The URL can be used to link to this page

Browse Search

Home My WebLink About20090056 J • • II COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(06/2006) DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST,RM 818,DENVER,CO 80203 phone—info:(303)866-3587 main:(303)866-3581 fax:(303)866-3589 http://www.water.slale.co.us • GENERAL PURPOSE Water Well Permit Application Review instructions 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 (check applicable boxes) Name or applicant i � Attach a detailed description of uses applied for. High Plains Disposal Inc. O Industrial ❑Other(describe): O Municipal ^ Mailing address 601 South Main Street Silite 215 O Irrigation Ci --- ---- ---- ®Commercial ry State I zip Grapevine I TX i 76051 7.Well Data (proposed) Telephone#. _.- - _._ I E-mail l0Puonal) ...._. _—.__._.. - Maximum pumping rate Annual amount to be withdrawn (817)410-4780 , andycunningham@mindspring.com 15 9Pm 11 1 5 acre-feet 2.Type Of Application (check applicable boxes) . ._ Total depth 0 Construct new well O Use existing well 400- 1000 feet ! Denver Basin-Laramie Formation ❑Replace existing well O Change or increase use 8. Land On Which Ground Water Will Be Used ❑Change source(aquifer) O Reapplication(expired permit) ❑Other: _ Legal Description(,ray be provided as an attachment):Part of the Northeast l/4 3. Refer To(if aPP licable of Section 24,Township 3 North,Range 66 West of the 6th P.M., — - W to Well permit " "-- 1 Water Court case Si --- - Weld County,Colorado,recorded in the Weld County Recorder's Office as Lot A.RECORDED EXEMPTION NO.RE-4049. Dasignaletl eas'n oetehminaron# 4. Location Of Pro osed Wellcrop.p. _____..____ -._ . _._ _-._-.---_-�..-- (If used forirtigahon,attach a scaled map that shows irrigated area.) County A. #Adds I B. Owner Weld County 1/4 of me NE v< 5.15 i High Plains Disposal Inc. Sacgon I Township N or S Range • E or W Pfindpal Mend an —C. ust any other well or water nghts used on this land: • 03 1 66 ®O 24 O® 16th Distance of wellfmm sectionlines(section lines are typically not property lines) 617 Ft rrom® N O S 1266 Ft from 0 E O W 9. Proposed Well Driller License#(optional): Fpr replaceme t wells only distance and direction from old well to new well 10.Signature Of Applicant(s) Or Authorize Agent direction ___ ..___ -_ . __..._ feel The making of false statements • Therein constitutes perjury in the second Well lo remn adNass(include(includeCity,ty,state.Zip) O cheat if wall address is same as killers t. degree, (13h) is)punishable h as a class 1 nts misdemeanor pursuant the to C.R.S. 24-4-104(13)(a). I have read the statements herein,know the contents • 17754 Platteville,Colorado 80651 thereo and state that they are true to my knowledge. Sign re be shgoaturel - - —"— Date Optional: GPS well location information in UTM format You must check GPS unit for r � .. required settings as follows: ( J H f �r ❑ _.___.._.._ — ..._..- __ ._.._.—Pool ham A,�9e j F neat muslb lIIM 1 ❑Zane 12 or ID i Fasting A C•t t h lt.,, a r Units must be Meters Offi Use Only Delete MUM be NACHO Northing _ _—_... _ _..__ _ _ . ._.__._ __.._____. -u5Gs map name -- ' CWR map no. i Surface elev. Unit must be set to true north Was CPS unit checked for above? O YES I Remember to set Datum to NADa3 LL__.. : 5. Parcel On Which Well Will Be Located Receipt area only .(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)_.. - I I A. Legal Description(may be provided as an attachment): Part of the Northeast 1/4 of Section 24,Township 3 North,Range • 66 West of the 6th P.M.,Weld County,Colorado,recorded in the ' Weld County Recorder's Office as Lot A,RECORDED i EXEMPTION NO.RE-4049. • __ __ I B. #of acres in parcel i C. Owner WE 5.15 High Plains Disposal WR D. Vfll this be the only well on this parcel?OYES 1]ND(if no—fist ether wens) DWea TOPO ___l .. _ _ _ MYLAR E. Slate Parcel lox(optional), Set DIV DIV WD BA MD • 2009-0056 COLORADO DIVISION OF WATER RESOURCES GWS-45 GENINST(06/2006) DEPARTMENT OF NATURAL RESOURCES • GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS Applications must be typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned to the applicant for more information. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the original form. FEES: This application must be submitted with a $100 filing fee. Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources, and Visa or MasterCard (card number and expiration date must be provided on a separate attachment). Fees are nonrefundable. USES: This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feed lot, geothermal, recovery wells, and other uses not otherwise noted in the following list: RESIDENTIAL use wells—Use of form GWS-44 is required LIVESTOCK watering on a farm, ranch, range or pasture(not feedlots)—Use form GWS-44 MONITORING/OBSERVATION wells—Use form GWS-46 GRAVEL PITS—Use form GWS-27 REGISTRATION of an existing well—Use form GWS-12(must have been in use prior to May 8, 1972) GEOEXCHANGE SYSTEM LOOP FIELDS—Use form GWS-72 REPLACEMENTS OF WELLS FOR THE ABOVE USES ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form) 1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be sent. 2. Check all boxes that apply. 3. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of • water right,the case number or determination number must be indicated. If applying to replace or change the use of an existing well, the permit number of the existing well must be indicated. 4. The county, 1/4 of the 11/ section designation, section#, township, range,principal meridian, and distances from section lines for the proposed well must be provided. (An option to providing distances from section lines and the % of the Y<section designation is to provide an accurate GPS location in UTM format. The required GPS unit settings must be as indicated on this form.) Colorado contains two (2) UTM zones. Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 108th Meridian (longitude). West of the 108th Meridian is UTM Zone 12 and east of the 108'" Meridian is UTM Zone 13. The 108 Meridian is approximately 57 miles east of the Colorado-Utah state line. On most GPS units, the UTM zone is given as part of the Easting measurement, e.g. 12T0123456. Check the appropriate box for the zone. Provide the property address of the well location if one exists. If it is the same as the mailing address, check the box next to the well location address. a Please attach a current deed for the subject parcel. Complete all boxes and provide a complete legal description of the parcel of land on which the well will be located. 6. Check all boxes that apply and attach a detailed description of the uses applied for. 7. Complete all boxes. 8. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation is a proposed use, provide a map of the land area with proposed irrigated areas accurately drawn, including section numbers and section lines.A list of all other wells or water rights used on the described land must be provided. 9. The well must be constructed by a Colorado licensed well driller, an authorized individual in accordance with the Water Well Construction Rules,2 CCR 402-2,or under the"private driller"provision as defined in CRS 37-91-102(12). 10. An ORIGINAL signature must be on the application. The individual signing the application must be the applicant or an officer of the corporation/company/agency identified as the applicant. An authorized agent may sign the application,if a letter signed by the applicant is submitted with the application authorizing that agent to sign on the applicant's behalf. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk(303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719- • 542-3368), Alamosa (719-569-6683), Montrose (970-249-6622), Glenwood Springs (970-945-5665), Steamboat Springs (970-879-0272), or Durango(970-247-1845),or refer to our web site at http://www.water.state.co.us for general information, additional forms, and access to state rules or statutes. • • Colorado Division of Water Resources Application Receipt No. 1313 Sherman St.Rm.818 Denver,CO 80203 Applicant's Name: • (303)866-3581 http://water.state.co.usid ofault.htm COMMERCIAL DRINKING AND SANITARY WELL WORKSHEET / CbdsS ]r oiLFfELo wns7c orSpps NI_ Fgc)Lrrl Name and Type of Business HIsH Pf-niui Plsvosgt ?Nc, _ 1. Is this application for a new well? )C_Yes _ No If no, is this application for a change of use for an existing well? Yes Permit Number of well (if applicable) No For wells used for drinking and sanitary purposes prior to May 8, 1972, a field inspection of the well to verify historic uses is required. See form GWS-12 Registration of Existing Well for further information. 2. Is another source of water available to the property? (i.e. water district or another well) Yes If yes, indicate what this other'source is (name of water district or well permit number) X No 3. Type of disposal system: I )C Septic tank/absorption leach field Central System (district name:) Vault (location sewage hauled to:I Other(attach copy of engineering design) 4. Water Demand Calculations (for average factors for water demand see below) Employees Number of X Number of Gallons X Number of Days = Gallons per Year . Employees per Employee per Day Employee Works per Year a X (S X 365 1 = fo, 95o I A Customers Number of X Number of Gallons X Number of Days Business = I Gallons per Year Customers per Day per Customer _ is Open per Year - 1II 30 X S X 365 5.`1/ 4so B Other Uses (Note: No uses outside of the-building would be permitted for these types of wells) Type of Use X I Gallons per Use per X Days per Year = Gallons per Year Day NIA X X C Total amount of water required: = Gallons per Year (A+B+C) = 65, aoo I For wells used for commercial drinking and sanitary purposes on and after May 8, 1972, the total water demand cannot exceed 108,600 gallons(1/3 of an acre-foot) per year. For wells used for commercial drinking and sanitary purposes prior to May 8, 1972, the total water demand cannot exceed 325,900 gallons 11 acre-foot)per year. General Guidelines lot Water Demand in Gallons per Day Day Workers at Offices—15 gallons/person/day Food Service Establishments(with toilet and kitchen wastes)—10 gallons/patron/day Churches(does not include food service)—5 gallonsfseat/day Overnight Lodging-50 gallons/customer/day On-Site Proprietor of Overnight Lodging(i.e.on-site owner of a Bed&Breakfast)-80 gallons/person/day • Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject. GWS-57 • 4.b ANDY CUNNINGHAM 03-9503-956210N8 ASHLEY CUNNINGHAM i/LI 1851)C NEON COURT o m GRAPEVINE 1%76051 ,rss p Mein d�PriYi,1)6e L.C7� A ��*� Lf Lu•L;' ILe> $ �00 — Aer nR �� CA-c, h,, And (t.kt, sailors d Bank of America • Far w"""L uL:1� 1:L 11000029: ❑0163167279906210 • Weld my Environmental Health Services D rtment • 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co.us III Septic Permit Application Application Number: SP-0800184 App Type: Health\Commercial\New\Septic Applicant Name: BRADLEY CURTIS LAMP, RYNEARSON &ASSOCIATES INC 808 8TH ST GREELEY, CO 80631 Owner Name: HIGH PLAINS DISPOSAL INC/ANDY CUNNINGHAM Parcel #: 121124100031-R3905705 Legal Desc: PT E2E2 24-3-66 LOT A REC EXEMPT RE-4049(.26R) Site Address: 17754 CR 32 PLATTEVILLE, CO 80651 App Specific Info: 1/2 Bathrooms 0 3/4 Bathrooms 0 Basement Plumbing No Full Bathrooms 1 Location Description Number of Bedrooms 0 umber of Persons 4 rcel Acres 5.15 Illrivate Water Supply Well Public Water Supply No Public Water Supply Utility TERMS AND CONDITIONS A permit fee,as set by separate ordiance 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 certfies that the proposed system will not be located within 400 feet of a community - age system.The undersigned certifies that all statements made,information and reports submitted herewith are,or will be,represented to.< r e and co rect to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the•- t appli-. or herein.Applicant further understands that falsification or misrepresentation may result in the denial of the applicati.' .r rev. atio .f a permi granted,and in legal action or perjury as provided by law. X t��-d��\- 1_r 9 Z o �'nerl .pl• ant ate • • ci (, Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 I COLORADO RECEIPT September 24, 2008 Application Number: SP-0800184 App Type: Health\Commercial\NethSeptic Owner Name: HIGH PLAINS DISPOSAL INC/ANDY CUNNINGHAM 601 S MAIN ST STE 215 GRAPEVINE, TX 76051 Site Address: 17754 CR 32 PLATTEVILLE, CO 80651 Rcpt# Pmt Type Pmt Method Ref# Pmt Date Amount Cashier Comments EHS-0800421 Paid Check 10271 09/24/2008 $ 600.00 SCERRILLO Total Payments: $ 600.00 • • Hello