HomeMy WebLinkAbout20080123.tiff Form No. OFFICE OF THE.TATE ENGINEER
GWS-25 COLORADO DIV�5ION OF WATER RESOURC
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303)866-3581 EXST
' WELL PERMIT NUMBER 275131
II
APPLICANT DIV. 8 WD 1 DES. BASIN 5 MD 9
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 NE 1/4 Section 27
GARY NOVOTNY Township 2 N Range 62 W Sixth P.M.
39592 WCR 18 DISTANCES FROM SECTION LINES
ROGGEN, CO 80652- 168 Ft. from North Section Line
1980 Ft. from East Section Line
(303) 849-5361 UTM COORDINATES (Meters,Zone:13,NAD83)
PERMIT TO USE AN EXISTING WELL Easting: Northing:
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 liability 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) Approved pursuant to CRS 37-90-105 for a change of use from that permitted under permit no.208893 and as one well to
• be used in one commercial business described as a resale/salvage yard. The commercial business must meet the
qualifications as defined in CRS 37-90-105(1)(c)(II). Use of this well in a commercial business having another small
capacity commercial well is prohibited unless a new permit to use this well is granted. Issuance of this permit cancels
permit no. 208893.
4) Water from this well may be used for domestic purposes inside 1 single family dwelling(s), and the watering of the
owners own large non-commercial domestic animals.
5) The pumping rate of this well shall not exceed 15 GPM.
6) The annual withdrawal of ground water from this well shall not exceed 3 acre-feet.
7) The irrigated area shall not exceed 1 acre of lawn and garden.
8) Production is limited to the alluvium of Bijou Creek or its tributaries. The depth of this well shall not exceed 120 feet or the
depth at which sandstone or shale is first encountered,whichever comes first.
9) This well shall be constructed within 300 feet of the location specified on this permit.
10) 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 NorthKiowa-Bijou
Ground Water Management District and the Division of Water Resources upon request.
NOTE: Noncompliance with the procedures outlined in the attached information sheet(form GWS-5)may void your well
permit.
2008-0123
,...T00;fi14_
For State Engineer By 1ØPROVED
ceipt No. 3620574 DATE ISSUED 09-05-2007 EXPIR 1O E It• 41 or 'A,
Form No. OFFICE OF THE OM ENGINEER •
GWS-25 COLORADO DMt.JN OF WATER RESOURCES
•
818 Centennial Bldg., 1313 Sherman SL, Denver, Colorado 80203
(303) 866-3581 -
LR
•
• WELL PERMIT NUMBER 208893 -
APPLICANT DIV. 8 CNTY. 62 WD 1 DES. BASIN 5 MD 9
Lot: Block: Filing: Subdiv:
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 NE 1/4 Section 27
GARY L & MARY NOVOTNY
39592 WCR 18 Twp 2 N RANGE 62 W 6th P.M.
ROGGEN CO 80652-
DISTANCES FROM SECTION LINES
(303)849-5361 168 Ft. from North Section Line
1980 Ft. from East Section Line
REGISTRATION OF EXISTING WELL
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 the
permit does not assure the applicant 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) This well is recorded and permit approved pursuant to CRS 37-92-602(5). The use of this well is limited to the
historical use as recorded with this office and by the terms of CRS 37-90-105, being a well used for domestic
purposes inside one single family dwelling(s) and irrigating no more than 30,000 square feet of lawn and garden,
with a maximum pumping rate of 14 GPM.
4) The date of first beneficial use, as claimed by the applicant is early 1940.
5) This permit has been approved with a change to the permit application form from that applied for by the
applicants. 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.). ___ 3- i/9/7 8.
•
OWNER'S COPY
APPROVED hear •
JWBReceipt No. 0426694 DATE ISSUED APR 09 19an BXP TION DATE �''
AUG-08-07 12:20PM FROM-Colo Div of Water Resources +30?8663569 T-485 P.002/002 F-565
• STATE OFtOLORADO
OFFICE OF THE STATE ENGINEER
Division of Water Resources
Department of Natural Resources `
• 1313 Sherman Street Roam 818 ,^
Denver,Colorado 80203
Phone(309)8683581
FM(303)8863689
hnp:llwww.weter.etete.to.ue alp Rleer.Jr.
Governer
August 8,2007
Hartle D.Sherman
Executive Director
areM
State Engineer
Annette Peters
PO Box 122
Roggen, CO 80652
Re: Well Permit No. 208893
Dear Mrs. Peters,
On July 31, 2007 we spoke over the phone about your domestic well with permit no.
208893. You had questions concerning the requirements for changing the use of the well
to allow for commercial use, because you were intending to put a salvage yard on your
property. Furthermore,you mentioned that before the county could rezone the property:
commercial,they needed evidence that the well could be changed to commercial use.
After talking with you a little further,you mentioned that you would not be running water
• from the well to the salvage yard,and the water would only be used in the home. If this
is the case well permit 208893 does not need to be changed to allow commercial use.
Again, as long as the well is only be used for the currently permitted domestic uses, and
not being used in any capacity in the salvage yard, no change of use is required.
If you should have any additional questions please contact me at this office.303-866-
3581 ext. 8253.
Sincerely, I\
Chris Grimes
Engineering Technician
•
•
51'AIE O?COLORADO
OFFICE OF THE STATE ENGINEER
dlvision of Water Resources oe co��,
epartment of Natural Resources �` R,�
1313 Sherman Street, Room 818 .
Denver,Colorado 80203 'rwre'
Phone(303)866-3581
FAX(303)866-3589
Bill Ritter,Jr.
http'.//www.water.state co us
August 16, 2007 Governor
Harris D.Sherman
Annette Peters Executive Director
P. O. Box 122 (Vacant)
Roggen, CO 80652 State Engineer
RE: Well Permit No. 208893(Rec. 426694)
Dear Ms. Peters:
Your request for information concerning the use of ground water for permit no. 208893 has been
received and reviewed. The well was registered for domestic use inside one single family
dwelling and 30,000 square feet of lawn and garden irrigation. As long as the well is used for the
approved domestic and lawn and garden purposes, with no use in a the commercial business, you
do not have to make changes to the permit.
If you have further questions concerning this matter, please contact this office.
• Sincerely
andy Johnson
Engineering/ ysi..I .ci:nce Technician
Designated asins e'm
•
I
COLORADO DIVISION OF WA RESOURCES Office Use Only • Form GWS-45(06/2006)
DEPARTMENT OF NATURAL RESOURCES `):C Ef VEO
1313 SHERMAN ST,RM 818, DENVER,CO 80203
phone—info:(303)866-3587 main:(303)866-3581 fax:(303)866-3589
http://www.water.state.co.us .A062, 'l 2007
�ENERALPURPOSE
Water Well Permit Application TATE RESOURCES
Review instructions on reverse side prior to completing form. COO,
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.
Go% J civ T J o t_n , 0 Industrial ❑Other(describe):
Mailing address Ni ❑Municipal
eck 5,g a �Ct `V ❑Irrigation .
Ciy State� l Zip code j Commercial/, do QYIeS4'/C
� e h co co 7.Well Data (proposed)
Telephone�9�� / E-mail(Optional)
(3dS) -q - 5 a(O I Maximum pumping rate m Annual amount to be withdrawn
l �5 gp 2.Type Of Application (check applicable boxes) 3 acre-feet
Total depth Aquifer
❑ Construct new well ®Use existing well •
�1
❑ Replace existing well $1 Change or increase use I O�o feet
❑Change source(aquifer) ❑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)
Well permit# Water Court case al
Designated Basin O? rci Determination# Well name or# •
S
4. Location Of Proposed Well .
• (If used for crop irrigation,attach a scaled map that shows inigated area.)
County
\Ne_A6, N,m,,,,athe MC 1/4 A. sr Acres /l B. Owner r.��� /',,
Section V'+` Township N ix S Range E w W Principal Meridian 4/v a�(i kb() 4/ (/
Q1
e N ❑ I 2, ❑ ® J -E,fV C. List any other wells or water rights used on the land: �./
• r 10 (P
Distance of well from section lines(sectionlines are typically not properly lines) NI -
i (a Y Ft from p N❑S ( 9 '6,o Ft fmmr E❑W 9. Proposed Well Driller License#(optional):
For replacement wells only-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) n®check t well address is same as in Item 1. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
3 g„. W el S 9 C e l R v fl�.e y,,to• ?t)4 sa 244-104(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: 3. '
n
AL7f7ez...70„.<4
o?i of
Format must be UTM V ennt� (/D name 8 title yI
❑Zone 12 or❑Zone 13 Easting / Ae Alb J .'1 ow ATe ,p
pt
Units must be Meters
Datum must be NADe3 Northing Office se Only
Unit must be set to true north USGB map name DWR map no. Surface elev.
Was GPS unit checked for above? ❑YES Remember to set Datum to NAM
5. Parcel On Which Well Will Be Located Receipt area only
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)
A. Legal Description(may be provided as an attachment):
l\ w Yy N Elk( - c*'on 27 71-op 2A) Trans Number 3620574
(2\a/n✓ L
G2 2 'FJnP
8127/2007 12:13:24 PM
on
. James Merlin(19)
Total Trans Amt:9100.00
CHECK
Check N1 Mbar' IAZB
B. a of acres in parcel (C..�' Owner I III WE Check Amount: $100.00
/ O Car 3 AJ0004n j WR
•D. Will this be the only well on lnls parcel?AYES ❑NO Of no list other wells) J CWCB
��� TOPO
E. State Parcel ID#(optional): MYLAR
SOS DIV WD BA MD
Colorado Division of Water Resources • •lication Receipt No.
137'3 Sherman St. Rm. 818
Denver, CO 80203 Applicant's Name
(303) 866-3581
http://water.state.co.us/default.htm
5ECEIVE
• COMMERCIAL SMALL CAPACITY WELL WATER USE BREAKDOWN WORKSHEET
(For Wells Located Within Designated Groundwater Basins)
Name and Type of Business Gar U, N by 0 4-y, _ Sad dayy( i / 'j pC.4,le a nesou
J ✓ -rv,rs Elwin)
1. Is this application for a new well? COW,
Yes
X No If no, is this application for a change of use for an existing permitted well?
K Yes Permit Number of well (if applicable) a 09;893
_ No For wells used prior to May 8, 1972 see form GWS-12 Registration of Existing Well
for further information.
2. Type of disposal system:
J{ Septic tank/absorption leach field
' Central System (district name:)
Vault (location sewage hauled to: I
Other (attach copy of engineering design)
3. Water Demand Calculations (for average factors for water demand see below)
Employees -
I
Number of X Number of Gallons X Number of Days = Gallons per Year
Employees per Employee per Day Employee Works per Year
(a X 1 X a6o = dg, , 5oo A
•ustomers
Number of X Number of Gallons X Number of Days Business = Gallons per Year
Customers per Day per Customer is Open per Year
3 X 5 X a co = -/1 )CO B
Outside
Square Feet of X Number of Gallons X Number of Days = Gallons per Year
irrigated Landscape per square foot per landscape is irrigated
day
3000 x ,41 c, x / Oa = 4 600 C
Other Uses - Provide breakdowns for all other substantial water usage (i.e. veterinary clinic, green houses, etc.)
Type of Use X Gallons per Use per X Days per Year = Gallons per Year
Day
X X = A/A D
Total amount of water required: R/1 75:-, gallons per year
(A+B+C+D)
e5 td2egaacre-ft per year
(1 acre-ft = 325,851 gallons)
0 . 3
General Guidelines for Water Demand in Gallons Der Day +. Fa-4otDay Workers at Offices - 15 gallons/person/day
d Service Establishments(with toilet and kitchen wastes) - 10 gallons/patron/day
urches (does not include food service) -5 gallons/seat/day
Overnight Lodging-50 gallons/customer/day (, J Q.
Landscape Irrigation -45 gallons/1,000 square feet/day /^/
On-Site Proprietor of Overnight Lodging (i.e. on-site owner of a Bed &Breakfast) -80 gallons/person/day ,Sat ,V
Additional water demand figures may be obtained from a private water consultant or from a technical reference on this subject. GWS-61 U
12/00
Colorado Division of Water Resources •
1313 Sherman Si.Rm.818 ,ii (`i y '' 2007 ApplicatiaRReceipt No.
Denver,CO 80203
(303)866-3581 Applicant's Name
'nJATER RESOURCES
http'/Mater state.caul/default.htm .T:ATE ENGINEER
0060.
• SUPPLEMENTAL INFORMATION FOR SMALL CAPACITY COMMERCIAL WELL PERMIT APPLICATIONS
(For Wells Located Within Designated Groundwater Basins)
Small capacity commercial well permit applications are evaluated pursuant to the provisions of CRS 37-90-105, which
allows for one well in one commercial business. Pending approval, the use of this proposed well for a commercial
business having another small capacity commercial well is prohibited. This supplemental information form is
necessary in order to determine whether your application qualifies within the provisions of this statute.
Please answer the following questions using type or black ink. If additional space is needed, identify the question number
on a separate sheet, then attach to this form. This form must be signed and dated below.
1. Name the type of business this proposed well will serve. Saiur, Ge () arc( / `eta f'
2. Will you own and operate this proposed well and the commercial business) 1.3 f
• If not, please explain who will own and operate this well and the business served by this well?
3. Do you qualify as one commercial business as defined under CRS 37-90-105(1)(c)(II) (see below for referenced
statute). ,J�
4. Do you current y have a valid permit for any other small capacity commercial well inside any Designated Ground
Water Basin in Colorado? ^3O
• If so, please provide the permit number(s)of,any valid permit(s) ypu have.
• . .
I (we) have read the statement made herein, know the content thereof, and state that they are true to my (our) knowledge.
[Pursuant to section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the second
degree and is punishable as a Class 1 misdemeanor.) l
Name/Title (print or type): />CAR j /�/O✓a l J)/ c>cv.4.)€‹
Signature /�/ ��.,A. Date: p - oR 7-07
J 777 /
Under CRS 37-90-105- Small Capacity Wells, paragraph (1)(c) (II) reads as follows:
To qualify as a "commercial business" under this paragraph (c), the business shall be:
(A) A business that will be operated by the well owner and that will have its own books, bank accounts, checking
accounts, and separate tax returns;
(B) A business that will use water solely on the land indicated in the permit for the well and for the purposes stated in
such permit;
(C) A business that will maintain its individual assets and will own or lease the property on which the well is to be located
or where the business is operated;
(D) A business that will have its own contractual agreements for operation of the business;
(E) A business that agrees not to transfer a permit issued under this paragraph (c) to another entity that also holds a
Osmall capacity commercial well permit under this paragraph (c); and
) A business that agrees to notify any potential buyer that such buyer shall notify the state engineer of any change in
ownership of such business within sixty days after any such change in ownership.
GWS-58
12/00
n.. WEL UNTY HEALTH DEPARTMENT a SE # :?i//�-'V ,2
ENVI MENTAL PROTECTION SERVICES ORG PERMIT#
Atha 1517 16TH AVENUE COURT REPAIR#
GREELEY, COLORADO 80631 LOAN #
PHONE: (970) 353-0635 ISDS # V/ z%G.
• FAX: (970) 356-4966
STATEMENT OF EXISTING FOR SEPTIC SYSTEM
(PLEASE FILL OUT IN BLACK INK ONLY)
PARCEL# / O / ;)-7 OO0O /i7
PROPERTY OW ER(kçt iVAdor.07 id 1427 AA.01/2,7 PHONE NO. (}04 ) gq9 c7 /
MAILING ADDRESS ,39S9C2 (V /f eiJ LS6)6 cc;
Cify State Zip
DESCRIPTION OF BUILDING (ex. house, mobile/modular home,shop,office) 711OdSC
SITE/LOCATION ADDRESS 390907 zuve /f ,-7,3}celJ (6 e)6;fid-
Ci{y State Zip
LEGAL DESCRIPTION PT/1 ' PTA}64 SECTION 6-.R2 TOWNSHIP-7,V RANGE4 ( )
SUBDIVISION /t)eeQ LOT /JA BLOCK/.1A FILING ALA
CENCUS TRACT A)* LOT SIZE/ACRES
COMMERCIAL YES/1Y0" RESIDENTIAL S 'N
NUMBER OF PERSONS 9 BASEME PLUMBING YES ' I
BEDROOMS 3 . BATHROOMS FULL 3/C 1/2
WATER SUPPLY PUBLIC _ UTILITY E
OFAIVATE /NO CISTERN YES ` I WELILS LL NO WELL PERMIT#1R 7a7JV±
SYSTEM SIZE: Septic tank material is constructed of(7,,iceeA and has ( 00 -'s-b° {4allons capacity.
FIELD: Trench square feet or Bed'),U lit“,-�,' square feet YEAR INSTALLEK
6.6Vg'.4fia,✓ on*Sac ;OOO #4
You are required to draw a diagram of the system on the reverse side of this form in black ink only and indicate
location, length,width,and distance from the dwelling..
The undersigned property owner hereby certifies that the above described septic system is in fact installed, as
described, and exists at this time on the parcel of ground identified by the above legal description and further states
that the system is/is not in good working order and to the best of his/her knowledge is/is not failing to function
properly.
I further understand that any falsification or misrepresentation may result in revocation of any permit granted based
upon this information hereby submitted and in legal action for erjury as rovided by law.
DATE
C✓
Subst J*d and swop to before me this `/ day of r .I_ l,U,/i' .__199, ( ,
�
by--±'t LiAAlti 1! �
Witness my had and official seal. My commission expires: " / 7 /2Q(y.1/it I
p i) 1'
1 11 I(L�_ /( c j�41,/./e/,"I-
TE NOTARY PUBLIC '/
STATEMENT OF EXISTING REVIEWED BY �ti` .- ,
ENVIRONMENTAL PROTECTION SPECIALIST
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