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Home My WebLink About20100523.tiff Form No. OFFICE OF THE STATE ENGINEER GWS-25 COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 (303)866-3581 • LR WELL PERMIT NUMBER 273367 - - APPLICANT DIV. 1 WD 3 DES. BASIN MD APPROVED WELL LOCATION WELD COUNTY SE 1/4 NW 1/4 Section 9 DONALD DUANE NESVIK Township 5 N Range 65 W Sixth P.M. • 1801 DILMONT AVENUE DISTANCES FROM SECJION LINES GREELEY, CO 80631- 2502 Ft. from North Section Line 2643 Ft. from East Section Line (970)381-2281 UTM COORDINATES (Meters,Zone:13,NAD83I REGISTRATION OF EXISTING WELL Easting: 528143 Northing: 4473767 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) Construction details for this existing well have not been provided to this office; therefore,it Is not known if the construction of this well is in compliance with the Water Well Construction Rules,2 CCR 402-2. The issuance of this permit does not relieve the well owner of responsibility or IiabHity in the event contamination of the groundwater source results from the construction or use of this well,nor does the State Engineer assume any responsibility or liability should contamination occur. 3) This well is recorded and permit approved in accordance with CRS 37-92-602(5)for historical use as indicated herein and described in CRS 37-92-602(1)(e), being a well producing 20 GPM and used for ordinary household purposes inside one(1)single family dwelling(s),the watering of domestic animals and poultry,and the Irrigation of not more than 10,000 square feet of home gardens and lawns. 4) The date of first beneficial use,as claimed by the applicant,is December 31, 1886. NOTICE:This permit has been approved subject to the following changes:The distances from section lines were calculated from UTM coordinate values provided with the permit application. You are hereby notified that you have the right to appeal the issuance of this permit,by filing a written request with this office within sixty(60)days of the date of issuance, pursuant to the State Administrative Procedures Act. (See Section 24-4-104 through 106,C.R.S.) 4-p.13 . ay 'go, R �,T. APPROVED ADB 1G 042nu— • Z • y I.Rece't t No.3631604 State Engineer DATE ISSUED 08-08-2008 B EXPIRATION DATE d r 2010-0523 ww • 1 r. nof c._ --- evc -i -hauls b nc. ITI STATE OF COLORADO For Office Use Only 1 OFFICE OF THE STATE ENGINEER 1 GW'S-I 1 B18 Centennial Bldg., 1313 Sherman St.,Denver,CO 80203 ! 6;2003 (303) 866-3581 Fax (303)866-3589 CHANGE IN OWNERSHIP/ADDRESS CORRECTION OF THE WELL LOCATION Insert the Well Permit Number 8.3 6 )� Name. address and phone of the person claiming ownership of the well:liliMIL/1:21t-- `l 1 e Rut at;i; v-.-- NAME(S) — — Mailing Address 1o°3 - 110 vv-A- City, St.Zip- � CIO C1 C1O(of) I__________ Phone ( I - —�.^ — This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above. This Mina is made pursuant to C.R.S. 37-90-14 _ Owner's Well Designation�____ WELL LOCATION: County_. 1 (Address) - (City ) (State) (Zip) 114 of the ._- 1/4, Sec. Twp. [1 N. or❑S., Range I E. or W., P.M. I r ' i1 Distance from Section Lines _ Ft. From L N. or_ S., FL From E. or W. Line. Subdivision Name _ _ _— �_. Lot , Block__ , Filing/Unit —__ The above listed owner(s)say(s) that he, she (they)own the well described herein_ The existing record is being amended for the following reasons: n Change in name of owner ❑Change in mailing address riCorrection of location for exempt wells permitted prior to May 8, 1972 and non-exempt wells permitted before May 17, 1965. Please see the reverse side for further information regarding correction of the well location. - I (we) claim and say that I (we) (are) the owner(s)of the well described above, know the contents of the statements made herein, and stale that they are true to my (our) knowledge. Please print the Signer's Name& Title Sign re(s)of the new owner_ Date 0\-onZC\ Qc) 2m0S\ It is the responsibility of the new owner of this well to complete and sign the form. Signatures of agents are acceptable if an original letter of agency signed by the owner is attached to the form upon its receipt. For Office Use Only State Engineer By Date INDIVIDUAL SL:WA(.d. DISPOSAL SYSTEM PERMIT I:"i N(:1. G-880099 WI:::L.I) COUNTY HEALTH DEPARTMENT REPAIR PERMIT ENVIRONMENTAL HEALTH SERVICES 1516 HOSPITAL ROAD . GFtE::I: L EY , CO 00631 353-0635 EXT...'..'A.'.5 4NI..:R PHILLIPS . JOSEPH & ALICE ADDRESS 4503 CAROL... AVI:::IIUE PH (415) 657-020 020 F RE::MON . (::r•1 9453(1 °DRE:SS OF PROPOSED D YS'TF:M 703 E. 16TH STREET GREELEY . CO 80)C6:31 :::GAL DESCRIPTION OF SITE : ≥ W4 NE4 SEC 9 TWF' 5 F.NG 65 k.JBDIVISI.ON : LOT 0 BLOCK 0 FILING 0 EE TYPE : RE::,'iIDE:NTIAI... LIMITING ZONE : 6.4 FEET ERV1:CE S : PERSONS 2 BATHROOMS 1 .00 LOT SIZE 1 .00 ACRES BEDROOMS 2 BASEMENT PLUMPING NO WATER SUPPLY PWE:I._L.. i.F:.l._l:C:ATI:(]N FEE $100.00 ECID BY RECEPTIONIST AID SIGNED BY ALI.CF:. I . PHILLIPS DATE 05/11 /80 DATE 05/11 /00 ERCOLAT1:ON RATE 5.2 MIN PER INCH LIMITING ZONE 6 FEET C)1:I.•. TYPE Sl.1:L1ABL..E PERCENT (:;ROUND ::LOF :: 0% DIRECTION EG'U:F.RES ENGINEER DESIGN NO ROM THE: APPLICATION INFORMATION SUPPLIED ANI) THE ON—SITE SOI:L.. PERCOLATION DATA HE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS ARE REQUIRED : SEPTIC TANK 1 000 GALLONS . 40MSORPTION TRENCH 250 SO. FT . ---Cum__-- .. . r�us(:IRp'T :FON DIED 3;36 _.1Y i T N P...°tiITT:ON. THIS PERMIT IS SUBJECT TO THE TUL.L..C NG -ADDTTTTnN L TERMS ANI) ON IONS : __........._._............_.._........_....__.................................. _.............._._....._.._........_....._.....__......_........._....._..__._..._._._._..........._._._._..... HIS PERMIT iii Is GRANTED TEMPORARILY TO ALLOW CONSTRUCTION TO COMMENCE. THIS PERMIT AY BE REVOKED OR SUSPENDED BY THE WELD COUNTY HEALTH DEPARTMENT FOR REASONS SET ORTH IN THE WELD COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS INCLUDING AILURE TO MEET ANY TERM OR CONDITION IMPOSED THEREON DURING TEMPORARY OR FINAL II ROYAL. THE ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE ASSUMPTION BY THE I :PAR•FME:NT OR ITS EMPLOYEES OF LIABILITY LtII...:I:•T••Y FOR THE FAILURE OR INADEQUACY OF:. THE I:::WAC;E: DISPOSAL SYSTEM. . . .i.NL ALICE R:I:NEBOLI) 05/12/80 -.1' c . k ::i .iv.. ENVIRONMENTAL ,SPEC:L'AI...:I:ST DATE HIS PERMIT IS NOT TRANSFERABLE AND SHAL.L.. BECOME VOID IF SYSTEM M CONSTRUCTION HAS UT COMMENCED WITHIN ONE YEAR OF ITS ISSUANCE. BEFORE ISSUING FINAL... APPROVAL OF HIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT TO IMPOSE ADDI•-•- IONAL. TERMS AND CONDITIONS REQUIRED TO ME:E:•I- OUR REGULATIONS ON A CONTINUING BA— TS. FINAL... PERMIT APPROVAL_. IS CONTINGENT i.11''ON THE F:I:NAI_. INSPECTION OF THE: COM-- i...ETE.I) SYSTEM BY THE WE:I_.I) COUNTY HEALTH DEPARTMENT. � .aTE:M INSTAL..L..... , ry%� I 'r,C'T�E:i�f...L:i�lL:1:i•al:"f:�l��: ............._.. ...... _FINAL VAI � � !'.j �- FINAL IN`"I'I�(" YI'F.:: (:)I•- SYSTEM EM IN STALLED � � 4,�` ENVIRONMENTAL SPECIALIST i"lE ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTHER STATE , COUNTY R L..00AL.,. REGULATORY OR BUILDING REQUIREMENTS , NOR SHAI...I... IT ACT TO CERTIFY THAT HE B,.ILLT SYSTEM WILL OPERATE IN COMPLIANCE: WITH APPLICABLE STATE , COUNTY ANT) IIIOCAL REGULATIONS ADOPTED PERSUANT T(.1 ARTICLE I...F 10 . TITLE 25 . CRS 1973 . AS AMENDED . XCE::F'T FOR THE: PURPOSE OF I-SIAT:BI._ISH:L'NG FINAL AlPROVraI... OF AN INSTALLED SYSTEM FOR S(JANCE OF A I...O(:;AL. OCCUPANCY PERMIT PURSUANT TO CRS 1973 25-10—iii (2) . F.. l I;INAL...-APPI...:I:(:;AN-r ; COPY--•WEI•n) WEI.1D•••I_HS MAY . i 9R4 tt \\is /\) P,7i� r E/ DI 1\. 4 . /IJOO_, a //afn /6 "` Hello