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2007-1532
GWS-25 COLORADO DIVIbION OF WATER RESOURCES
818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203
(303)866-3581
LIC
WELL PERMIT NUMBER 255953 - -
APPLICANT DIV. 1 WD 2 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
NE 1/4 NE 1/4 Section 7
GIB DAVID SMITH Township 2 N Range 66 W Sixth P.M.
P O BOX 10 DISTANCES FROM SECTION LINES
COMMERCE CITY, CO 80037- 985 Ft. from North Section Line
1100 Ft. from East Section Line
(303) 619-9452 UTM COORDINATES
PERMIT TO CONSTRUCT A WELL Northing: Easting:
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 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
34.81-acre parcel known as part of the NE 1/4 of Section 7, Twp. 2 North, Rng.66 West, 6th P.M., Douglas County,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 the user's own non-commercial domestic animals, and the irrigation of not more than 1 acre of home gardens
and lawns.
5) The total depth of the well shalt not exceed 550 feet,which corresponds to the base of the Laramie Fox Hills aquifer. At a
minimum, plain casing shall be installed and grouted through all unconsolidated materials and shall extend a minimum of
ten feet into the bedrock formation 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 3.5 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.
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 ntire roducing
interval of the approved zone or aquifer indicated above. r_ _56 (9.0(1
APPROVED ,, •
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JLV
State Engineer g
Receipt No.0513687 DATE ISSUED 03-19-2004 EXPIRATIO DATE 0 - 9 006 ,
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555 NORTH 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 304-6415 FAX: (970) 304-6411
WSITE: WWW.CO.WELD.CO.US
APPLICATION / RECEIPT
Initials: RM
Permit Number: SP-0300324 Receipt Number: HAP-03326
08-13-2003 Amount: $375.00 Payment Method: Check Notation: 4648
Owner Name: SMITH GIB
Applicant Name: SMITH GIB
Parcel Number: 130907000017
Location: APPLIED FOR TBA 85 TO RD 20 1/2 EST SID
Account Code Description Amount
2560-41400-4221-4203 New Septic Permit $375.00
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: UBC MODULAR
Commercial: (Y/N) N Residential: (Y/N) Y Acres: 34
Number of Persons: 4 Basement Plumbing: (YIN) Y
Number of Bedrooms: 3 Bathrooms: Full - 2 3/4: 0 1/2: 1
\ r Public: (Y/N) N Water Supply:
N+ ..per Private: (Y/N) Y Cistern: (Y/N) N Well: (Y/N) Y Well Permit Number: TBA
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 --,--Cii_j(>11/1i1756.. 3.-1 2)-0 3
Owner/Applicant Date
orm RT_HAPP
Wt_. county rieattn uepartment «,IVO
Percolation Test and Soils Data
. High Plains Engineering
1. 735 Denver Avenue • Fort Lupton CO 80621
Phone 303-857-9280 • Fax 303-857-9238
°! 034439
P tt�r A PART OF THE NE 1/4 OF SECTION 7, T2N, R66W OF THE 6TH PM.
Legal Oescription WELD COUNTY, CO
Property Owner Info
Name GIB SMITH
Street P.O. BOX 10
City, State,Zip COMMERCE CITY,CO 80037
Phone 303-619-9452
re ev it ie.;771,7,!' r r h, - yp�pyx }
smeared ur'aces ncountered at GREATER THAN 8 feet
Raptoved:YES
Sand or Gravel Added: NO Estimated depth to maximum
seasonal water table if not
Date and Time 7/31/03 date encountered in profile:
Presoak Water Added: 11:00 time
Amount of Presoak Is area believed to be subject t
Water Added: 15 gallonsseasonal fluctuations which coal
Date and Time result in a seasonal water table withIn
Percolation Test 8/1/03 date 8'q dace?
Started: 10:00 time �(, � ...._ .w° '''-'4"
Did Water Remain in Hole After the Overnight 0.5
Swelling Period? to NORTH direction
POW 1 NO
Hole 2 NO T „ , ,y4
Hole 3 NO Encountered @ GREATER TI-IAN 8 j feet
Hole 4 NO
Hole 5 NO Estimated depth if not encountered int
Hole 6 NO profile:
Fete:*' ' iitp, 41100440011
04451,1flinettC L1aep On)
Hole 1 36 7.58 Type of Bedrock:j
Hole 2 38 13.89
Hole 3 39 9.26
Hole 4 37 11.90 Is bedrock fractured or weathered?
Hole 5 36 6.94
Hole 6 38 11.90 Is bedrock believed to be permeable
Average 10.2 (perc rate<60 min/in)?
we. .. t.ounty neattn veparunent ...........
Percolation Test and Soils Data
No
ii
te: Soils must be classified using unified system ASTM D2487
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2 SANDY SILT(SM)
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WELL GRADED SAND(SW)
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I certify that the above information is correct and complete to the best of my knowledge and
that all tests were performed in the accordance with the provisions of Weld County Health
Department individual sewage disposal regulations by myself or under my supervision.
�. High Plains Engineering
_
Signature o:o ` . -: 735 Denver Avenue
czco j
:0 � � Ft. Lupton, CO 80621
Stit. p.> 303-857-9280
y_ r l
Date c:
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