The URL can be used to link to this page

Browse Search

Home My WebLink About20092829.tiff COLORADO DIVISION OF WA RESOURCES Office Use Only • Form GWS-45(06/2006) DEPARTMENT OF NATURA ESOURCES — lc 1313 SHERMAN ST, RM 818, DENVER, CO 80203 phone—info:(303)866-3587 main: (303)866-3581 fax:(303)866-3589 http://www.waterstate.co.us ©ENERAL PURPOSE ater 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 of applicant Attach a detailed description of uses applied for. Lone Star, LLC. ❑ Industrial ❑Other(describe): Mailing address --- ❑ Municipal 1701 N. Highway 385 ❑ Irrigation a City I State i Zip code 171 Commercial Andrews TX 70714 7.Well Data (proposed) Telephone# E-mail(Optional) (800)367-4550 Jim lee@palmertank.net Maximum pumping rate gpm Annual amount to be withdrawn 2. Type Of Application (check applicable boxes) l0 2.0 acre feet Total depth Aquifer ❑ Construct new well ❑ Use existing well 281 feet I Laramie Fox Hills ElReplace existing well ® Change or increase use El Change source(aquifer) El Reapplication (expired permit) 8. Land On Which Ground Water Will Be Used ❑ Other: Legal Description(may be provided as an attachment): 3. Refer To(if applicable) Attached. Well permit# Water Court case* 37044 Designated Basin Determination# Well name or# 4. Location Of Proposed Well (If used for crop irrigation,attach a scaled map that shows irrigated area_) C _...._County Weld County NW 1/4 of the NW 1/4 A. #Ames B. Owner _-______ ___ _ 37.3 Lone Star,LLC. Section Township N or S Range E or W Principal Meridian -- ® ❑ ! ❑ ® 6th C. List any other wells or water rights used on this land 64 Distance of well from section lines(section lines are typically not properly lines) 124 Ft.from M N❑ S 112 Ft.from El E E1 W 9. Proposed Well Driller License#(optional): For replacement wellsonly-distance and direction from old well to new well 10. Signature Of Applicant(s) Or Authorized Agent feet direction The making of false statements herein constitutes perjury in the second Well Location address(Include City,State,Zip) El Check if well address is same as in Item t. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. 15988 WCR 49 LaSalle, Co 80645 24-4-104(13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Sign here(Must be original signature) Date Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows: 64/219 Format must be UTM Print name 8 t ❑zone 12 or O Zone 13 I Easting Units must be Meters NAM Northing Use Only Datum must be NA Northing —.— Unit must be set to true north USGS map name i DWR map no. Surface elev. Was GPS unit checked for above? El YES Remember to set Datum to NAD83 1 5. Parcel On Which Well Will Be Located I Receipt area only (PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description(may be provided as an attachment): Attached. B. 4 of acres in parcel I C. Owner WE 35 Lone Star, LLC. WR . WO this be the only well on this parcel?EYES ONO(if no—list other wells) CWCB TOPO 2009-2829 E. State Parcel ID#(optional): MYLAR SB5 DIV WD BA MD • • LEGAL DESCRIPTION • The North Half of the North Half of Section 18, Township 3 North, Range 64 West of the 6r" P.M., Weld County, Colorado, described by metes and bounds as follows: Beginning at a found 3 %" aluminum cap in a range box stamped PLS 10855 at the Northwest corner of said Northwest Quarter; Thence North 89°09'05" East(assumed bearings)for 2453.97 feet along the north line of said Northwest Quarter to a found 2 '/=" aluminum cap approximately 1.8' below asphalt road surface stamped LS 24670; Thence South 00°40'50" East for 661.79 feet along the East line of said Northwest Quarter to a set 3 '/4" aluminum cap stamped LS 37067; Thence South 89°07'46"West for 2417.30 feet along the south line of said North Half of the North Half of the Northwest Quarter to a '/:" rebar with 1" yellow plastic cap stamped PLS 10855; Thence continuing South 89°07'46"West for 39.87 feet along said South line to the west line of said Northwest Quarter; Thence North 00°24'15"West for 662.74 feet along said West line to the POINT OF BEGINNING. Containing 1,626,206 square feet. The North line of said Northwest Quarter is assumed to bear North 89°09'05" East with all other bearings referenced thereto. • Lamp, Rynearson&Associates, Inc. P:\engineering\0208037\survey\text\0208037 legal description February 4,2009 • I • • • DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1 N 17TH 631 • GREELEY, CO 80631 WEBSITE: www.co.weld.co.us ' ADMINISTRATION (970) 304-6410 FAX (970) 304-6412 O PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420 FAX (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES (970) 304-6415 COLORADO FAX (970) 304-6411 THIS PACKET PROVIDES THE FORMS NEEDED TO APPLY FOR A PERMIT TO INSTALL AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM WHEN ALL REGULATORY REQUIREMENTS CAN BE MET. ALL PERMIT APPLICATIONS MUST BE SIGNED BY THE O WNER/AUTHORIZED AGENT. NO PERMIT APPLICATIONS WILL BE ACCEPTED BY MAIL. PROCESSING TIME: Please allow FIVE (5) working days from the date of the inspection to process your permit. APPLICATION FORMS/FEES: The following forms must be submitted to schedule your inspection. A PERMIT WILL NOT BE ISSUED UNTIL THESE ITEMS ARE SUBMITTED. • ( ) 1. COMPLETED INFORMATION PAGE: with appropriate fee of$500.00 for Residential, $600.00 for Commercial, or $100.00 for Minor Repair Permit. ( ) 2. ENGINEERING: Soil tests, geological report, engineered design less than (20) twenty years old (if necessary), AND site plan. TWO signed and stamped originals are required. ( ) 3. PARCEL NUMBER: This can be obtained from the Assessor's office at (970) 353-3845 ext 3650, or on the county website under property information and maps. ( ) 4. AUTHORIZATION FORM: Completed if applicant is not the property owner. ( ) 5. MAP TO PROPERTY. Prior to permit issuance, a site inspection will be made. Please be sure the SITE is marked, and the location of the WELL or CISTERN and ABSORPTION SYSTEM are also marked with stakes or flagging. If we can't find your site, we cannot process your application! • If you have any questions regarding the permitting process for individual sewage disposal systems, please call (970) 304-6415. a itot SEPTIC PERMIT INFORMATION FORM COLORADO To obtain an I.S.D.S. permit, one must file an"application for Individual Sewage Disposal System" at the Weld County Environmental Health Services office and pay the application fee. A"repair"fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be provided on the septic information form. MMERCIAL PERMIT X RESIDENTIAL PERMIT (ANEW r REPAIR $600.00 NEW or REPAIR $500.00 VAULT PERMIT MINOR REPAIR PERMIT NEW or REPAIR$150.00 $100.00 PARCEL NO.: 121518000018 (12 DIGIT NUMBER) LEGAL DESCRIPTION: SECTION 18 TOWNSHIP 3N RANGE 64W ACRES 35 SUBDIVISION N/A LOT BLOCK FILING THIS INFORMATION CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 SITE ADDRESS 15988 WCR 49, LaSalle, CO 80645 DIRECTIONS TO SITE From WCR 49 go east on WCR 32 approximately 4/10 of a mile. The proposed lity is south of the existing oil & gas tanks on the south side of WCR 32. PROPERTY OWNER: Lone Star, LLC (Jim Lee) MAILING ADDRESS: 1701 N Hwy 385 CITY Andrews ST TX ZIP 70714 HOME PHONE: ( 432) 638-9471 WORK PHONE(800 ) 367-4550 FAX(432) 523-9601 Jim Lee@palmertank.net EMAIL ADDRESS: APPLICANT NAME: Lamp, Rynearson & Associates, Inc. (Dan Hull, PE) MAILING ADDRESS: 808 8th Street CITY Greeley ST CO ZIP 80631 HOME PHONE: ( 970) 301-1047 WORK PHONE( 9713 356-6362 FAX()70 ) 156-6486 EMAIL ADDRESS: Dan.Hull@LRA-inc.com DESCRIPTION OF BUILDING(EX: HOUSE, MOBILE HOME,MODULAR, SHOP,OFFICE) Modular IF OBTAINING A REPAIR PERMIT, WHAT IS BEING REPAIRED? N/A NUMBER OF PERSONS 6 IN FLOOD PLAIN AREA? YES itT0 NUMBER OF BEDROOMS 0 ARE PERCOLATION HOLES MARKED FOR INSPECTION?, ES O BASEMENT PLUMBING YES ,NO CENSUS TRACT BATHROOMS: FULL 1 %III /z LIC WATER SUPPLY YES/r/Ii) NAME PRIVATE WATER SUPPLY YES/NO WTI)/CISTERN PERMIT# 37044 • • d • DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 1555 17th Avenue Gree ley,y, CO 80631 WEBSITE: www.co.weld.co.us ADMINISTRATION: (970) 304-6410 WI I I g C FAX: (970) 304-6412 PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420 FAX: (970) 304-6416 ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415 COLORADO FAX: (970) 304-6411 AUTHORIZATION FORM RE: xx PERMIT APPLICATION I.S.D.S. EVALUATION SALE OF PROPERTY WATER SAMPLE I Dan Hull represent Lone Star, LLC (Jim Lee) for the property (Agent/Applicant) (Owner) located at 15988 WCR 49, Weld County, Colorado LEGAL DESCRIPTION: SEC 18 TWN 3N RNG 64W • SUBDIVISION NAME: N/A LOT BLK I can be contacted at the following phone #'s: Home (970) 301-1047 Work (970) 356-6362 Fax# (970) 356-6486 The property owner can be contacted at the following phone #'s Home (432) 638-9471 Work (800) 367-4550 Fax# (432) 523-9601 Correspondence mailed to (only one): (XX Agent/Applicant Property Owner DATE L/z• �°� OWNER'S SIGNATURE • • 1 PLEASE DRAW A MAP TO YOUR PROPERTY. • N t I 13 I 6xISTI,C) 6I I TANK GA ti 1 O 0 L 1 , ri / .(IS TIN b -• tC11 V/ Tp-1(:IPI , I I x, a - I • 3 I • Hello