4 21 I 1 I S 1 I ews I 1••�2000'Ir- LoW ne./ MAP . .. ..l... ammo............- 'a - • - ` PRaL). R� D. ' ' WRJ'5.Rer. 16 COLORADO DIVISION OF WATER RESOURCES JIMJ 1 O)IR92. nen uY. • 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 l� 114R3 PERMIT APPLICATION FORM en 3 0 Application must aJ PATER RES.•.-rt- s be complete where 1 )A PERMIT TO USE GROUND WATER �TEEN0I'ni applicable. Type or ( )A PERMIT TO CONSTRUCT A WELL Oter print in BLACK FOR:-( )A PERMIT TO INSTALL A PUMP INK.No overstrikes �•�' or erasures unless ( ) REPLACEMENT FOR NO. - /�� S initialed.' - 'I • )OTIiER' •: - . . - WA`('E COUR`f`CASE NO..' . • .. (1) APPLICANT- mailing address FOR OFFICE USE ONLY; DO NOT WRITE IN THIS COLUMN N1 n 'ado NAMEM4 C.R C. WO !I AS Receipt No. 31°x'67 /, STREET ..213 7 /27�4y- / heft _ Basin '''''•1? Dist. CITY kJ./ 4 ton L-O SO 60/ (Slate)rr�'S � (zio) CONDITIONS OF APPROVAL D d TELEPHONE NO. A / - �3 / This well shall be used in such a way as to cause no material injury to existing water rights. The�/r (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 / �,t! - right from seeking relief in a civil court action. ,v 14 of the " ' 'ti,Section O� // Twp. 1 , , Rng. �o • (,t• t0 P.M. IN.a1 I ) 'E.W • (3) WATER USE AND WELL DATA . • • Proposed maximum pumping rate(gem) / S Average annual amount of ground water / to be appropriated (acre.feet): Number of acres to be irrigated: p. `7 Proposed total depth (feet): ( o D Aquifer ground water is to be obtained from: t t-eLntt,aY'tiQ r7C)-d9C —2-1(10 Owner's well designation GROUND WATER TO BE USED FOR; -IN) HOU£EIIOLDUSCQN[r - or ( dun(B) -'n ('C) DOMESTIC(1) ( 1 INDUSTRIAL (51 0-1 D4) LIVESTOCK (2) ( ) IRRIGATION (6) ( )COMMERCIAL(4) ( ) MUNICIPAL (81 I 1 OTHER (91 APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) PERMIT NUMBER (4) DRILLER • . ,, —,n/ DATE ISSUED Name_ / .1 C aces.9r-e EXPIRATION DATE Street qty (STATE ENGINEER) (State) (zip) BY Telephone No. Uc.No. _ I.D. COUNTY (3.3- -- OZ r I H. /". ^� „ I I (5) THE'LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED BELOW - 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 + — -- + — 4....- _ 4-— -+ _ -F 4 — 4 � /C'o h.from l�no'��o urn) sec.line I 14 1 MILE,5280 FEET---,PI I -30 ft. from (.✓e1 T we. line 1 T + + 4- + + + - least or writ) I LOT • BLOCK FILING e I I I + — 4- i NORTH SECTION LINE — + — I SUBDIVISION I 1 I I I (7) TRACT ON WHICHWELL WILL BE +NonrH+ _ Jr_ — _ — LOCATED Owner: l r< .04 w_ + _ — —D + No,of acres o off' el-`- , will this be J 1 I o I I m I the only well on this tract71�PS -I— + G I I 9 -I- - {-w I ° (8) PROPOSED CASING PROGRAM z I Li) I Plain Casing + -- 3- - -I- - — — -I- — -m + /s' in.from --f'[ 1 I I I if '42- in.from 1 D k-to C- 9 ft. + - + I SOUTH SECTION LINE — 4- - 4 Perforated casing / /} II I I I T in.from p l9 ft.to /t ft. T + + + -I- + 4 +- -I- in.from ft.to ft. III I I I I (9) FOR REPLACEMENT WELLSgiwdistance t - -a- ` .1._ — + — + -- -(— — +- — +- — , , and direction from old well and plane f.r plugging - --The scale-of the diagram is 2 inches a-1-mile — —--T _,,=-11.____ _ Each small square represents 40 acres. WATER EOUIVALENTS TABLE IRounded Figures) An acre-foot covers 1 acre of rand 1 foot deep 1 cubic foot per second(cis)...449 gallons per minute Wpm) A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot...43,560 cubic feet...325.900 gallons. 1,0009pm pumped continuously for one day produces 4.42 acre-feet. (10) LAND ON WHICH GROUND WATER WILL BE USED: h.Owner(s): d€4 No.of acres: S '. Legal description: (11) DETAILED DESCRIPTION of the use of ground water: Household usa and domestic wells must indicaes type of disposal system to be used. 1P e...9 ,≥`e tic L c% 0QPi.v (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 (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO-THE BEST F HIS KN WLEDGE. Sr l OF APPL�NTlS 0 wiwu 1-401�-' / ¢3r�,0J 7� Use additional sheets of paper if more space is required. INDIVIDUAL Si3E:WAGGE. D:I:S:31''(: SA1... SYSTEM PERMIT dC),. Ci `'.'O:L;i£i> 4'4 WELD COUNTY HEALTH Dl::i::DEPARTMENT NEW PERMITIE NV:I:RONMliia' TAI... HEALTH SERVICES :1. 51.7 16TH AVENUE COURT, GREELEY„ CO 006;31 .:≥:ii;:i--06.:7;5 IEi:XT',....<..<.'.5 • WNER. KORAS, STEPHEN & ,TIi NNIF R ADDRESS 2772 WCR Al PH (303) °:136-9252 52 HUDSON CO 00642. DDRESS OF PROPOSED SYSTEM 2'7::10 WCR 4:1. HUDSON CO £:30642 E(3AL_ DESCRIPTION OF SITE: SEC 21 TWF' 1 RHO 65 UBDIV:I:S:3lol'1: LOT 0 BLOCK 0 FILING 0 SE_ TYPE: RESIDENTIAL I:AL.. SINGLE FAMILY DWELLING ER VICES: PERSONS 3 BATHROOMS 2.00 LOT SIZE 5.00 ACRES BEDROOMS ::≥ BASEMENT PI...Uh'lrcl:NG NO WATER SUPPLY DWELL. PPLIC:A'rIoN FIE:I::: $150.00 E_C.:'D BY MORRISOh1,L..oRRA:rPIEi: SIGNED BY STEPHEN S. KORAS DATE.: 06/15/92 • DATE: 06/13/92 ERCOL.ATIClhi RATE: :13.7 MIN PER TENCH L..:I:M:ET :ENG ZONE:: 0 FEET OIL TYPE SUITABLE PERCENT GROUND SLOPE 0:': DIRECTION ECTUIRE:S ENGINEER DESIGN NO IN 100 YEAR FLOOD PLAIN ZONE NO ROM THE: APPLICATION INFORMATION SUPPLIED AND THE OH-SITE SOIL_ PERCOLATION DATA HE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED: ......:PTIC TANK :1000 GALLONS, ABSORPTION TRENCH 549 SQ.. FT. � OR A. 6� ABSORPTIOIO N BED 780 so. FT. N ( :ETIoN. 'rF :[E PERMIT :r ' :Ey'�.lri<�TEE: :r 'T' THE FOLLOWING ADS ITI.ONIAL_ TERMS -, • • �� :0ND.L rIONS Ai..._..._...F,"-� L cu; :..4-::Ca.S. t€2--C..._. 'HIS PERMIT IS GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT IA? BE REVOKED OR• SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET ` JRTH IN THE WEL..D COUNTY . INDIVIDUAL SEWAGE: DISPOSAL SYSTEM REGULATIONS INCLUDING AlLURE.''TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL 1F'PROVAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE IEPAR"MENT OR ITS EMPLOYEES OF LIABILITY FOR THE FAILURE OR INADEQUACY OF THE :EWA - DISPOSAL SYSTEM. /1 J �3 ENI... .. EN ENVIRONMENTAL :a DA/:L 6/° <' ENVIRONMENTAL DATE HIS PERMIT IS NOT TRANSFERABLE AND SHALL_ BECOME VOID) IF SYSTEM CONSTRUCTION HAS IOT COMMENCED WITHIN ONE: YEAR OF ITS ISSUANCE.. BE:FORE ISSUING FINAL.. APPROVAL OF 'HIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE: RIGHT TO IMPOSE: ADDI-.. 'TONAL_ TERMS AND CONDITIONS REQUIRED TO MEET OUR REGULATIONS ON A CONTINUING BA-- 3Is. FINAL PERMIT APPROVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE CCIII— 'L..E7E.:D SYS'T'EM. BY THE WEI_.I) COUNTY HEAI...T "I DEPARTMENT. SYSTEM INSTALLERF':I:NAL.. :I:NS:3P° :C JN OF SYSTEM /ATE )ATE t(,nI SYSTEM ENGINEERENGINEERAF'I 'fi(:1U "YP -c3I ._.................._....._........................ E INSTALLED - I::NV.:F:(:)I�I'11::NT _ ::3f IE:CI:AI...:I:S T rilE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE::, 000NrY Jr. ' """:AL. REGULATORY OR BUILDING REQUIREMENTS, NICIIt SHAL.L.. IT ACT TO CEF.. ...FY THAT CI-IE JBJECT SYSTEM WILL.. OPERATE:: IN COMPLIANCE WITH APPLICABLE STATE::, COUNTY AND _OCAL.. REGULATIONS ADOPTED PEE:RSUJAhl'T 'r0 ARTICLE 10., TITLE 25,, CRS :1973. AS AMENDED, EXCEPT FOR TI-IE: PURPOSE Di ESTABLISHING FINIAL_ APPROVAL.. OF AN 11191AL.I...ED SYSTEM FOR ISSUANCE OF A LOCAL.. OCCUPANCY PERMIT PURSUANT T.0 CRS 1973 25- :L0- :I.:L:I. (2) . ')RTG:FNAI.....APP(.TC:Al..L.T,: COPY.._wrl..iD WCI-ID......:119 MAY.. :1.984 1 , Z.5 V 4 i n p• , 1 s/ . ^` W •r o • •j O k e-... '1.• i • j ...�. Hello