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Home My WebLink About20100148.tiff 06/21/2004 10:48 9703534257 R R WELL PUMP PAGE 02 TOR" "•• PUMP INSTALLATION AND TEST REPORT ors ow.us.a+y 12 11Kvo STATE OF COLORADO. OFFICE OF THE STATE EN(31 EER • 1. WELL. PERMIT NUMBER 2. OWNER NAME(S) Parker & Parsley Developmen4 Mailing Address _ 2.56 3 0 WCR 5 5 City. St. Zip IceKstrY, Co. 80644 Phone (303 ) 353-11 163 , __ __ . 3..wF.�L_LOCgTIONAS DRILLED: sw 1/4 NW 1/4,Sec. a 7 Twp.__...5 ._a___,Ran9e___5.4 .._.ieL._..— &STANCc9 FROM SEC. LINES: 1652 ft from 4ca.rtilr Sec. line. and 40 0 ft. from fWest�—Soc. line. SUBDIVISION: 'owe LOT BLOCK , FILtNG(UNT)_ ...-..STREET ADDRESS AT WELL LOCATION; ____ _,._ 4. PUM P__pA!A:Type Submersible l Installation Completed 1-16-92 _._ Pump Manufacturer Cnttlds Pump Model No. 5g$.03 _ Design GPM _,_ 5 at RPM 'IA n n , HP_„j12.3 , , Volts___,7 3 0_, Fuil Load Amps___3......6.— • Pump Intake_Depth 4Q _ Feet. Drop/Column Pipe Size 1" Inches, Ind PVC c.h1_10 ____.— A_QQA19NAL INFORM kTION FORDUMPS GREATER NAT 501 GPM: TURBINE DRIVER TYPE: O Electric Q Engine ❑Other Dusign head feet, Number of Stages , Shah size inches. ., �-..... ...._..arern• a:as+.. - •msrirrfG. �4:�a�� S. o lLIB PaNTpn+gNT: I rr�� Aldine Installed YesC_J No, Orifice Depth ft. . Morlttor Tube Installed ©Yes C!]No,Depth ft.___._. - Flew Meter Mfg. Meter $efial No._ ._... _________ ___.._.___... ..._— • _, I. Ra,.& l ;.,:.;'ont,•_ . "o..,,and Gallons,l f Acre ;Oat,O Seci:.n;�+; ?ex my �.. _ ,--_.._..... .._ Ill 6. TVSr DATA: C]Check box 0 Test data is submitted oh Supplemental Form. Date Total Welt Depth _. 5-� ,. Time 1 11J . - _-__ _�..--- _____ ...-- Static Level 2j Rate (GPM) S _—_— Da:e Measured 1-:1.6_-92 Pumping Lvl_££- __ 7. DISINFECTION: Type 13I_ _ _ __,.Arnt. Used 1 �._._._._._.._ _.. -- a. Wafer Otrality analysis available, Q Yes r_-_-] No -.—..._........... — -- Tom= -- ---_._.._.-- __—_.____.r... 9. lore arks _._---------•— ----------.— ___-- -- ---_._..,..— ,....__—.-__—_. --._—._..__...._._ 10. l th.ave mad the statements media herein and know the contents thereof, and that they are trve to my kricwie:ige [nursI,lant to Section 24-4-104 (13)(a) C.A.S., the making of false statements herein constItutc5'perjuy in ':se ceco^d degree .and is punshabie as a Cuss 1 misdemeanor.] CONTRACTOR _E j..3_w0 1.__bs._p vim i_Inc. ._ _ Phone ( 303}..3,5 3•-31.18_.._ tic. No.857 . Mailing Address Pr.t7,_ 2O), 02? Glzgg.3. . Gp $11-.3 2 _ - — - _.•_.:....... ...._.. gaine/Titfe (f le-se type or print) Signature r - .- Date L.,,c:1�,N ER.-.... __.„„._». ._..__.__.,._..._._-_... ..x..��• . • '-/ ._ . _.... .._._.._...... . I.-.17.-2 2. ...__-.. III 2010-0148 I , !..i<.1t" 0}..t` INDIVIDUAL SEWAGE .il.<.,.. '`t_ AL SYSTEM PERMIT.I NO... G—9i01 : :t•, WED...... 1 T.' DEPARTMENT , PERMIT �::!r. (.:(..I COUNTY t �• HEALTH NEW Ga .... ?:ct'';(.fr' ]II::.NTf"tl_ HEALTH SERVICES • 1517 16TH AVENUE COURT , GREELEY . CO80631 3c:;3...•0t)35 EX T.2225 .222::.`: OWNER ...r� '••< r rr-'r,r,, ,: PETROLEUM I_.[. ADDRESS 25630 ' C:: 55 `•i 't, )e c3_ i".3Cli•.E.:.l-,: E-!••Is••,<�E...E::. i F'!::. 1 li...... .11�; !••l.. 1''-.::._ E+v .: h'! "•.:i ..t '.. k:F E• I::,Y CO q0644 r! 4 n ADDRESS OF PROPOSED SYSTEM 25630 WCR 55 KERSEY CO 80644 LEGAL DESCRIPTION OF 1.E. J E::. 'E::.(., _.. . "WP .. , .NI 64 H :DI: :ESI:(: N : LOT 0 fl_0PR 0 FILING r:';t USE TYPE : COMMERCIAL ,'M;`tI._;... OFFICE BLDG SERVICES : PERSONS .x BATHROOMS 1 .00 l..t•:l"I" J.::.. 2.99 ACRES ! I SUPPLY 0 BASEMENT! PLUMBING Nn {x�I'•`•'i�'E' 'i ,rlf V '"Wf';i::[j5 APPLICATION "•EEE... 15090 E:•:I::: D BY .':r': ...__ .. i'':' _ ... ... .:: E::: SIGNED BY BLAKE E:0 U S i DATE 06/06/91 DATE 06/06/91 PERCOLATION RATE l f f::, 2. Mil' PER INCH LIMITING ZONE 8 FEET SOIL TYPE UNSUITABLE PERCENT GROUND ND .'LLir'E::: 0% DIRECTION REQUIRES ENGINEER DESIGN YE ,.. FROM [ :-Err. APPLICATION INFORMATION SUPPLIED AND J THE ON-SITE SOIL PERCOLATION DATA THE FOLLOWING 0WIN(; MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED : IRED : SEPTIC TANK 1000 GALLONS,', ABSORPTION TRENCH EQ. FT, OF., ABSORPTION BED E.1 ';10 SQ. FT. . .r. .._,.i,.I..,..,. ,,t THIS . _ PERMIT .t. .• I r E•I' T�:. .r! AND :', ,,,I'•J i_:,:.,. t .I-o i'., 1 h i I,.: SUBJECT 'T'0 f'H I:. 1• C. ...I...... . I v(. ADDITIONAL .-.E:?f TERM.S'>' A P•D , THIS PERMIT IS GRANTED TEMPORARILY { I (.7 ! CONSTRUCTION , ;1 COMMENCE, THIS E' 'E ALLOW ... I�''PERM: i I••: ! BE REVOKED ..... :•:UHENDED BY THE WELD COUNTY HEALTH DEPARTMENT -•(. R I•':;._i"1,,`>0NE SE- FORTH ,.,t L _., ._ COUNTY ,..... r' r— .I. .. i i.,. 'I E'i', I N THE WELD a.,E;{. N fINDIVIDUAL >E:::W GE: DISPOSAL SYSTEM M REGULATIONS ..: E(::...... ... I.NE MEET T ,��•`�Y 0 t','• CONDITION IMPOSED ..i'i..l THEREON i.J iv j DURING ... .,t r TEMPORARY{..G;,4' ._t!:',• IN AL i FAILURE ! k.! t}f...... I ANY. i TERM � :!.:.s',!...,. 1 I•: .«'� •• ...t '' '1 L.i. .. r"l,._ r, ISSUANCE .. ..s ASSUMPTION AE:::.,Rt-'i'=1:.. THE — AN: .. OF THIS : PERMIT DOES NOT CONSTITUTE ,,..S 0 k ;••Et:..1 - ...E ,�.i'T (. �� (`t,.. ,.., , ',, f1 ` .!. t .«,t` DEPARTMENT I -I-T.•, i..,, i:. f. . LIABILITY I wr 4iR I' k... ITS ;::.i"I!' .._... .......,_ !...i" FOR,. THE'C:. FAILURE,... ... . ,.. f�' ( ! OF THE SEWAGE DISPCAL SYSTEM .. C o r p .._. lt- l_ 31 - l r` LF JUDY SCHMIDT f M ,_` 07/23/9i l v Colo'^ I - 3t - '1 Z ENVIRONMENTAL SPECIALIST DATE PERMIT E I Y � TRANSFERABLE ti xt D SHALL t H C THIS 1"'' ,Trt t .1.,_ ICI(.; t AND t:.: e. [1 r•t..._. BECOME VOID (' SYSTEM CONSTRUCTION .,. NOT COMMENCED ('I:�,rt��1::'�.aWITHIN iJ' :,i ,'�'\f.[ i•'�. t='" � <'<� E .�)I'. FINAL 1�%i l-''APPROVAL J''!�b'` 4 k. �� e �..:...t.,�,...I...,C:.dl �' YEAR ITS.. ISSUANCE,i.:!....: ':` �' ...�.'::. ISSUING t s• .. I'• I... .T E• \' PERMIT THE WELD COUNTY HEALTH T..f I'' I. '1't IMPOSE ADDI- TIONAL ' E"1:E:... E:.,',:',.� t :,::. ka•,...;...:.: i.:t.1'..::�. ,'II::.{::i,... ! I! .:.E''%'It'. ..,:�1•.. � ............. . ....�.. THE... ,,.:.,s•+"i TO .t.i"IE''t.,,:>,... TERMS AND CONDITIONS REyolRLD ! u mi (:JE.!R R EE.,EJt...AT .1,.JJ\E::' (.Jt4 A CONTINUING BA- SIS , FINAL APPR0VL IS CONTINGENT '< 'T•J..tI:. FINAL INSPECTION OF THE COM— PLETED -t-i_I'`I N .'T%•t_.1...[... _..__._._.__.........,__„......,..............':: INf:lI... . '!tl!'I... .. 'J!:t Sia:',1.1 : :" R..... _ C�L TYPE SYSTEM .i..'ti,.i t E... .......xJ ;- ... ... .... . ... ,..-. ,fit ..,...r. i....i.<.. (' ..I..E:" ISSUANCE t.. THIS PERMIT DOE ±': , IMPLY 'i "j't.: UiLR iA ! , .....- :.�.i,! •`!r LOCAL REGULATORY 1{:1Y' OR BUI :.ti- r5atrr sc,..' NOR YI_ _ _,M.'I::' '� ..E,Tlit . . t�at,..:...t.T ,': - ,:; i ,`_S'' is . ...... .... ._. ,r�; , .... .,.I''� ...'..!: .. ,....t.! ,tt,.:.... WITH f:i E� .....J...:f••t.;......_. STATE .. C0UNT ��I',i) ...,.. ..... ,y .R :�i; .'.•:iis „ i:. H•T'i "t=M EXCEPT ,.. I i!.i. THE!I::. i t.1'��:t ......... ... ...... .�,),:i......... . ._. ..., FINAL � ... ,.... ... :`��!"•' ... ... :'•�i...._._.. ,.. . ... � ,—. .. i •t• 5,i:•iN •,r- CF .•, ".,f..•,.:i t-: ,. :F,,..; t'+N' ' 7 — 2 ook2 &1 4 ay, ii 4q, otia"` I &o/c — A ok I . No . Mk `ittia utiCat to cus ' cc Z. h-rpole noi- Lute t 3 . No Le..(' ectp ok [(Az- g P,pt not (a r od-k. pc46(, s taut not && 4,tL. c ud out:, pip, Nit to' tbui 6. / d t Hello