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Home My WebLink About20100896.tiff Form No. OFFICE OF THATATE ENGINEER • GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 • (303)866-3581 LIC , WELL PERMIT NUMBER 66600 -F APPLICANT DIV. 1 WD2 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY NE 1/4 SW 1/4 Section 2 MARY ANN PLONKA Township 1 N Range 66 W Sixth P.M. 16230 HWY 52 DISTANCES FROM SECTION LINES FORT LUPTON, CO 80621- 2240 Ft. from South Section Line 2240 Ft. from West Section Line (303) 857-1911 UTM COORDINATES (Meters,Zone:13,NAD83) PERMIT TO USE AN EXISTING 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 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 37-90-137(4)and the findings of the State Engineer dated December 12,2007. 4) The use of ground water from this well is limited to commercial,domestic, livestock,animal watering,and irrigation. 0 The pumping rate of this well shall not exceed 15 GPM. The average annual amount of ground water to be appropriated shall not exceed 7.8 acre-feet. Production is limited to the Laramie Fox Hills aquifer. 8) 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. 9) The entire length of the hole shall be geophysically logged as required by Rule 9 of the Statewide Nontributary Ground Water Rules prior to installing casing. 10) The owner shall mark the well in a conspicuous place with well permit number(s), name of the aquifer,and court case number(s)as appropriate. The owner shall take necessary means and precautions to preserve these markings. 11) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all diversions must be maintained by the well owner(recorded at least annually)and submitted to the Division Engineer upon request. 12) This well shall be located no more than 200 feet from the location specified on this permit. 13) Pursuant to CRS 37-90-137(9)(b)and the Denver Basin Rules, no more than 98%of the nontributary ground water withdrawn annually shall be consumed and the well owner shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98%of the water withdrawn will be consumed. 14) This well is subject to administration by the Division Engineer in accordance with applicable decrees, statutes, rules, and regulations. 15) This well shall be constructed at least 600 feet from any existing well,completed in the same aquifer,that is not owned by the applicant. NOTE:The ability of this well to withdraw its authorized amount of water from this non-renewable aquifer may be I t n the 100 years upon which the amount of water in the aquifer is allocated,due to anticipated water level declines. 12.1Z-01 2010-0896 • < APPROVED / JLV State Ert-neer Receipt No. 3621301 DATE ISSUED 12-12-2007 EXPI TION DATE 12-12-2008 ' ADDITIONAL INFORMATION RIPARDING WELL CONSTRUCTION AND WIDABANDONMENT REGULATIONS. WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER You may construct the well and/or install the pump yourself if the well is entirely for your own use, is on property you own, and is constructed, or pump equipment is installed,with equipment owned and operated by you, and provided you have passed a required examination as prescribed by ehe State Board of Examiners of Water Well Construction and Pump Installation Contractors("Board"). It is your responsibility to omplete and submit the Well Construction and Test Report (Form No. GWS-31)and/or the Pump Installation and Test Report (Form No. GWS-32). These forms are available from our website at the following link: http://www.water.state.co.us/pubs/wellforms.asp, or from any Division of Water Resources office. The well must be constructed and the pump installed in accordance with the well construction standards of the Board. The WATER WELL CONSTRUCTION RULES state that all wells of this type must be disinfected after construction and after pump installation. The WATER WELL CONSTRUCTION RULES and the BOARD OF EXAMINERS RULES can be obtained from our website at the following link: http://www.water.state.co.us/boe/, or purchased from any Division of Water Resources office for a small fee. The rules cover well construction, pump installation, disinfection, abandonment and contractor licensing regulations. If you are constructing your own well or installing pumping equipment, it is recommended that you obtain a copy of these rules for reference. WELLS TO BE PLUGGED AND ABANDONED MUST BE PLUGGED IN ACCORDANCE WITH RULE 16 (SHOWN BELOW) OF THE WELL CONSTRUCTION AND PUMP INSTALLATION RULES. A WELL ABANDONMENT REPORT, FORM NO. GWS-9, MUST BE SUBMITTED TO CONFIRM THE PLUGGING OF THE WELL. This form is available from our website at the link stated in the first paragraph on this page,or from any Division of Water Resources office. RULE 16 STANDARDS FOR PLUGGING,SEALING,AND ABANDONING WELLS AND BOREHOLES 16.1 General - The plugging, sealing and abandonment of all wells, monitoring and observation wells, monitoring and observation holes and test holes that are no longer intended for use, and the plugging, sealing, and abandonment of dry holes, collapsed or unusable boreholes, and other incomplete wells or excavations is necessary to prevent contamination of ground water and the migration of water through the borehole. It is the ultimate responsibility of the well owner to have an existing well properly plugged, sealed and abandoned. The well construction contractor or authorized individual is responsible for notifying the well owner in writing of these plugging requirements. 16.1.1 In the event a borehole(s)is not completed for the intended purpose, the contractor will notify the well owner of e well owner's responsibility for the proper abandonment of the borehole(s)according to Rule 16.1. If the well owner does not gree to allow the contractor to abandon the borehole(s), the contractor shall notify the Board of Examiners, in writing, of the existence of the borehole(s)and the contractor's effort to notify the well owner of the well owner's abandonment responsibilities under Rule 16.1 16.1.2 Persons authorized to install pumping equipment may plug, seal and abandon wells that do not require the removal of casing that penetrates more than one aquifer or the ripping or perforating of casing opposite confining layers. 16.1.3 Materials used for backfilling shall be clean, inert, and free from contaminants. The well casing may be cut off below land surface so that it will not interfere with the anticipated use of the land. If the casing is cut off below land surface, the uppermost five (5)feet of the remaining casing shall be filled with grout or a watertight cover shall be permanently attached to the remaining casing and the excavation shall be filled with materials that are not more permeable than the surrounding soils and adequately compacted to prevent settling. 16.2 Wells or Boreholes In Type II and Type III Aquifers -Wells completed into unconfined aquifers and unconsolidated aquifers shall be plugged, sealed and abandoned by filling the well to the static water level with drill cuttings,clean sand or clean gravel, then with clean native clays, cement or high solid bentonite grout to the ground surface. The uppermost five (5)feet of casing shall be filled with grout or a permanent watertight cover shall be installed at the top of the casing. If casing is removed, the hole shall be filled as described above to within five (5)feet of the ground surface. The top five(5)feet of the hole shall be filled with materials less permeable than the surrounding soils that are adequately compacted to prevent settling. 16.2.1 Dewatering wells, horizontal drains, monitoring and observation holes, percolation holes, piezometer holes, sumps,test holes and dry holes shall be plugged,sealed,and abandoned either pursuant to Rule 16.2 or by removing all casing that was installed and by filling the hole(s)with drill cuttings,clean native clays,cement or high solid bentonite grout to within five (5)feet of the ground surface. The top five(5)feet of the hole shall be filled with materials less permeable than the surrounding soils that are adequately compacted to prevent settling. 16.3 Wells or Boreholes in Type I Aquifers - Wells which were constructed through more than one aquifer shall be plugged and sealed by placing a cement grout plug at the confining layer above each aquifer. If records do not show that the casing opposite each confining layer has been grouted when originally installed, the casing shall be either completely removed from the hole, or perforated or ripped opposite such layer prior to placing the grout plug. Plugs shall be no less than forty (40) ' art in length and shall be designed to withstand the maximum potential hydrostatic pressure differential between the aquifers. e well casing, except for the grout plug intervals, shall be completely filled to the land surface with clean native clays, cement or high solid bentonite grout.A watertight cover shall be permanently welded or attached to the top of the casing. 3 •(it Weld County ESonmental Health Services Deoartm 1555 N. 17th Ave' Greeley, ) 3 80, Phone: (970) 04-6 Fax: (970) 304-& ' www.co.weld.cc COLORADO Septic Permit - Repair Limiting Zone Qualifier Limiting Zone Feet Limiting Zone Inches Soil Description Ground Slope Slope Direction Soil Type Suitable In 100 Year Flood Plain Engineer Evaluation Received Engineer Job Number Engineer Design Required Engineer Letter Received Variance Required EHS Septic Install (Site): Septic Tank Size Absorption Trench Absorption Bed Chamber Option 1 •Trench Option 1 Bed Option 1 Chamber Option 2 Trench Option 2 Bed Option 2 Chamber Option 3 Trench Option 3 Bed Option 3 Additional Terms and Conditions EHS Septic Actual (Final): Septic Tank Size Absorption Trench Specification Absorption Bed Specification Chamber Model Number of Chambers Additonal Terms and Conditions Design Type Lift Station Lift Station Size Tank Anchored Water Reduction • 4 ©ii-;:,H, • Weld County Eonmental Health Services Departm S 1555 N. 17th Ave Greeley, ) 3 861 i‘iIl Phone: ((970) 304-& Fax: (970) 304-64 IIDc www.co.weld.cc , COLORADO Septic Permit - Repair Application Number: SP-0800036 Applied: 03/10/20( App Type: Health\Commercial\Repair\Septic Expires: 03/10/20( Applicant Name: MARY ANN PLONKA 16230 HWY 52 FORT LUPTON, CO 80621 Owner Name: PLONKA MARY ANN Parcel#: 147102300044-R1446302 Legal Desc: PT SW4 2-1-66 LOT B REC EXEMPT RE-3193 (.27R) SITUS: 16230 52 HWY WELD 000000000 Site Address: 16230 HWY 52 FT LUPTON, CO 80621 EHS Application Documents: Authorization Form No at) Authorization Form Signed By ate Authorization Form Signed Map Yes SOE System Diagram No Percolation Holes Flagged Yes Pumping Receipt(For Loans and ISDS) No Date Pumped (For Loans and ISDS) EHS Septic General: Location Description 16230 HWY 52, FT LUPTON Repair Reason Type Repair for Upgrade Associated Building Permit Associated Building Permit Number Application Date 03/10/2008 Septic Permit Expiration Date Waive Fees No Waive Fees Comment Number of Persons 3 Number of Bedrooms 3 Basement Plumbing Yes Full Bathrooms 1 3/4 Bathrooms 2 1/2 Bathrooms 1 Public Water Supply No Public Water Supply Utility Other Water Supply Utility Private Water Supply Well Private Water Supply Permit Reference Number filkarcel Acres ear Installed 1994 4 EHS Perc Test(Site): Percolation Rate Qualifier Percolation Rate Value 06,/it DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT • 1555 N 17TH 631 GREELEY, CO 80631 WEBSITE: www.co.weld.co.us WIlD ADMINISTRATION (970) 304-6410 FAX(970) 304-6412 PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX(970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 COLORADO FAX (970) 304-6411 March 27, 2008 Mary Ann Plonka 16230 Highway 52 Fort Lupton, Colorado 80621 RE: Individual Sewage Disposal System Permit No.: SP-0800036 Location: 16230 Highway 52, Fort Lupton Dear Ms. Plonka: • This is to inform you that your Engineer Designed Septic System has been reviewed by the Weld County Board of Health and approved. A copy of the Weld County Board of Health I.S.D.S. Review Form and your I.S.D.S. Permit are enclosed. PLEASE NOTE THAT THE SYSTEM MUST BE INSPECTED BY A REPRESENTATIVE OF THIS DEPARTMENT AND BY THE DESIGNING ENGINEER, BEFORE THE SYSTEM CAN BE APPROVED FOR OPERATION. THE ENGINEER MUST CERTIFY TO THIS DEPARTMENT, IN WRITING, THAT THE SYSTEM HAS BEEN INSTALLED ACCORDING TO HIS/HER SPECIFICATIONS. Should you have any questions regarding your septic system, please contact this office at your earliest convenience at (970) 304-6415. Sincerely, Stephen J. Wiatrowski Environmental Health Specialist • SJW/ms $ cc: High Plains Engineering Engineer Job No: 08-1612 • • • • WELD COUNTY BOARD OF HEALTH ENGINEER DESIGNED SYSTEM REVIEW PROPERTY OWNER: Mary Ann Plonka PERMIT NO.: SP-0800036 (CRep) LEGAL DESCRIPTION: PT: SECTION: 2 TOWNSHIP: 1 RANGE: 66 SUBDIVISION: LOT: BLOCK: FILING: SITE ADDRESS: 16230 Hwy 52, Ft. Lupton FACILITY: Residential 3 Bedroom home, with 5 patron for the RV storage per day. ACRES: 30 PERC RATE: 20 SOIL: suitable WATER SUPPLY: well LIMITING ZONE: >8 feet XXX ENGINEER DESIGN (3.5) EXPERIMENTAL DESIGN (3.14) ENGINEER: High Plains Engineering ADDRESS: ESTIMATED FLOW: G.P.D. 788 PRIMARY TREATMENT: Standard tank CAPACITY: 1000 gallons DISPOSAL METHOD: Absorption/ET bed or trench SIZE: 462 (additional) square feet REQUEST FOR VARIANCE: STAFF COMMENTS: The system is adequately sized for the proposed load. The permit is to add 462 square feet to the existing 846 square foot bed for a total of 1308 square foot bed. STAFF RECOMMENDATION: Approval ENVIRONMENTAL PROTECTION SPECIALIST: Kevin Antuna REVIEWED BY BOARD: March 25th, 2008 B.O.H. DECISION: APPROVED: ✓ DENIED: TABLED: m_f+(q/ FLn Chair mach Weld County Board of Health . 0:\PAM\Isds Shells\boh engineer review.doc 4 • Weld County En•nmental Health Services Departmei 1555 N. 17th Avent Greeley, CO 864 Phone: (9 70) 304-64' Fax: (970) 304-64' www.co.weld.co.i e COLORADO Setc Permit - Repair Percolation Rate la 6 Limiting Zone "� ft 0 in Description '"p6% "" r// Ground Slope t{ Direction 5 6 Soil Suitable (Y1 1 y Engineering Design Required&N) \ In 100 Year Flood Plain (Y/63 /V From the application information supplied and the on-site soil percolation data the following minimum installation specifications are required: 7^attct Septic Tank Icon J gallons Absorption Trench sq ft or Absorption Bed " sq ft Chambers: Hancor Standard or Hi-Capacity, EQ36 or BioDiffuser Trench Bed Infiltrator Quick4 Trench / Bed ?O Hancor Narrow(15in) Envirochamber Trench Bed_7_ In addition, this permit is subject to the following additional terms and conditions: 6O.1,y Lad / PcUnit IS 14.),x �{L '/`ng � ,,uid�9 � f ` ?A; to-clln-fri /3c r✓,ctrf E/ (9&Ccvc) ) • NOTICE This permit is granted temporarily to allow construction to commence.This permit may be revoked or suspended by the Weld County Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet any term or condition imposed theron during temporary or final approval.The issuance of this permit does not constitute assumption by the department or its employees of liability for the failure or inadequacy of the sewage disposal system.This permit is non-transferable and non-refundable.Before issuing final approval of this permit the Weld County Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is contingent upon the final inspection of the completed system by the Weld County Department of Public Health and Environment.This permit expires one year from the application date. X*' 11TaSpecialist -a •a S •o� Envi onme I Health Date • 4 Hello