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Home My WebLink About20053171.tiff Form No.: OFFICE OF THE STATE ENGINEER GW,S-25 COLORADO DIVI' 1N OF WATER RESOURCES • 818 Centennial Bldg., 1313 Sherman St, Denver, Colorado 80203 (303) 866-3581 698 WELL PERMIT NUMBER 045562 _ APPLICANT DIV. 1 CNTY. 62 WD 2 DES. BASIN MD Lot: Block: Filing: Subdiv: APPROVED WELL LOCATION WELD COUNTY DARRELL BEARSON NE 1/4 SW 1/4 Section 27 9743 WCR 16 Twp 2 N RANGE 67 W 6th P.M. FT LUPTON CO 80621- DISTANCES FROM SECTION LINES (303)857-9323 2000 Ft. from South Section Line 2000 Ft. from West Section Line PERMIT TO CONSTRUCT A WELL ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT CONDfIIONS 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. ) Approved pursuant to CRS 37-90-137(4)and the findings of the State Engineer dated O )3r /99 5 4) Production is limited to the Laramie-Fox Hills Aquifer which is located at a depth of approximately 375 feet below land surface and extends to a depth of approximately 645 feet below land surface. Plain casing must be installed and sealed to prevent the withdrawal of ground water from other aquifers and the movement of ground water between aquifers. 5) 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. 6) This well shall be constructed not more than 200 feet from the location specified on this permit. 7) The maximum pumping rate shall not exceed 30 GPM. 8) The allowed average annual amount of ground water to be withdrawn is 23.4 acre-feet 9) The entire length of the hole shall be geophysically logged as required by the Statewide Nontributary Ground Water Rules prior to installing casing. 10) A totalizing flow meter must be installed on the 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. 11) The owner shall mark the well in a conspicuous place with well permit numbers(s), name of the aquifer, and court case numbers(s) as appropriate. The owner shall take necessary means and precautions to preserve these markings. 12) 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. 13) This well is subject to administration by the Division Engineer in accordance with applicable decrees, statutes, rules, and regulations. APPROVED - n 1 DAM A z Receipt No. 0389750 State Engineer DATE ISSUED OCT 16 1995 EXPIRATION DATEOCT 16 199S% 2005-3171 FINDINGS OF THE STATE ENGINEER IN THE MATTER OF AN APPLICATION FOR A PERMIT TO CONSTRUCT A WELL IN WATER DIVISION NO. 1, WELD COUNTY, COLORADO APPLICANT : DARRELL BEARSON AQUIFER: LARAMIE-FOX HILLS PERMIT NO.: MSsz as p In compliance with C.R.S. 37-90-137(1) and the Statewide Nontributary Ground Water Rules, Darrell Bearson, 9743 Weld County Road 16, Ft. Lupton, CO 80621, (hereinafter "applicant") submitted an application for a permit to construct a well. Based on information provided by the applicant and records of the Division of Water Resources, the State Engineer finds as follows: 1. The application was received complete by the State Engineer on August 31, 1995. 2. The applicant proposes to construct the well in the NE1 of the SW1 of Section 27, Township 2 North, Range 67 West, 6th Principal Meridian. 3. The proposed well is located outside the boundaries of a designated ground water basin. 4. The applicant proposes to apply the water withdrawn from the well to the following beneficial uses: Commercial (Dairy operation). 5. The proposed maximum pumping rate of the well is 30 gallons per minute, and the requested average annual amount of ground water to be withdrawn is 25 acre-feet. 6. The applicant is the owner of the land on which the well will be constructed. 7. The proposed well would withdraw ground water from the Laramie-Fox Hills Aquifer (hereinafter "aquifer"), which, according to the Denver Basin Rules, is located at a depth of approximately 375 feet below land surface and extends to approximately 645 feet below land surface at the location of the proposed well. 8. The location of the proposed well is more than 600 feet from any existing well completed in the aquifer. 9. According to a sworn statement, the applicant owns, or has consent to withdraw ground water underlying 80 acres of land as further described in said statement, which is attached hereto as Exhibit A. 10. Withdrawal of ground water from the aquifer underlying the land claimed by the applicant will not, within one hundred years, deplete the flow of a natural stream at an annual rate greater than one-tenth of one percent of the annual rate of withdrawal and therefore the ground water is nontributary ground water as defined in C.R.S. 37-90-103(10.5). ' • , Applicant: Darrell Bea .n Page 2 Aquifer: Laramie-Fox Hills Permit No.: 41662 o 11. In considering whether the requested permit shall be approved the provisions of C.R.S. 37-90-137(4) and the Denver Basin Rules shall apply. Withdrawals shall be allowed on the basis of an aquifer's life of 100 years, C.R.S. 37-90-137(4)(b)(I). 12. The quantity of water in the aquifer, exclusive of artificial recharge, underlying the 80 acres of land described in Exhibit A is 2,340 acre-feet. This determination was based on the following as specified in the Denver Basin Rules: a. The average specific yield of the saturated aquifer materials underlying the land under consideration is 15 percent. b. The average thickness of the saturated aquifer materials underlying the land under consideration is 195 feet. 13. A review of the records in the State Engineer's office has not disclosed that there are any existing wells or other water rights claiming or withdrawing ground water from the aquifer underlying the land claimed by the applicant. Based on the above, the State Engineer finds that there is water available for withdrawal by the proposed well and no material injury to vested water rights would result from the issuance of the requested permit subject to the following conditions: a. The allowed average annual amount of water to be withdrawn from the aquifer by the well shall not exceed 23.4 acre-feet (the quantity of water which is considered available divided by the 100 year aquifer life). b. The well shall be constructed no more than 200 feet from the location specified on the permit application. c. The applicant shall submit geophysical and lithologic logs after the construction of the well. The geophysical logs shall be obtained from the hole before the casings are installed. d. The maximum pumping rate of the well shall not exceed 30 gallons per minute. e. A totalizing flow meter must be installed on the 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. f. Production is limited to the Laramie-Fox Hills Aquifer. The well must be constructed with plain, non-perforated casing properly grouted so as to prevent intermingling of water between aquifers. g. Pursuant to C.R.S. 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 applicant shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98% of the water withdrawn will be consumed. • Applicant: Darrell Bea, n Page 3 Aquifer: Laraeie-Fox Hills Permit No.: 6 e,©pa h. The owner shall mark the well in a conspicuous place with appropriate well permit numbers, name of the aquifer, and court case numbers. He shall take necessary means and precautions to preserve these markings. p Dated this /3 day of R , 19 C/..C. d¢ � ha.". Ha((((D. Simpson State Engineer By: Al Eckermann, P.E. Water Resources Engineer Prepared by: DAM 389750.FDG/Form #0546(o) *y.C("1VED 'NRJ.5-$ev. 76 L ,_ORADO DIVISION OF WATER RESL ICES i� 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 AUG 2 1 '95 PERMIT APPLICATION FORM "�1 1- fy Gn`CwdRP."9 Application must ��v ��Cr':i'E .':4&'tom-:� be complete where - ( X) A PERMIT TO USE GROUND WATER WILD applicable. Type or ( X) A PERMIT TO CONSTRUCT A WELL AG 1 '95 print in BLACK FOR: ( X) A PERMIT TO INSTALL A PUMP INK.No overstrikes (Q'A7ea:•:; or erasures unless ( ) REPLACEMENT FOR NO. -'rApr,`- initialed. ( ) OTHER WATER COURT CASE NO. (1) ANT - mailing �address , ^ ,,_ FOR OFFICE USE LONLY: DO NOT WRITE IN THIS COLUMN NAME APPLIC 'e ""`�"' Receipt No. 3 / 5, / `""' - \ STREET 92K_9 wc4/ Basin Dist. CITY Fee lc94tt ` .0 roe,"ay./ (State) (zip) CONDITIONS OF APPROVAL TELEPHONE NO. 3P 3-- g7 5 — 93. 3 This well shall be used in such a way as to cause • no material injury to existing water rights. The (2) LOCATION OF PROPOSED WELL 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 County jeL0 right from seeking relief in a civil court action. N E's" - S+,off the S 3<, Section �ra-'7 SE- 5-co Twp. !Y, Rng. C.O 7 ', Cfl P.M. a3-"' IN,S) (E,W) (3) WATER USE AND WELL DATA �t Proposed maximum pumping rate (gpm) 3 V Average annual amount of ground water n r" to be appropriated (acre-feet): d�c7 Number of acres to be irrigated: 0 • Proposed total depth (feet): • C.t///-5 0 Aquifer ground water is to be obtained from: IRR,9MiP —FK /7/4.5 Owner's well designation Pelf r y uJ r✓l f GROUND WATER TO BE USED FOR: ( ) HOUSEHOLD USE ONLY - no irrigation (0) ( ) DOMESTIC (1) ( ) INDUSTRIAL (5) (�,�1 LIVESTOCK (2) (• ) IRRIGATION (6) l' COMMERCIAL (4) ( ) MUNICIPAL (81 ( ) OTHER (9) APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) PERMIT NUMBER (4) DRILLER /. DATE ISSUED ^ Name C ,�fove>-s D EXPIRATION DATE Street 714,/ /.t,C 6?j 3 Citytt hvt,pfo "'I ! DA-0 cgt,07-1 r.._r,1(STATEE(�I,CaI,�P1EEF1..__._,_ (State) (Zip) ..,M: !/j p- BY !iv' r 'NCR rrt'F ' Telephone No. 0-"/ oy/ Lic. No. e O / /� I.D. j COUNTY 4Z (5) THE LOCATION OF THE I-..UPOSED WELL and the area on (6) THL vVELL MUST BE LOCATED DELOW- which the water will be used must be indicated on the diagram below. by distances from section lines. Use the CENTER SECTION (1 section, 640 acres) for the well location. .q r C + — + — + - + - '+' - 4_ - + - + - 4_ "C 000 ft. from a �J sec. line (north or south) �4 1 MILE,5280 FEET ey 000 ft. from UV sec. line I (east or west) T - + + + + + LOT BLOCK FILING # I + _ _ I NORTH SECTION LINE I SUBDIVISION I I — 'I- r I I I (7) TRACT ON WHICH WELL WILL BE f NORTH I w_ _ + _ _ _ + _ + I LOCATED Owner: e gfi'J iii 9 lvl 7' L n ± No. ofacres O O . WillthisbeN I -i rn m the only well on this tract?I 6 + (8) PROPOSED CASING PROGRAM 2 Plain Casing— -m + f 1/a in.from 0 ft. to lieet ft. I I I I in. from ft. to ft. + — + SOUTH SECTION LINE — _4_ - i Perforated casing I I I y a in. from yOD ft. to Co SO ft. 4- +- + + 4 4 -I- 4- 4- in.from ft. to ft.' I I I I (9) FOR REPLACEMENT WELLS give distance and direction from old well and plans for plugging - f - + - - - -I- - + - + - + it: �-. The scale of the diagram is 2 inches= 1 mile Each small square represents 40 acres. • • WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second lets) . ..449 gallons per minute(gpm) A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot...43,560 cubic feet. .,325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. - - (10) LAND ON WHICH GROUND WATER QWILL BE USED: • Owner(s): a 7e4fa-j _Mao y 1,2 td .6.12,0—,1,4-0"--, No. of acres: ! e-0 `/ Legal description: 1 -5-1-c-,-fr. Sea .27 7:9241 /4 ?ad 4/m (11) DETAILED DESCRIPT N of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. 1 4 • (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for(purpose) Description of land on which used nfoNe- (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FO TH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. a SIGNATURE OF APPLICANT(SI Use additional sheets of Daoer if more space is reauired. Exy/sir A• .. ( es20 GWSi (Rev.April 1987) STATE OF COLORADO Al OFFICE OF THE STATE ENGINEER 31 9,j DIVISION OF WATER RESOURCES itA7E.?RF, NONTRIBUTARY GROUND WATER LANDOWNERSHIP STATEMENT 1 (We) U a-rreGL Se.R raced (Name) claim and say that I (we) am (are) the owner(s) of the following described property consisting of Fp acres in the County of 4e . O , State of Colorado: (INSERT PROPERTY LEGAL DESCRIPTION) s � y seC .2 7 ram � � 7U 6 p41 . and, that the ground water sought to be withdrawn from the if tgt3nnt"C rot /PO S. aquifer underlying the above-described land has not been conveyed or reserved to another, nor has consent been given to its withdrawal by another. Further, I (we) claim and say that I (we) have read the statements made herein; know the contents hereof; and that the same are true to my (our) own knowledge. Oarrelt Z . [.9ea.rso.d Bradley narre/l /3earsort gel 99 (Signature) (Date) ?Veit.) 4 15,2R2so77 rate e a emirs o "7 g .2C Ci.5 (Signature) (Date) INSTRUCTIONS: ' Please type or print neatly in black ink. This form may be reproduced by photocopy or word processing means. See additional instructions on back. 1313 SHERMAN ST RM 818 DENVER CO 80203 (303)866-3581 L- X/7%8/ T 17 • (pa3c z) «n w. .STATE OF COLORADO 'OFFICE OF THE SPATE ENGINEER °~f �i✓ 818 Centennial Bldg., 1313 Sherman Sc,Denver, Colorado 80203 pa (303) 866-3581 31 45, • NONTRIBUTARY LANDOWNERSHIP OR CONSENT VERIFICATION OF NOTI I (We) B U�ne C(_ oue rry (Name of.Well Permit Applicant) claim and say that I (we) have given notice pursuant to CRS 37-90-137(4)(bS) of the application for a well permit by registered or certified wail, return receipt requested, no less than ten days prior to :raking of the application for'the_permit,to every record owner of the overlying land.and to.every. person who has a lien or mortgage upon, or a deed of trust to, the overlying land recorded in the county in which the overlying land is located. The names of the persons given notice are listed below: 6O6' fine /eD % occ2is/err e91 e15 4Q,No Further, I (we) claim and say that I (we) have read the statements made herein; know the contents hereof; and that the same are true to my (our) own knowledge. 9ar/vI � G. L. Sep ',rot( erne" nlcrreI I Sear<on ��/ ' �F✓C • (Sign e) • (Date) Net/t e..o PS o ,l )yI l S .CS eof !1S'o,7 r- • (Signature) (Date) '^ INSTRUCTIONS PLEASE TYPE OR PRINT NEATLY IN BLACK INK. THIS FORM MAY BE REPRODUCED BY PHOTOCOPY OR WORD PROCESSING MEANS. SEE ADDITIONAL INSTRUCTIONS ON BACK. DARRELL BEARSON ,� RECEIPT NO. 389750 • AQUIFER DEPTH LOCATION: NE1/4 OF SW1/4 OF SEC. 27, T.2N. , R.67W. (2000 SSL, 2000 WSL) Ground Elevation: 5005 Number of Acres: 80 ELEVATION DEPTH TO ANNUAL NET APPROP STATUS AQUIFER BOT. TOP SAND BOT. TOP A-F UPPER DAWSON ---- ---- ---- LOWER DAWSON ---- ---- - -___ ____DENVER UPPER ARAPAHOE ---- ---- ---- ____ LOWER ARAPAHOE LARAMIE-FOX HILLS 4362 4631 189.8 643 .374 22.77 NT note: E indicates location is at aquifer boundary and values may be more approximate. SATURATED THICKNESS ANNUAL APPROPRIATION FOR A. 80 ACRE TRACT LOCATED: SEC. TWP RNG ACRES 27 2N 67 80 NON-TRIBUTARY NOT NON-TRIBUTARY TOTAL AVERAGE ANNUAL AVERAGE ANNUAL ANNUAL AQUIFER ACRES SAT.' APPROP ACRES SAT_ APPROP APPROP UPPER DAWSON LOWER DAWSON DENVER UPPER ARAPAHOE LOWER ARAPAHOE LARAMIE-FOX HILLS 80.0 193.6_x' - 23.2 23 .2 Ig5 X gO X . IS = a, 3 � � � • GWS-18• (April 1987) • STATE OF COLORADO OFFICE OF THE STATE ENGINEER ECE /ED DIVISION OF WATER RESOURCES APR 1 8 1989 NOTICE OF WELL COMPLETION WAgil OTL Well Permit No. 3,/ 7 F • WELL OWNER-Mailing Address Name MICA a I arse .✓ Telephone No. c:7-5-7-_73-7_3 Address 975'3 etic F% l opTDN Ce 1) 106 g/ (Street No. ) (City) (State) (Zip) WELL LOCATION 4/114/4 of the 51_1/4, Section ,27 , Twp. c2 /y , Rng.L7 _6(. , L '_PM 23/49i0 ft. from 50t/TA Sec. Line & a7od ft. from _j0,52- ___ Sec. Line Date of well completion: /o2 —/6 , 19 Y '7 Name and Lic. No. of Contractor: -LL OYO C7,4'4". J42 f (Name) (lic. No. ) Additional information filed pursuant to Rule 7A(6) is attached: (Yes/No) (c(we) claim and say that Owe) 69 (are) the owner(s) of the well described above and that the construction of the well was completed, lawfully, under the well permit, on the date indicated; and the statements made herein are true to my (our) knowledge. This notice if filed in accordance with Section 37-90-137(3)(a) (II) C.R.S. • • (Signature of Owner) (Date) INSTRUCTIONS This form is required for wells constructed under permits approved pursuant to the provisions of Colorado Revised Statute 37-90-137(4) and must be filed with the Division of Water Resources prior to the expiration of the well permit as required by Statewide Nontributary Ground Water Rule 7A. Type or print neatly in black ink. This form may be reproduced by photocopy or word processing means. (DWR OFFICE USE ONLY) • 1313 Sherman Street 8th Floor Dever Colorado 80203 (303) 866-3581 GWS-19, (April 1987) _�� STATE OF COLORADO j•", :.,,* 7. OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES ` i S 12E9 14147.2 .7174-rt,T.1 NOTICE OF COMMENCEMENT OF BENEFICIAL USE Fa Well Permit No. 3 4-//77•/-1- WELL OWNER-Mailing Address f„Name /Gn a I Beet r sco/2" Telephone No. 337 930;3 Address 974/3 LOC 41 /4 Frio iateit/ COL d 5--O601/ (Street No. ) (City) • (State) (Zip) WELL LOCATION/V'±'1/4 of the 5LL 1/4, Section a7, Twp. 2 N Rng. to 7 LA" € PM p) vac, ft. from .,SDor/1 Sec. Line & ,1VDo ft. from cas'T Sec. Line Date of first beneficial use of ground water: / a /O -, 19 g7 Use ,QQf the ground water Se 7'3C ThHA'S ./eoc f''eLQ/ £2(/ 3' `uesrock Glct(R J 0 p retTjQ r! c,• - ' a.dare-L of,FeCC 4r S .`�'- I (we) claim and say that I (we) am (are) the owner(s) of the well described above and that the commencement of beneficial use of ground water from this well, lawfully made under the well permit, occured on the date indicated; and that the statements made herein are true to my (our) knowledge. This notice is filed in accordance with Section 37-90-137(3) (a) (II) , C.R.S. /7-97 (Signature of Owner) (Date) INSTRUCTIONS This form is required for wells approved under permits issued pursuant to the provisions of Colorado Revised Statute 37-90-137(4) and must be filed with the Division of Water Resources within 30 days after the first commencement of use. Type or print neatly in black ink. This form may be reproduced by photocopy or word processing means. • (DWR OFFICE USE ONLY) • • • • 1313 Sherman Street 8th Floor Denver Colorado 80203 (303) 866-3581 _JLORADO DIVISION OF WATER RE:,•.URCES • Tras FORM MUST BE SUBMITTED 1313 Sherman Street - Room 813 FEB i, 5 '^r),3 WIiHn 60 DAYS OF COMPLETION Denver, Colorado 80203 ( ' THE WORK DESCRIBED HERE- WATER RSSOURC%G Ii I.TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION N REPORT EA„.3• ENGINE_a R• - PERMIT NUMBER WS-( ! / -F mlB_ WELL OWNER Minhal 4 Rparcnn NW % of the SE % of Sec. 77 ADDRESS 10501 WCR # 25 1/2 T. 2 N R 67 W 6th. I @'t. Lupton, CU. 8U621 ' DATE COMPLETED 17-10 , 19 R7 HOLE DIAMETER WELL LOG • 8 3/4 in. from 0 to 620 ft. Water From To Type and Color of Material Loc. — in. from to ft. 0 14 Brown sandy clay in. from to ft. 14 90 Brown clay DRILLING METHOD Rotary 90 264 Blue shale CASING RECORD: Plain Casing 264 403 Blue shale/thin layers of coal 6 5/8" steel 0 435 403 435 Blue shale 435 Size _ & kind from to 435 610 Fox Hills sands 610 610 620 Blue shale Size & kind from to Size & kind from to Perforated Casing Size 6 5/8& kind steel from 435 to 620 Size & kind from to Size & kind from to GROUTING RECORD Cement Material 00-435 Intervals i LOG Placement Method Pump SICA Ran cementing basket at 435' L ��111 GRAVEL PACK: Size z. 1 I Y I ' I 4 . " Interval e Fi TEST DATA 12-10 8" Date Tested , 19 _ Static Water Level Prior to Test 136 Type of Test Pump Air Length of Test 3 hrs. Sustained Yield (Metered) 40 GPM TOTAL DEPTH 620' Use additional pages necessary to complete log. Final Pumping Water Level Jet from 600' • io Evi Eece GCOPI'1J-(c.tL LOG (UGCEivcO • PUMP INSTALLATION RERa`RT --a. 1r?i"-t Pump Make T >' rowered by HP • A Pump Serial No. w a WATER Motor Serial No. • w �> TABLE 1; `j w �,w Date Installeo < J .,v^ Cr w Pump Intake Depth _ _ _ _ It Remarks t. :'r a ?` x p . w - 's .o q r.., x , • 'n` : f i, WELL TEST DATA WITH PERMANENT PUMP a ••K:1- `ij 0 I— Date Tested -J r • CONE OF 4a— a .:.a DEPRESSION Static Water Level Prior to Test ° o is iy Lagth of Test Hours ` . 11/4.:!1 ,.3tained yield (Metered) GPM ► l Pumping Water Level 11, Remarks ti,-. `y y;'-;r • it CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation described hereon; that he has read the statement made hereon; knows the content thereof, and that the same is true of his own knowledge. Signature � License No. 227 State of Colorado, County of ,TeffPrcnn SS Subscribed and sworn to betore me this Sth day of Fell , 19 REL. ..-. 4 • My Commission e pire Peb , 19 92 . Notary Public " ti 2c!1,�"fl� X,A,u) I FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller. B]R-2u-J] !� k \ cj A D .."... COLORADO DIVISION OF WATER RESOURCES I `, J r-( VA IS FORM MUST BE SUBMITTED 1313 Sherman Street - Room 818 Jt1��r WiTHIN 60 DAYS OF COMPLETION Denver, Colorado 80203 3 1 1989 CP Th:'E WORK DESCRIBED HERE- .- ')'J. TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION QflREPORftra 1K. - PERMIT NUMBER 3`!`17y`F4.�u� E.,P1'FF1v WELL OWNER P) Echa..1 S. Lf eart4on NW 'h of the 5E 1/.. of Sec. 27 ADDRESS 10501 WC2 25z FL. Lupfr8562cc. T 2 N , R. 67 !V 6th DATE COMPLETED Derembea /0, 1987 , 19 HOLE DIAMETER WELL LOG in. from to ft. Water From To Type and Color of Material Loc. — in. from _ to ft. in. from to ft. DRILLING METHOD CASING RECORD: Plain Casing • Size & kind from to Size & kind from to Size & kind from to Perforated Casing Size & kind from to Size & kind from to Size & kind from to GROUTING RECORD Material Intervals Placement Method GRAVEL PACK: Size Interval TEST DATA . - Date Tested • - - - , 19 Static Water Level Prior to Test Type of Test Pump Length of Test Sustained Yield (Metered) TOTAL DEPTH 620 ' Use additional pages necessary to complete log. Final Pumping Water Level PUMP INSTALLATION REPORT P • Pump Make rr{acu53 i. s^ - Su6men L6Le \ Y �ype .. .'.'r; �� . . owered by Pierfni cLf j HP 5 �• A Pump Serial No. 9411G85 's av w J WATER Motor Serial No. a-86 'V .5 W td TABLE W 0 W Date lnstalleo ///8/88 i- " W Pump Intake Depth 509 ' rt' f• _ _ _ . ". :r Remarks - , z z _ - r` z c , • a i DI • w ' g x . : I WELL TEST DATA WITH PERMANENT PUMP a. • : 0 dr 0 F- DateTested //08/88 x. an CONE OF F a DEPRESSION Static Water Level Prior to Test 283 ° o • Length of Test l wo(21 Hours ' . .stained yield (Metered) /5 GPM �F• Pumping Water Level 465' ` `' Remarks A p t ‘,..r. w CONTRACTORS STATEMENT The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or pump installation described hereon; that he has read the statement made hereon; knows the content thereof, and that the same is true of his own knowledge. License No. / Signature /)�?*m H r� -� 7 5 State of Colorado, County of We/o.' SS Subscribed and sworn to betore me this 27 day of Slanuany , 19 89 My Commission eexxpires: Novembers 2 , 19 92 `r Notary Pub tcL�m-Cz� � � FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller. V:RJ.5.Eev. 76 CC JRADO DIVISION OF WATER RESOL .ES % ,i, ^ 0 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 ).,09 +'. E7 s" S2).);il°S PERMIT APPLICATION FORM 2;1AtF•E5ic;fna ..r+Application must Ma a complete where r:;: -- ri,vE (X ) A PERMIT TO USE GROUND WATER applicable. Type or it Y-� ( ) A PERMIT TO CONSTRUCT A WELL print in BLACK _ .;,F•0R: ( ) A PERMIT TO INSTALL A PUMP :_h—;j'8--'u=' 2:46 ,- INK.No overstrikes 'j' 0 'j '''''u 03211(2 or erasures unless ( ) REPLACEMENT FOR NO. ::": Pc r i• initialed. RATER VK„a;},"C7S P 3a .. Z:tG1N!_in ( - OTHER leeAretical70.4 FD? i-e*p-Red - a: I IL 6L U WATER COURT CASE NO. NM e l CtE =-.cT (1) APPLICANT -/mailing address FOR OFFICE USE ONLY: D6'-NOT WRITEi1t =THIS COLUMN ////C 4.2 J . aeet Ys�� 9 �� / �ii ra /1 i'r" (,:C' NAME q 7-V-7 / Receipt No. STREET l �C,f 1 Basin Dist. CITY Cr IVPr0W Ca. MOloa/ (State) (ZIP) CONDITIONS OF APPROVAL TELEPHONE NO. -26 3 - es7- & 9/6S- This well shall be used in such a way as to cause no material injury to existing water rights. The (2) LOCATION OF PROPOSED WELL 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 County LA.) . L 0 right from seeking relief in a civil court action. • /V W X of the S E 'A, Section A 7 1) APPROVED FOR AN EXISTING WELL CONSTRUCTED Twp. 4/, Rngr_h_l__ l4 P.M. UNDER.R.S. 37-90-137(4)LL T NO. 3ANDI-F TIEEFINDINGS OF OF THE iN.51 (E.WI STATE ENGINEER DATED 3/28/89. /3) WATER USE AND WELL DATA 2) THE MAXIMUM PUMPING RA OF This WELL SHALL NOT EXCEED 15 GALLONS PER MINUTE. _ 3) THE ALLOWED AVERAGE ANNUAL AMOUNT OF WATER TO BE WITHDRAWN BY THIS WELL IS 22.3 ACRE—FEET. Proposed maximum pumping rate (gpm) /5 4) GROUND WATER PRODUCTION FROM THIS WELL SHALI BE LIMITED TO THE LARAMIE-FOX HILLS AQUIFER. Average annual amount of ground water 5) THE WELL SHALL BE CONSTRUCTED NO MORE THAN to be appropriated (acre-feet): 200 FEET FROM THE LOCATION SPECIFIED HEREON. 6)_ A TOTALIZING FLOW METER MUST BE INSTALLED. Number of acres to be irrigated: Nfl/e (NOTE: NON—CONSTRUCTION CONDITIONS IN FINDINGS) . rqc v• n • aw Proposed total depth (feet): 6 a-0 Aquifer ground water is to be obtained from: A etY6c Al a C- Co fC /7/ /LS • Owner's well designation GROUND WATER TO BE USED FOR: ( ) HOUSEHOLD USE ONLY - no irrigation (0) ( ) DOMESTIC (1) ( ) INDUSTRIAL (5) (J() LIVESTOCK (2) ( ) IRRIGATION (6) ()a COMMERCIAL (4) ( ) MUNICIPAL (8) ( ) OTHER (9) APPLICATION APPROVED F. DETAIL THE USE ON BACK IN (11) 0349"74 - r PERMIT NUMBER APR (4) DRILLER 1 1989 DATE ISSUED IL 1J 7 /IV r1i?; jl sr;g. me O y EXPIRATI N DATE - - Street rnn0 //(/[1[/a NR M. ' City GOLd'eN yO5/03 EER) (State)S �(Zi P) .- a /J BY Q "P ��A , _v ': Telephone No. 1123-. ay �6 Lic. No. d Cr� j_ LD. •.,.1......:. -.._tr_,...C6UNTY-::``J • (5) THE LOCATION OF THE . .iOPOSED WELL and the area on (6) T.-_ WELL MUST BE LOCATED BELOW which the water will be used must be indicated on the diagram below. by distances from section lines. Use the CENTER SECTION (1 section, 640 acres) for the well location. /� •*''B,' SU'CTAA ;-;2/ eo ft. from ter' sec. line 1 — it — _L — Jr- — -4- - -i - + - + -- -r- onorth or south) I 1 1 MILE,5280 FEET-- )-I c72 y ea ft. from r Sisec. line (east or west) + + rt + + ± ± + LOT 6 BLOCK C FILING x O I I I i NORTH SECTION LINE _ SUBDIVISION O — I I T (7) TRACT ON WHICH WELL WILL BE I LOCATED Owner: 44:CA al S, gears TNORTHI W- _ i — — -ii- — _m � ± (J T 2 a No. of acres .� . Will this be J y o M I the only well on this tract? S e-S + w /, 3 — + (8) PROPOSED • CASING PROGRAM F z r- r- I Plain Casing N W } - - + 1 I in.from 0 ft. to '17/TD'S ft I I I I in.from ft.to ft. —- + 4_ - _ Perforated casing - SOUTH SECTION LINE /I /'36- (p// I Cad 7 in.from - ft. to .© ft. + 4- --i- + + 4 4- + in. from ft. to .`t. _ I I (9) FOR REPLACEMENT WELLS give distance • and direction from old well and plans for plugging 4_ - 4 - + - -{- - _F - _H - + - + _ -i_ it: -" The scale lof the diagram is 2 inches= 1 mile T/Nr'e are No GI-Me,- ' I''Each small square represents 40 acres.' - �x.) e HS. WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) :. .449 gallons per minute (Om) - A family of 5 will require approximately 1 acre-foot of water per year. • 1 acre-foot . . ,43,560 cubic feet . . .325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (10) LAND ON WHICH GROUND WATER WILL BE USED:Owner(s): 44 1^c.X a G --C• ,�e a rs p oil d !7 No. of acres: 9 0 Legal description: ('' ul ! SE 4 6/Sec .27 t0nv tv or�pin (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. Da_FRy .1ivesTaefG wa ter in/9 Sep T,a re,Fix- 6A- NV Ze et.cA /Fi'cii . O e?74,v O perc ri(w o-,tld 5e Ne r(`-1- OPP c e 11s E9 R 7- ref-0; r (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for(purpose) Description of land on which used /VC Ale No I/e Ale de._ (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF HIS KNOWLEDGE. SIGNATURE OF APPLICANT(S) Use additional sheets of paper if more space is required. FINDINGS OF THE STATE ENGINEER IN THE MATTER OF AN APPLICATION FOR A PERMIT TO CONSTRUCT A WELL IN WATER DIVISION NO. 1 , WELD COUNTY, COLORADO APPLICANT : MICHAL S. BEARSON AQUIFER : LARAMIE-FOX HILLS PERMIT NO. : a9-q174 -Fr In compliance with C.R.S. 37-90-137(1) and the Statewide Nontributary Ground Water Rules, Michal S. Bearson, 9743 WCR 16, Fort Lupton, Colorado, (hereinafter "applicant") submitted an application for a permit to construct a well . Based on information provided by the applicant and records of the Division of Water Resources, the State Engineer finds as follows: 1 . The application was received complete by the State Engineer on March 20, 1989. 2. The applicant proposes to withdraw water from a well originally con- structed under expired well permit No. 32591-F. The well is located in the NW1/4 of the SE1/4 of Section 27, Township 2 North, Range 67 West, 6th Principal Meridian. 3. The well is located outside the boundaries of a designated ground water basin. 4. The applicant proposes to apply the water withdrawn from the well to the following beneficial uses: livestock, commercial . 5. The proposed maximum pumping rate of the well is 15 gallons per minute, and the requested average annual amount of ground water to be withdrawn is 24 acre-feet. 6. The applicant is the owner of the land on which the well will be con- structed. 7. The well would withdraw ground water from the Laramie-Fox Hills Aquifer (hereinafter "aquifer") . 8. The location of the well is more than 600 feet from any existing well completed in the aquifer. 9. According to a sworn statement, the applicant owns, or has consent to withdraw ground water underlying 80 acres of land as further described in said statement, which is attached hereto as Exhibit A. 10. Withdrawal of ground water from the aquifer underlying the land claimed by the applicant will not, within one hundred years, deplete the flow of a natural stream at an annual rate greater than one-tenth of one percent of the annual rate of withdrawal and therefore the ground water is nontributary ground water as defined in C.R.S. 37-90-103(10.5) . Applicant: Michal S. Bearson Page 2 Aquifer: Laramie-Fox Hills Permit No. : 11 . In considering whether the requested permit shall be approved the provi- sions of C.R.S. 37-90-137(4) and the Denver Basin Rules shall apply. Withdrawals shall be allowed on the basis of an aquifer's life of 100 years, C.R.S. 37-90-137(4) (b) (I) . 12. The quantity of water in the aquifer, exclusive of artificial recharge, underlying the 80 acres of land described in Exhibit A is 2232 acre-feet. This determination was based on the following as specified in the Denver Basin Rules: a. The average specific yield of the saturated aquifer materials under- lying the land under consideration is 15 percent. b. The average thickness of the saturated aquifer materials underlying the land under consideration is 186 feet. 13. A review of the records in the State Engineer's office has not disclosed that there are any existing wells or other water rights claiming or with- drawing ground water from the aquifer underlying the land claimed by the applicant. Based on the above, the State Engineer finds that there is water avail- able for withdrawal by the proposed well and no material injury to vested water rights would result from the issuance of the requested permit subject to the following conditions: a. The allowed average annual amount of water to be withdrawn from the aquifer by the well shall not exceed 22.3 acre-feet (the quantity of water which is considered available divided by the 100 year aquifer life) . b. The well shall be constructed no more than 200 feet from the location specified on the permit application. c. The maximum pumping rate of the well shall not exceed 15 gallons per minute. d. A totalizing flow meter must be installed on the 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. e. Production is limited to the Laramie-Fox Hills Aquifer. f. Pursuant to C.R.S. 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 applicant shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98% of the water withdrawn will be consumed. Applicant: Michal S. Bearson Page 3 Aquifer: Laramie-Fox Hills „-, Permit No. : :34-4-6174 -F- g. The owner shall mark the well in a conspicuous place with appropriate well permit numbers, name of the aquifer, and court case numbers. He shall take necessary means and precautions to preserve these markings. Dated this of �G�s , 19 �� . G. x\aw. ris A. Danielson Stare 4ngineer Steve Lautenschlager Water Resources Engineer Ground Water Section Prepared by: RAC 1360I/Form #0546(o) APPLICANT: MICHAL S. BEARSON PERMIT NO. : 3•`q'7'f- EXHIBIT A PAGE 1 OF 1 GWS-1 (Rev. April 1987) STATE OF COLORADO OFFICE OF THE STATE ENGINEER :vl2. J .J DIVISION OF WATER RESOURCES u yE"'C.h{ 9 NONTRIBUTARY GROUND WATER LANDOWNERSHIP STATEMENT I (We) " CA a_ S BearscN (Name) claim and say that & (we) (are) the owner(s) of the following described property consisting of _O_ acres in the County of 4-04a /-0 State of Colorado: T i E,Rm Pm DESCRIPTION) A (INSERT PROPERTY LEGAL DESCRY iIv�7; �e, pe us a iN St of rife SEy Sec a7 ca and, that the ground water sought to be withdrawn from the I61YLMiC Fax W,ii.s aquifer underlying the above-described land has not been conveyed or reserved to another, nor has consent been given to its withdrawal by another. Further, I (we) claim and say that I (we) have read the statements made herein; know the contents hereof; and that the same are true to my (our) own knowledge. • M -4.�cc, 4 3_6 - 19 (Signature) (Date) (Signature) (Date) INSTRUCTIONS Please type or print neatly in black ink. This form may be reproduced by photocopy or work processing means. See additional instructions on back. 1313 Sherman Street 8th Floor Denver Colorado 80203 (303) 866-3581 _ �' V , Li k �1t-rte' �' L_OC:A1'Ic:;N: NW1/4 OF SEJ./4. Or—. SEC:. 1 :20 , k. 6 7W. (2400 SSL_ , 2400 LSL) '�` Ground Elevation: 5040 Number- of Acres: 00 ELEVATION DEPTH TO ANNUAL -_ - NET _ ----- --- APPROP STA AQUIFER BUT_ TOP SAND SOT. TOP A- F UPPER DAWSON ---_ --_- ---_ _._-- .. ------_-_ ---__- --.- LOWER DAWSON ----- ---- ---- -- -------- -------- -1- DENVER ---- ---- ---- -- ---- ------- -- UPPER ARAPAHOE ---- ---- ---- ____ __.. LOWER ARAPAHOE ---- -__- ---- -. -__..-. LARAMIE-FOX HILLS 436:,0 4628 186 e-,:-::0 412 22_.:≥0:; N note: E indicates location is at aquifer boundary and va.luc_: may he more approximate. want to do another (Y/N) ":' s • MEMORANDUM TO: George Van Slyke FROM: Rich Cooper DATE: • Bo( nn SUBJECT: Applicant: MK-HAL. S. Well Permit No: 3 Z Sa L F _-/Owners Well No:: Location: 0W 1/4 SC= 1/4 Sec Z- , Twp 2 N , Rng LCD ZI-10O feet from _ & Z�i �?c� feet from Attached are geophysical logs for the subject well. Please provide the data indicated below. Aquifer Depth to ToD Depth to Base Sat. Thick., _ teVie `t37/ e.'+ . 7qo 3 2,O-o S51- COMMENTS: )ep.c.a tt t Ya - k z — {� ✓�s� E5f sn21— 11/4- L --� BY: - �=- !l!2 �1�� DA__: ii774 IN) O1-11 N • • At ca GIS oi 44 CO Zi% t yr� N t^ jc J a N � N N W ' p O' -i Z G(!r Py Z Z Oo • ^ op coo .. =ir1•ss • -ROY ROMER p JERIS A. DANIELSON Governor //////�� m State Engineer ,•� _ * 1876 x OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES 1313 Sherman Street-Room 818 Denver, Colorado 80203 (303) 866-3581 March 14, 1989 Michel S. Bearson 9743 WCR 16 Fort Lupton, Co. 80621 RE: Well Permit Application For An Existing Well, Expired Permit No. 32591—F, Receipt No. 97770 Dear Mr. Bearson: Please amend the legal description in the attached Landownership Statement to describe your entire 80 acre land area. I assume this area is the W1/2 of the SE1/4 of Section 27 as described in your original Landownership Statement for expired permit No. 32591-F. I am also returning your well permit application. In the application for expired permit No. 32591-F you noted in item #3 and #11 that the ground water from the well would be used for commercial use in a dairy operation along with livestock use. You may wish to indicate the same proposed uses in the new application. Please return the amended statement and application to this office. inc elycr, r Richard Cooper Engineering Technic'an Ground Water Section 25tl vF.s-key. ;^s C .ORADO DIVISION OF WATER RESC ;CES . 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 PERMIT APPLICATION FORM _ Application must rCE1VED be complete where' ,- I X) A PERMIT TO USE GROUND WATER applicable. Type ornrrn5 �^ ( g) A PERMIT TO CONSTRUCT A WELL .1 —08-37 11 P print in BLACK FOR: ( X) A PERMIT TO INSTALL A PUMP 032177 ':=,1,00 INK.No overstrikes '-yC{_i0E: P0011 or erasures unless WATER REM.UflCES ( ) REPLACEMENT FOR NO. — :n r. initialed. SUt'+;E.00lt'.IttE• _"3 ( IOTHER -- -� -- _,,T" (;13,1,:- WATER COURT CASE NO. ;_, _ 0 (1) APPLICANT - mailing address FOR OFFICE USE ON LY:,DO NOTIWR_ITE FN THIS COLUMN Nichal S . BearsonO9c/(7 SEE NAMERece�ippt N L NOTc: R AL; ;I' 1-\'''.1.. it FOZ.VtAT.O 57REET 10501 W. C . R . 251 Basin.... - a 4-)- CITY Fort Lupton Colorado 80621 CONDITIONS OF APPROVAL (State) (Zip) TELEPHONE NO. 303-857-6468 This well shall be used in such a way as to cause • no material injury to existing water rights. The (2) LOCATION OF PROPOSED WELL 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 County Weld right from seeking relief in a civil court action. NW of the SE /a,Section 27 1) APPROVED PURSUANT TO C.R.S. 37-90-137(4) ANI TIE FINDINGS OF THE STATE ENGINEER DATED Twp. 2 N Rng. 67 W 6th P.M. 10/15/87. IN.S) IE.WI 2) THE ALLOWED AVERAGE ANNUAL AMOUNT OF WATER TO BE WITHDRAWN BY THIS WELL IS 22.3 ACRE-FEET. (3) WATER USE AND WELL DATA �3) THE MAXIMUM PUMPING RATE OF THE WELL SHALL NOT EXCEED 15 GALLONS PER MINUTE. 4) GROUND WATER PRODUCTION FROM THIS WELL SHALT Proposed maximum pumping rate (gpm) 15 BE LIMITED TO THE LARAMIE FOX HILLS AQUIFER WHICH IS LOCATED 412 FEET BELOW LAND SURFACE Average annual amount of ground water 24 AND EXTENDS TO A DEPTH OF 680 FEET. PLAIN to be appropriated (acre-feet): CASING MUST BE INSTALLED AND SEALED TO PREVENT THE WITHDRAWAL OF GROUND WATER FROM OTHER Number of acres to be irrigated: none AQUIFERS AND THE MOVEMENT OF GROUND WATER 9 BETWEEN AQUIFERS. 5) THE WELL SHALL BE CONSTRUCTED NO MORE THAN Proposed total depth (feet): 700 ' 200 FEET FROM THE LOCATION SPECIFIED HEREON. 6) THE ENTIRE LENGTH OF THE HOLE SHALL BE _y.�Aquifer ground water is to be obtained from: (� NIA GEOPHYSICALLY LOGGED ACCORDING TO THE ATTACHED r/�S+/(3 � --tee A O4,,,,e - PL." /7t A 7) A TOTALIZING FLOW METER MUST BE INSTALLED. (NOTE: NON-CONSTRUCTION CONDITIONS IN Owner's well designation FINDINGS) . RAG IO.i4fi1 GROUND WATER TO BE USED FOR: ( ) HOUSEHOLD USE ONLY - no irrigation (0) s.( ) DOMESTIC (1) 1 I INDUSTRIAL (5) '�� a tee" (X ) COMMERCIAL(X I LIVESTOCK 2(4) ( I MUNICIPALn(8161 ® I 12 -S?R 1 I OTHER (91 APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) 032591-F rr PERMIT NUMBER (4) DRILLER ATE ISSUED OCTU "1 1 987 "Name R & R Well & Pump , Inc . EXPIRATION DATE 0CT 2 2 198E Street P . O . Box 577 it . . City Greeley Colorado 80632 (ST TE EN IN (State) (Zip) 303-353-31 857 e Telephone No. 1L . No. / I.D. / J COUNTY 6 .2- (5) THE LOCATION OF THE r ROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED•SECOW which the water will be used must be indicated on the diagram below. by distances from section lines. Use the CENTER SECTION (1 section, 640 acres) for the well location. -)- ft_from - + ` . __ -4- - + — -H_ — 4 — + 2400 (Dorm or South) sec. line. 14 _1 MILE,5280 FEET 2400 ft. from Ea_ Z sec. line- f + T + + ± --- + (east or west) LOT 0 -BLOCK 0 FILING x 0 + _ -4_ - i NORTH SECTION LINE SUBDIVISION 0 I 1 - ± - I (7) TRACT ON WHICH WELL WILL BE NORTH* ZI — T — — — + — LOCATED Owner: Michal S . Bearsc n + No. of acres R 0 ai . Will this be z se O m the only well on this tract? yes - — 4- HI o (8) PROPOSED CASING PROGRAM I w w Plain Casing in.from +1 ft. to 2 0 0 ft. _ in. from ft. to ft. + — + SOUTH SECTION LINE - _l_. _ H- Perforated casing I I I I 5 7 /8 oap.fpom 200 ft. to 450 ft. + + + + -I- + 4 + + in. from ft. to ft, I I I (9) FOR REPLACEMENT WELLSgivedistance _1(... —)- — � — T — ± — 4- - - -✓— — + and direction from old well and plans for plugging it: ..--, The scale of the diagram is 2 inches= 1 mile There are no other wells Each small square represents 40 acres. WATER EQUIVALENTS TABLE (Rounded Figures) An acre.foot covers 1 acre of land 1 foot deep 1 cubic foot per second (cfs) . . .449 gallons per minute (gpm) A family of 5 will require approximately 1 acre.foot of water per year. 1 acre-foot. . .43,560 cubic feet .. .325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (10) LAND ON WHICH GROUND WATER WILL BE USED: Owner(s): Michel S . Bearson 80 - 41 111 �/ No. of acres: �5 Legal description: *SSE-4, Sec . 27 , T2N , R67W, 6PM (11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal system to be used. Septic System Ft Leach field— Water to be used for dairy operation and livestock use and general office use at dairy . (12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers. Type or right Used for (purpose) Description of land on which used none none none • (13) THE APPLICANT(Sk• STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE' BEST '0'0". HIS KNOWLEDGE. ordi.a SIGNATURE OF APPLICANT(SI ;. °' �,: Use additional sheets of naner if mnrp soars. is rennirnrl FINDINGS OF THE STATE ENGINEER IN THE MATTER OF AN APPLICATION FOR A PERMIT TO CONSTRUCT A WELL IN, WATER DIVISION NO. 1 , WELD COUNTY, COLORADO APPLICANT : MICHAL S. BEARSON AQUIFER : LARAMIE-FOX HILLS PERMIT NO. : 032581- F In compliance with C.R.S. 37-90-137( 1 ) and the Statewide Nontributary Ground Water Rules, Michal S. Bearson, 10501 W.C.R. 25-1/2, Fort Lupton, Colorado 80621 , (hereinafter "applicant") submitted an application for a permit to construct a well . Based on information provided by the applicant and records of the Division of Water Resources, the State Engineer finds as follows: 1 . The application was received complete by the State Engineer on October 5, 1987. 2. The applicant proposes to construct the well in the NW 1/4 of the SE 1/4 of Section 27, Township 2 North, Range 67 West, 6th Principal Meridian. 3. The proposed well is located outside the boundaries of a designated ground water basin. 4. The applicant proposes to apply the water withdrawn from the well to the following beneficial uses: Commercial , livestock. 5. The proposed maximum pumping rate of the well is 15 gallons per minute, and the requested average annual amount of ground water to be withdrawn is 24 acre-feet. 6. The applicant is the owner of the land on which the well will be constructed. 7. The proposed well would withdraw ground water from the Laramie- Fox Hills Aquifer (hereinafter "aquifer") , which, according to the Denver Basin Rules, is located 412 feet to 680 feet below land surface at the location of the proposed well . 8. The location of the proposed well is more than 600 feet from any existing well completed in the aquifer. 9. According to a sworn statement, the applicant owns, or has consent to withdraw ground water underlying 80 acres of land as further described in said statement, which is attached hereto as Exhibit A. Applicant : Michal S. Bearson Page 2 Aquifer : Laramie-_o Hills Permit No. : O3,Cbi '-F 10. Withdrawal of ground water from the aquifer underlying the land claimed by the applicant will not, within one hundred years, deplete the flow of a natural stream at an annual rate greater than one-tenth of one percent of the annual rate of withdrawal and therefore the ground water is nontributary ground water as defined in C.R.S. 37-90-103(10.5) . 11 . In considering whether the requested permit shall be approved the provisions of C.R.S. 37-90-137(4) and the Denver Basin Rules shall apply. Withdrawals shall be allowed on the basis of an aquifer' s life of 100 years, C.R.S. 37-90-137(4)(b) (I ) . 12. The quantity of water in the aquifer, exclusive of artificial recharge, underlying the 80 acres of land described in Exhibit A is 2232 acre-feet. This determination was based on the following as specified in the Denver Basin Rules: a. The average specific yield of the saturated aquifer materials underlying the land under consideration is 15 percent. b. The average thickness of the saturated aquifer materials underlying the land under consideration is 186 feet. 13. A review of the records in the State Engineer' s office has not disclosed that there are any existing wells or other water rights claiming or withdrawing ground water from the aquifer underlying the land claimed by the applicant. Based on the above, the State Engineer finds that there is water available for withdrawal by the proposed well and no material injury to vested water rights would result from the issuance of the requested permit subject to the following conditions: a. The allowed average annual amount of water to be withdrawn from the aquifer by the well shall not exceed 22.3 acre-feet (the quantity of water which is considered available divided by 100 year aquifer life) . b. The well shall be constructed no more than 200 feet from the location specified on the permit application. c. The applicant shall submit geophysical and lithologic logs after the construction of the well . The geophysical logs shall be obtained from the hole before the casings are installed. d.. The maximum pumping rate of the well shall not exceed 15 gallons per minute. • Applicant : Michal S. Bearson Page 3 Aquifer : Laramie- _o ills Permit No. : (>`ti Ji_- F e. A totalizing flow meter must be installed on the 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. f. Production is limited to the Laramie-Fox Hills aquifer. The well must be constructed with plain, non-perforated casing properly grouted so as to prevent intermingling of water between aquifers. g. Pursuant to C.R.S. 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 applicant shall demonstrate to the reasonable satisfaction of the State Engineer that no more than 98% of the water withdrawn will be consumed. h. The owner shall mark the well in a conspicuous place with appropriate well permit numbers, name of the aquifer, and court case numbers. He shall take necessary means and precautions to preserve these markings. Dated this t5k day of QC*.o'oe ' , 1987. • a . 4 JE • anielson State Engineer By: 1 Tk Steve Lautenschlager Water Resources Engineer Ground Water Section Prepared by: RAC 1296I/Form #0546(o) APPLICANT: NICHAL. S., BEARS0P, PERMIT NO. 1hi,;5J EXHIBIT A - PAGE 1 OF 1 GWS-1 (Rev. April 1987 f;(E ��j�, �.,E� �^ GOT n '987 STATE OF COLORADO OFFICE OF THE STATE ENGINEER WATER RESOJRCM DIVISION OF WATER RESOURCES S7pyf•ENGINEER COtO. ��YrJ/NONTRRIEUTARY GROUND /WATER LANDOWNERSHIP STATEMENT I (We) --,e Zc%7A4- S xS.�e -- aV (Name) claim and say that I Ewe-) am (a-re) the owner(s) of the fo_lowing described property consisting of $c7-_ acres in the County of __Alelat State of Colorado: {{�� p • (INSERT PROPERTY LEGAL DESCRIPTION) � )/2._ CP Y1 al: ,fic 2`7 72-r� ,Pk7141 e-ir b P> -7.- and, that the ground water sought to be withdrawn from the il»}te_2d 11.5" aquifer underlying the above-described land has not been conveyed or reserved to another, nor has consent been given to its withdrawal by another. Further, I (ws) claim and say that I (sac) have read the statements made herein; know the contents hereof; and that the same are true to my (our) own knowledge. • (Signature) ( ate) (Signature) (Date) INSTRUCTIONS Please type or print neatly in black ink. This form may be reproduced by photocopy or work processing means. See additional instructions on back. 1313 Sherman Street 8th Floor Denver Colorado 80203 (303) 866-3581 • LOCATION: N141/4 OF SE]./4 OF SEC. , .T 2N. , Fi.67W. (2 400 SSL., 2400 ESL) 'r` Ground Elevation : 5040 Number of Acres: GO ELEVATION DEPTH TO ANNUAL NET ---- ------ ----- APPROP SIA AQUIFER BUT_ TOP SAND BUT. TOP A-F -------------------- UPPER DAWSON - --- ---- ---- LOWER DAWSON -------- ----- ---- ---- .----- ---- - DENVER ------ ----- --- - ---- ---- ------ -- UPPER ARAPAHOE ---- ----- ----- ------ ---- ____ -- LOWER ARAPAHOE ---- ----- ----- LARAMIE-FOX HILLS 4360 4628 .186 r-.:i0 412 22_303 N note: E indicates location is at. aquifer boundary and vcllu_ c-L.; may be more approximate_ wan L. to do an other (Y/N) z z N _ o F- '- d Q o W 2r ) rNis ;� u_„")� '° ZDNN Q 2 • �+N ll.V V LL1 �� 1�j� I� 2 eZ -2_ N RECENSO GWS-18 (April 1987) g 2 6 '95 STATE OF COLORADO OFFICE OF THE STATE ENGINEER LNnTRA@'nUAC_= DIVISION OF WATER RESOURCES SIAM t"" '"`74 COLA NOTICE OF WELL COMPLETION Well Permit No. oh/ 556A WELL OWNER-Mailing Address Name 1pR,Qe' (/ Sears ow Telephone No. 303- 16-7-117073 Address '774'3 eve'? /6 40121-01 Co 8068 (Street No. ) (City) (State) (Zip) WELL LOCATION /�rr77 �/ Rng•� t PM !fit 1/4 of the �W 1/4, Section :231, Twp. ;24, , 200O ft. from _5ourb Sec. Line & Alai ft. from _West Sec. Line Date of well completion: rf/uaY5 19 76 Name and Lic. No. of Contractor: 6/See5 Vi'i!(;r(9 b9D (Name) (lic. No.) Additional information filed pursuant to Rule 7A(6) is attached: (Yes/No) a (we) claim and say that(I (we) am (are) the owner(s) of the well described above and that the construction of the well was completed, lawfully, under the well permit, on the date indicated; and the statements made herein are true to my (our) knowledge. This notice if filed in accordance with Section 37-90-137(3)(a)(II) C.R.S. Darartza 41-•.2 5t.p (Signature of Owner) (Date) INSTRUCTIONS This form is required for wells constructed under permits approved pursuant to the provisions of Colorado Revised Statute 37-90-137(4) and must be filed with the Division of Water Resources prior to the expiration of the well permit as required by Statewide Nontributary Ground Water Rule 7A. Type or print neatly in black ink. This form may be reproduced by photocopy or word processing means. (DWR OFFICE USE ONLY) 1313 Sherman Street 8th Floor Denver Colorado 80203 (303) 866-3581 7Up4-rvnmi ivv. vvvo-ice STATE OF COLORAD0 • sN: • OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES -NOTICE OF COMMENCEMENT OF BENEFICIAL USE 1,ff:A;r.. t4 COLO WELL PERMIT NO. © SC6 02 1. WELL OWNER-MAILING ADDRESS: Name ign-4Reif BeGLf^S'D/✓ Address 974/3 zvc R ! 6 Pt- `o t iv Cole, SO / (No. & Street) (City) (State) (Zip) p Telephone No. 303- .y3-2- / .7 S 2. WELL LOCATION: �7 NE 1/4ofthecite 1/4,Section 017 ,Twp. rQ /V ,Rng. / kv, P.M. a O e o ft.from the S0L/ A section line and '-coo ft.from the ties? section line. 3. DATE OF FIRST BENEFICIAL USE OF GROUND WATER: -rie J / /9 9 4. USE OF GROUND WATER: - I•lde s ro ck s T70°Sc. hie L.O I (we) claim and say that I (we) am (are) the owner(s) of the well described above and that the commencement of beneficial use of ground water from this well, lawfully made under the well permit, occurred on the date indicated, and that the statements made herein are true to my (our) knowledge. This notice is filed in accordance with Section 37-90-137(3)(a)(II) or Section 37-90-108(2)(d), Colorado Revised Statutes. • Dan ,a2-0-4..41-07-- (Signature of Well Owner) (Date) INSTRUCTIONS: This form is required for wells approved under permits issued pursuant to the provisions of Colorado Revised Statutes 37-90-137(4) or 37-90-111(5) and must be filed with the Division of Water Resources within 30 days after commencement of use. Please type or print neatly in black ink. Office of the State Engineer and Colorado Ground Water Commission Division of Water Resources 1313 Sherman Street Room 818 Denver CO 80203 (303)866-3581 cus-r • 11/90 ' ' STATE OF COLORADO, OP 4CE OF THE STATE ENGINEER ^ RECEIVED 1. WELL PERMIT NUMBER 04/5;51,07 F SEP 2 7 1996 2. OWNER NAME(S) O, r1-4 Oaa.7%5ar ATES sowGEs " -� Mailing Address �j) -NlC� rL WSTATE ENGMEER COLO. City. St. Zip pi- Jar i. c o 1v Phone ( ..3 ) r57 -9 3 13 3. WELL LOCATION AS DRILLED: /\/4 1/4 S:✓ 1/4, Sec. ;-) Twp.—ia N , Range 62cu —jam? v DISTANCES FROM SEC. LINES: Aonn ft. from Sor./14 Sec. line. and r,Opd ft. from t-Q es7 Sec. line. (north or strum (nnsr or nosh) SUBDIVISION: LOT BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: c • ('em( 4. PUMP DATA: Type S v6 y„Ri. S 16b, -- Installation Completed — /7 —9i Pump Manufacturer 6jo-u {.�/.5 ----- ---_ Pump Model No. „ZS G.5 Design GPM ) 5 at RPM HP S_ _ , Volts _a,3 0 , Full Load Amps Pump Intake Depth ,5-3o Feet, Drop/Column Pipe Size /9/" _Inches. Kind 54±p ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM: TURBINE DRIVER TYPE: Li Electric ❑ Engine ❑ Other Design Head feet, Number of Stages , Shaft size inches. 5. OTHER EQUIPMENT: Airline Installed❑Yes No. Orifice Depth ft. . Monitor Tube Installed LJ Yes No, Depth ft. Flow Meter Mfg. Meter Serial No. Meter Readout In Gallons, 14 Thousand Gallons, I-1 Acre feet, ❑ Beginning Reading n EST DATA: X Check box if Test data is submitted on Supplemental Form. Date 0-/ -qro Total Well Depth 6/13 Time y/JN( Static Level .) a5 Rate (GPM) _30 Date Measured 1—3a _yb Pumping Lvl. Sob _ 7. DISINFECTION: Type A iA Amt. Used $ h6 B. Water Quality analysis available. ❑ Yes No 9. Remarks t0. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge [Pursuant to Section 24-4104 (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.) • CONTRACTOR 6/cVCY.5 .D' JJN/42y Phone 00) '5-dad/ Lic. No._6 . Mailing Address 21U j LO MA 3/ r/ k oPFd-A Oz, e) 5L0 m 7- ( Name/Title (Please type or print) Signature Q� Date • a, . S4__ /�6.�ave1, Pac7 /T.p"-- k �lG�v�1 S-5 769 r•-•"' VVCLL LiUIVJ 117UU I ILJIV HIVU I CJ I 1-1C1-1-11-11 • For Office Use only i GUS 31 STATE OF COLORADO�FFICE OF THE STATE ENGINEER ^ RECEIVED „/20 1 i�l tIVEU 1. WELL PERMIT NUMBER 4 yssj,a /-' SEP 2 7 1996 2. OWNER NAME(S) oc,LY-el, ,Qaor?„cOh _ WATERRES`U _. Mailing Address 9` 2v3 cwCft/ /[. STA coo. City, St. Zip At l,.,via ton ('AA0 Phone (3 ) 3. WELL LOCATION AS DRILLED: NE 1/4 Sw 1/4, Sec._a7 Twp. a M , Range ‘2A) •G73-fin/ , DISTANCES FROM SEC. LINES: OO)0 .__ ft. from Scarf/1 Sec. line, and n2 co _ ft. from West Sec line. OR (north or south) Mast or west) SUBDIVISION: LOT BLOCK FILING(UNIT) STREET ADDRESS AT WELL LOCATION: ,72.5f 3 t4,C/2¢ie _'-/c!,v,,p}s„ Ca A.o R-6Q XI 4. GROUND SURFACE ELEVATION ft. DRILLING METHOD . DATE COMPLETED I- 3 a 76, . TOTAL DEPTH %/D ft. DEPTH COMPLETED (o/O ft. 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (h) Depth Description of Material (Type. Sim, Color. Water location) _le— n 6 t Otto J16Jo /Is —_— . /n -3D CLay - -- --- 3o-7y sA,t b c _ 7o-7S Cs i".4) 7. PLAIN CASING 7s-iaa ..5.4,“le OD (in) Kind Wall Size From(et) To(ft) Tan-s9s Coati ,mss-.2553hcz.. Ge 55-??o sA es 2e pa.rdti4- sa,, x1 — .s1..t PERF. CASING: Screen Slot Size: YDu,.c 4 Cal i ,8n -yas gnr,/r< 0-A, ,A• y% site 4.1., 1$8' yes" 6/c' -- Ssv SA-,,.d ,x o 575 JA-,,,e! K s 2 a-A e ,e S95- 6Th sJ,et -e B. FILTER PACK: 9. PACKER PLACEMENT: Material Type Size Interval Depth 10. GROUTING RECORD: terjal Amount Density Interval Placement REMARKS: e7.1d.v,/ 35..mc4t _okb a -/yds /oosinee Or, 11. DISINFECTION: Type A+h Amt. Used . ,S 1,1,3 12. WELL TEST DATA: k Oheck,box if Test Data is submitted on Supplemental Form. TESTING METHOD Svb s...e,„s/6-le Static Level ,log _ ft. Date/Time measured /-30 - 76 `7 ,4Ar , Production Rate (3 gpm. Pumping level _3 o O ft. Date/Time measured " - 7_ pfr, .,./PM , Test length (hrs.) ,) . Remarks 13. 1 have read the statements made herein and know the contents thereof, and that May are true to my knowledge. (Pursuant to Section 24.4-,04 (13)(a) C.R.S.. the making of false statements herein constitutes perjury in the/second degree and is punishable as a class I misdemeanor.) CNTRACTOR (-Ave 1-s 1 %.1 h/. 4, Phone (303 ) 9.52-Jow Lic. No. 6987 ,ingAddress 7j6l& C S3/ s- Avt/a , Co--L© 5-o 6 a / r lame/Title (Please type or/print) Signature Date D h x 771 i 9/C1�/ E 63 tett-L.i 1 1 5 - S/9%6 4•0O O r^ �CF'O4\P9 'FOY P.OMER �C •Ai JERIS A. DANIELSON Governor r,, O State Engineer r e7/ 41876 OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES 1313 Sherman Street-Room 818 Denver, Colorado 80203 (303) 866-3581 Michal S. Bearson 10501 W.C.R. 25 1/2 Fort Lupton, Co. 80621 RE: Well Permit No. 32591—F Dear Mr. Bearson: Please be advised that well permit No. 32591—F expired on October 22, 1988. The well permit holder failed to file notice of well completion as required by Section 37-90-137(3) (a)(II), C.R.S. (1986 Supp) and the Statewide Nontributary Ground Water Rules (2CCR402-7) prior to the expiration date of the well permit. Since the well has been constructed, it is necessary for the owner of the well to maintain a valid well permit. Failure to obtain a new permit could result in orders to plug and abandon the well. An application form and Landownership Statement form are enclosed for your convenience. A $60. filing fee should accompany the application. The conditions of approval on the expired well permit No. 32591-F required that the well be geophysically logged prior to the installation of the well casing. A review of our records indicates that the required geophysical log has not yet been received by this office. Please obtain a copy of the log and submit it with the new permit application. If you have any questions concerning this matter, please contact Rich Cooper of this office. Sincerely, Steve Lautenschlager Water Resources Engineer Ground Water Section SPL/RAC Enclosures ORDER OF THE STATE ENGINEER IN THE MATTER OF WELL PERMIT NO. 32591-F LOCATION: NW1/4, SE1/4, SECTION 27, TOWNSHIP 2N, RANGE 67W APPLICANT: MICHAL S. BEARSON THE STATE ENGINEER FINDS: The well permit was issued pursuant to Section 37-90-137(4), C.R.S. (1986 Supp) on October 22, 1987 and had an expiration date of October 22, 1988. The applicant failed to file notice of well completion as required by Section 37-90-137(3) (a) (II) , C.R.S. (1986 Supp) and the Statewide Nontributary Ground Water Rules (2CCR402-7) prior to the expiration date of the well permit. The well permit is hereby expired and is of no further force or effect. Dated this apt day of IF;Lnp-C\K `C' 1/4-a, , 19 . a. Aso.tii.A6 Jeris Da ielson + State Engin er Y �Je Steve Lautenschlnschlager Water Resource Engineer Ground Water Section Prepared by: RC cc: Division 1 Applicant 0596I/Form #0838(G) MAR-04-195=: 10:35 ^ WELL COUI IT, HEALTH DEPT __ 1970356496,6 P.0_ WELD Co HEALTH DEPARTMENT 1517 16TH AYENUE 'COURT, GREELEY, CO 80631 (970) 353 -0635 EX 2225 FAX (97O) 356-4966 • Permit # : . SP-9600547 Sec/Twn/Rng1: • Status : ISSUED Permit Type : ! RNEW c-commercial. A-residential - VEH. RSPa r. vauur Applied: 10/14/1996 Parcel No : : 1311 27 Issued: 10/15/1996 Finaled: Location: ' 4500 WCR 1621 rj c 1 Legal Desc : APPLICANT BEARSON NELVA Phone : (303 ) 857-93: ' 9208 WCR 25, FT LUPTON .CO 80 21 OWNER BEARSON DARRELL Phone: (303 ) 857-656" ! 9208 WCR 25, FT LUPTON CO 80 21 SEPT-ENGR CROWE CECIL R ALPHA EN?INEE ING Phone : (970) 857-23c PO BOX 392 , FORT LUPTON, COL RADO 80621 SEPT-INSTL ! SELF . Phone: (970) 999-99' X, GREELEY CO 80631 Description: MOBILE HOME • 27-02-67 Commercial {Y/N) : N Residezi ial (Y/N) : Y Acres : 80 . 00 Number of Persons : 2 Basement Plui ing (Y/N) : N • "'umber of Bedrooms : 3 Bathro ms-> Pull : 1 3/4 : 1 1/2 : water Public (Y/NI : Ut lity Name : Water Private (Y/N) : Y Cis ern (Y/N) : Well (Y/N) : Y Water Permit No: Percolation' Rate: 23 . 3 Limiting Zone : . 08 ft 00 in Desc : % Ground Slope : 4 Dir: W Solt- Suit ble (Y/N) : Y Engineer Design Req' d (Y/N) : fq In 100 Yr Flood Plain (Y/N) : Minimum Installation SepticjTank: 1000 gal Absorption Trench: 729 sq. ft . Abso ption Bed: 939 sq. ft . Actual Installation Septic! Tank: 1L"0-1) gal Absorpt ' on Trench: sq. ft . Abso tion Bed:- } sq. ft .Ci-'9 O NOTICE 1::= issuance of this pcxmlt dots not imply cutyliancc with athat aata, count:, or local ragutatory or building requirements. nor shall is act co ccrtify',chat the subject system will operate in complier ce with applicable state. county and local regulations adapted persuanc to Arcicic IA. Title '_5, CAS no amended, except fot c!r purpose of establishing final approval of installed system for issuance of k local occupancy permit persuanc to CRS 19"s 15 10.111 (21 . This permit is not cransEerable. The Weld County Health Department res:rve>: the right co impo-ne.additional t.ernn and conditions required to meet oor rc4ulociona on a cone inning basis. Pi nnl permit a,provnl *sae contingent upon the final impaction of the ^ 'pieced system by chel veld Cooney Health Deportment. J / g,-N rig &alit- M 1691n4-fetvU i Of/ �L, TOTAL P.02 WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970) 353-0635 EXT 2225 FAX (970) 356-4966 Permit # : SP-9600195 Sec/Twn/Rng: 27 02 67 PERMIT Permit Type : RNEW C-commercial, R=residential + NEW, REPair, VauLT Applied: 04/08/1996 Parcel No : 1311 27 000043 Expires: 04/03/1997 • Location: 9455 WCR 16 FORT LUPTON CO 27-02-67 Legal Desc : 20410-A E2SW4 27 2 67 9455 WCR 16 WEL APPLICANT BEARSON NELVA Phone : (303) 857-6468 9743 WCR 16 , FORT LUPTON CO 80612 OWNER BEARSON DARRELL L & NELVA M & BEARSON MICHAL S & BRADLEY D, 9208 WELD CO RD 25, FT LUPTON CO 8 Description: MOBILE HOME Commercial (Y/N) : N Residential (Y/N) : Y Acres : 90 . 00 Number of Persons : 1 Basement Plumbing (Y/N) : N Number of Bedrooms : (5 Bathrooms-> Full : 2 3/4 : 1/2 : Water Public (Y/N) : Utility Name : - . Water Private (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y Water Permit No: -"Percolation Rate : '�0.`j Limiting Zone : ?g ft _ in Desc : 9,5 Ground Slope : -- Dir: _ Soil Suitable (Y/N) : y(S Engineer Design Req' d (Y/N) :fOQ In 100 Yr Flood Plain (Y/N) : �() From the application information supplied and the on-site soil percolation data the following minimum installation specifications are required: 7 Septic Tank: 1001 ) gallons, Absorption Trench Y,tD` I sq. ft . or � //' Absorption Bed /um sq. ft . In addition,, this permit is subject to the following additional terms and conditions : 1RscrU • • • NOTICE This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Health Department for reasons set forth in the Weld County individual sewage disposal system regulations including failure to meet any term or condition imposed thereon 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 not transferable. Before issuing final approval of this permit the Weld County Health Department reserves the right to impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is �.ingent upon the final inspection of the completed system by the Weld County Health Department. 9-129 u c'5 Environmental Specialist Date WELD COUNTY HEALTH DEPARTMENT 40.1 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970) 353 -0635 EXT 2225 FAX (970) 356-4966 Permit # : SP-9600546 Sec/Twn/Rng: PERMIT Permit Type : RNEW c.commercial, R=residential NEW, REPair, vauLT Applied: 10/14/1996 Parcel No : 1311 27 Expires : 10/09/1997 Location: 4500 WCR 16 27-02-67 Legal Desc : €J Li APPLICANT BEARSON NELVA ' Phone : (970) 857-6468 9208 WCR 26 , FORT LUPTON CO 80621 • Phone : (970) 857-6468 OWNER BEARSON DARRELL 9208 WCR 26 , FORT LUPTON CO 80621 INSTALLERS BEARSON DARRELL Phone : ( 970) 857 2308 ENGINEER CROWE CECIL ALPHA ENGINEERING PO BOX 392 , FORT LUPTON CO 80621 Description: MOBILE HOME Commercial (Y/N) : N Residential (Y/N) : Y Acres : 80 . 00 Number of Persons : 3 Basement Plumbing (Y/N) : N Number of Bedrooms : 3 . Bathrooms-> Full : 1 3/4 : 1/2 : 1 , Water Public (Y/N) : Utility Name : weer Private (Y/N) : Y Cistern (Y/N) : • Well (Y/N) : Y Water Permit No : 045562F Percolation Rate : tiSI, L. Limiting Zone : >52ft 0 in Desc : 26. Ground Slope : q Dir : . r�/v Soil Suitable (Y/N) : Engineer Design Req' d (Y/N) : In 100 .Yr Flood Plain (Y/N) : Prom the application information supplied and the on-Bite soil percolation data the following minimum installation specifications are required: G/ Septic Tank : /GOO gallons, Absorption Trench 173---sq. ft . - or Absorption Bed I2-4.-A2 sq. ft . In addition, this per 3 it is subject to the followin / additional terms and conditions : � l On" fi 'G"e'�^' 1F -.• ' c is c; L1 4 il NOTICE ILI C °//S/5 Thispermit is granted temporarily to allow construction to commence. This permit ay be r oked or suspended by the Weld County Health Department for reasons set forth in the Weld County individual sewage disposal sy em regulations including failure to meet any term or condition imposed thereon 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. permit is not transferable. Before issuing final approval of this permit the Weld County Health Department reserves the right 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 Cognty Health De artment. C---47-:(7.Ex wvn y9F� WELD COUNTY HEALTH DEPARTMENT 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970) 353 -0635 EXT 2225 FAX (970) 356-4966 Permit # : SP-9600079 PERMIT Permit Type : RNEW c=commercial, R=residential + NEW, REPair, VAULT Applied: 02/12/1996 Parcel No : 1311 27 000040 Expires : 02/06/1997 Location : 9743 WCR 16 , FT LUPTON 27-02-67 Legal Desc : 20409-B W2SE4 27 2 67 (2R) 9743 16 CR WELD APPLICANT BEARSON DARRELL L & NELVA M & BEARSON MICHAL S & BRADLEY D, 9208 WELD CO RD 25, FT LUPTON 3) 857-6468PTOO OWNER BEARSON DARRELL L & NELVA M & Do (T0 BEARSON MICHAL S &BRADLEY D, 9208 WELD CO RD 25 , FT LUPTON CO 8 Description : MOBILE HOME Commercial (Y/N) : Residential (Y/N) : Y Acres : 90 . 00 Number of Persons : 2 Basement Plumbing (Y/N : 1 3/4 : 1/2 : 1) N Number of Bedrooms : 3 ta Water Public (Y/N) : N Utility Name : Water Private (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y Water Permit No : ZaL Limiting '$ ft in Desc :Zone :.-. Percolation Rate : j — —96 Ground Slope : H Dir: Soil Suitable (Y/N) : Engineer Design Req' d (Y/N) : /vvm In 100 Yr Flood Plain (Y/N) : From the application information supplied and the on-site soil percolation data the following minimum installation specifications are required: Septic Tank : frtri9 gallons, Absorption Trench 1,0 sq. ft . or Absorption Bed /0-17 sq. ft . In addition, this permit 1 is subject to the following additional terms and tN conditions: t\ q) ,(- -05:1)C. i -PP.tk, NOTICE This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the weld County Health Department for reasons set forth in the Weld County individual sewage disposal system regulations including failure to meet any term or condition imposed thereon 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 not transferable. Before issuing final approval of this permit the Weld County Health Department reserves the rig n impose additional terms and conditions required to meet our regulations on a continuing basis. Final permit approval is ingent upon the final inspection of the completed system by the weld County Health Department. X "'Aim)Environment4,t,01 Specialist D�t ;-...7P“:...'„::' - y .. iDU1••:,... SEWAGE DISPOSAL SYSTEM PERMIT NO, 1.7,—':;00: WELD COUNTY HEALTH DEPARTMENT NEk' PERIT .,•• -.•., l-Y-,•,. .....:, .t.r.,dr:.fr._r*' 1 !)r... HEALTH SERVICES - (r. 1517 16TH AVENUE COURT, GREELEY . CO-;' -y...{.}{t,.3 EXT. '}22::;' 3,.. • .FT. LUPTON CO 20621 ' AT-27PESE 0:: PROPOSED SYSTEM 974:5 WCR 16 !::.oRT LUPTON CO S0621 SEF,VICE... • PERSONS:.i. .. _,_,. ' w BATHROOMS;-�;•�C?t�7;•t,_ 2.00 ,_OT' SIZE 3').;:?i 11�'₹�;ES . EASEMENT PLUMBING NO WATER SUPPLY PWEJ . ._-._,...-`i . I U N FEE '.;.',150, 00 yy�� • RE: ' D .:. . RECEPTIONIST i I D. SIGNED (,. r r._ DATE• 11 /08/TO t i W]`.1-. 5•'1 i t t::.:i F'+W 1 1(+� DATE ii /08/90 '.':....;!..'.';_f _ . Oyer RATE t�0,0 MIN PE''. INCH LIMITING ZONE f FEET• • t L..rE -t PERCENT GROUND SLOPE 2Z DIRECTION S/W REQU... ._-... ENGINEER:ER DESIGN I: N w . .,.. _. ."}: •."r 'r'z•-•APPLICATION INFORMATIONINSTALLATION � .. - ..: ._ ... ,..i. _. ..U a.:_ PERCOLATION .Yr•'hl r 1 I ON—SITE r :.... . ...::...LO„•1r\S MINIMUM �T!. -r SPECIFICATIONS t.1 _ ARE DATA SEPTIC TANK . ,. ,. , '' ...... .... ...... .._ -:! ..�t':..: �••1 f�.r'. REQUIRED : r• I f SUPPLIED'r AND THE ...,..t, . I,.• 1 AN₹.:- 1000 'u•f•°ii_.₹_.1.�..'1``.,.�!• ABSORPTION TRENCH s•"I r' T. ^. OR • +.i:Yt. .r. ; PERMIT'• 1", i� t T• ABSORPTION BED is 3636 Q F 1 ..'i.. 'i: ;t l , ...r i . j: FOLLOWING ONAL , AND • 7-7S " ERMIT IS GRANTED TEMPORARILY ALLOW CONSTRUCTION ,,, .._ _ ., _ �•l l„₹_.,_ 1"C� ;•i_;:t:r - ,CR r.73 .7-!..: .{. : :"iwr'.. WELD r'liii,l,f• INDIVIDUAL�7} it SEWAGE T t",(:.₹'. ₹ti�»(A;,.'.•�i. , ::'...- : ... -..TC ..W .._n. . .. ._ DISPOSAL "'T'ar't REGULATIONS NDED BY THE WELD COUNTY HEALTH INCLUDING,� ET ANY TERM OR Cf'INDITION IMPOSED THEREON DURING TEMPORARY OR FINAL 17F :77:V.:-,:— . r,... . },.. ... . .::t:. i.?r- 1`...1.S PERMIT f DOES NOT CONSTITUTE ASSUMPTION BY 'Y'S_:•::• ..r ; Or, ITS w. __ _.O+'�E..„..: OF LIABILITY FOR y THE ,.....A ,..,._ — _. .. ... ...„. r, THE₹₹_. FAILURE_Jr`';�: OR INADEQUACY OF . THE r.~i:l►� .re Terri SPECIALISTE . 1 r_ 70 -90 I``'e�₹�i SMITHSMITHW48/9°Co--y>J / l/ ENVIRONMENTAL 7't .; i.:' r AND SHALL BECOME VOID IF AS ...... . M 1...». ,.. ........'•:.;..... r.'......:. . . ... .. . YEAR - . . ... ISSUANCE, - ._ "₹"E.)t:i�. .t.,�',.'.•1rf.Y" '� 'T:t��`i₹... Ir:PJl`Iy`rJ,V, _ i_. . .... ... ................. n .t CONDITIONS'-.. .__ . . .... ,... n. ..., ,..,, ,...,.. ._ .._w: 1-i 1... 1'₹₹t Y•r, of`''i'• .`�' ''•Ili'.r't • jai; i ::�, 1.}F'i::•r;;li• �it:�•�:•�� ₹,•;::•�₹�,_,; ,...�, •� 1' .:..:.T.. 7:::M.. .. PERiXIT f:',:7.PRCVAL IS CONTINGENT UPON THE FINAL INSPECTION OF THE CO..1— LE"-ED SYZTEM BY 7'...!E WELD COUNTY- HEALTH_.. ��"�'y 7� 1�J 'gyp,-_ J� , :.. -..?'' ... ,.. f•:.._i...t_.1'i% ., Y Wrlo.J��.v. �,, .,�� f� �// •s��J�..�[tea.-CE. .... . WITH l 7:UANCE OF THIS PERMIT DOES NOT .IMPLY S, NOR SHALL IT ACT TO :EPTIFY THAT f WILL :: PERATE IN COMPLIANCE r-STEM. .... .. "i, .. - :)(•�� .. :? t::... _�pti\'l" WITH APPLICABLE...:............ STATE, f�("1?,(,liT •1' ,A-,;..Ii:,, .. .. . ,:) ADOPTED, , r I,. i' TO ARTICLE�.�:.₹...T:: 10, TITLE ryr. 7• , AS AMENDED. 4.CE* ' FCE: THE PURPOSE 07.... _ , : ;.•₹.:�..:; 'r PERMIT, i s ESTABLISHING P R S S •41 HS P+ 06P INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. G-900 WELD COUNTY HEALTH LT'1"I DEPARTMENT NEW PERMIT ENVIRONMENTAL HEALTH SERVICES ' 1517 16TH AVENUE COURT, GREEL..EY, CO 80631 353-0635 EXT,,2225 • . , _ 25-1/2 • . P11 (303) 857 OWNER �tl;"i'1f;;�l:l't•! I?r'tl�ifviFF'I...I.. L. ADDRESS 1 iJ50'i WCR FORT L..UPTON CO 80621 . ADDRESS OE PROPOSED SYSTEM 9209 WCR 25' . FORT LUPTON- CO 00621 •• . - LEGAL DESCRIPTION •OF SITE : W2 SEC 18 TWP 2 IFF:i-!(;- ,_, . SUBDIVISION : LUP ON MEADOWS • I..O T. r BLOCK O . FILING • . O USE TYPE : RESIDENTIAL H(3(JSIw SERVICES-: PERSONS 4 BATHROOMS 4 .06 . LOT SIZE 28.00 ACRES BEDROOMS 3 BASEMENT PLUMBING 't'l:::S WATER I:1 SUPPLY P.WE:LL�~. �, '\. r . t APPLICATION ION FEE• $150.00 • '.N+ RL.C ' 0 BY RECEPTIONIST AID •• SIGNED(::?`!E:U BY NELVO BCARSON y ... Dt� • 09/25/90 • DATE 09/25/90 . '•`_ , ' - , , . 1 PERCOLATION RATE: 'T...2. MIN PER INCH . • : I...I:ii:I: i I NG ., ONE 2 r FEdT. ..-- `' OIL TYPE ,t''1:11 AT{L.C�• l-,Ef •Cl- t cFOLJi;�'x? I._+:,rF I::: O D 1 Ea ro -1..,, ,. ; : : ' :... ' REQUIRES ENGINEER DESIGN NCl • FF(:IM THE: APPLICATION INFORMATION SUPPLIED AND THE ON-SITE FOIL F'EF.COL:A.T.ION ,TEAT • THE FOLLOWING MINIMUM INSTALLATION SPECIFICATIONS . ARERE(:;(JIPED . • . SEPTIC F'TIC T'Al'k i'GQ0 ( ALL..ONS, ABSURF'T'ION - TREKH, 52: S.Q .1.T . .. . . ABSORPTION BED C . .. 7i i S G. rT.:: .. ' y . . ADDITION, THISPERMIT IS S(JI:3JECT TO TilE f"OLLOWING:•:AD'DIT.IONAL.,:TERMS; ANA/ ,'I , • • -'_': �,� THIS PERMIT IS` GRANTED TEMPORARILY TO''AtIOW..C;f71' TROCTION; T(:1 CUMl4ENCC.- THIS'. PEF: MAY BE REVOKED OR SUSPENDED BY .THE I•'IE WELD .COUNTY. HEALTH DEPART'i•1i iT .l"OR 1 EA-SONS: S FORTH IN THE WELD COUNTY INDIVIDUAL. SEWAGE DISF'OSAI... ,:�YSTCM '1 CCULATIONE.•INCLUDI. FAILURE TO MELT • ANY TERM OR CONDITION 'IMPOSED THI:::I I:::UNA)ORING TE11F,orARY OR FTNA APPROVAL.ROVAL,, THE ISSUANCE DF THIS PERMIT DOES NOT 'CONSTITUTE:•A S'&JF'PTION BY THE DEPARTMENT OF ITS EMPLOYEES OF LIABILITY FOR THE F ,:i:I 1...HI 1 IW INADpUAC T ,UI THE SEWAGE I?ISI"+.7.sr,I... SYSTEM . + -: -�C � �_c'•`-,-; WE I't:a.1..Tl:;:F: •. 4. ` • 09/27/9 _3 L, 1A �,y,/9. y-y-9/ I:::i!'� :E:F�C1i!�ii:j'dTAL SF'E(vI AL?SST DAiTE'•THIS PERMIT T IS NOT TRANSFERADLE AND SHALL BECOME ' OID . Iw~ SYSTEM `CON;STRUC;TION 'I-i NOT COMMENCED WITHIN ONE YEAR OF ITS ISSUAiNCE. . BLIUI E;__IS'.S'LiI;NG F TNAL:;AIPROYAL THIS PERMIT THE WELD COUNTY HEALTH DEPARTMENT RESERVES THE RIGHT:•TO'IMPOSE ADD TIONr.l._ TERMS AND CONDITIONS REQUIRED TO MEET :.OUR REGUL.AT' ONS-.-ON :A :CONTINUING.• LF EIS. FINAL._ PERMIT APPROVAL Is CONTINGENT UPON THE FINAL • INSF'CC:TION OF THE COi . PLETEI? SYSTEM BY THE WELD COUNTY HEALTH DEPARTMENT. • c I SYSTEM INSTALLER ____W Se. .__._______..:..J____......_FF':I:itrlf ItNS ,Ec ' :iN l•( .. L _- G SYSTEM ENGINEER ____I�DN� . _-..w.-._._................___...._r=•il�APPROVAL: 1 TYPE OF SYSTEM INSTALLED ENVIRONMENTAL SPECIAL:r.ST• •^:: ISSUANCE OF THIS PERMIT DOES NOT IMPLY COMPLIANCE WITH OTI-IE:R STATE., COUNT't LOCAL REGULATORY OR BUILDING; REQUIREMENTS, NOR SHALL IT ACT TO CERTIFY THAI THE SUBJECT SYSTEM LJ:I:LI... OPERATE IN COMPLIANCE WITH APPLICABLE STATE, COUNTY Air. LOCAL REGULATIONS ADOPTED F'ERSIJANT TO ARTICLE 10, TITLE '5, CRS 1973, AS AMEND EXCEPT FOR THE PURPOSE OF ESTABLISHING FINAL.. APPROVAL OF AN INSTALLED SYSTEM.., F ISSUANCE . OF A LOCAL_ OCCUPANCY PERMIT PURSUANT TO CRS 1973 --j0--IIi (2) _.. ..).--IV ' AA '�•••'a' a nJ 4 i t!i1 maJIVYL7tlML .»VVMUi= Uja'r'l ai,\I- 6YS I EYt1� No. ----if COm //i)u-A,e WELD COUNTY HEALTH DEPARTME� ^ Q New f ��0� O ENVIRONMENTAL HEALTH SERVICES SU{ / 1518 Hospital Road,Greeley, CO 80831 Repair t _ 383-05.401 EXT. 270p / BP ^OWNERI 'rrz i- SO - I I i7 -O 0 ADDRESS Iu5c i W C. 1' ,` a. / ( c%(�, e..' ADDRESS OF PROPOSED SYSTEM /-?..2-c? / c ' 'J ,i/, A ,iP p SHONE I LEGAL DESCRIPTION OF SITE: PT- 4-1' S / TI�, R 66 SUBDIVISION -- - COT , BLOCK , FILING USE TYPE: RESIDENTIAL '-'')-- &,'/=` /-Lams I INS IYUTION COMMERCIAL I I OT1E au SERVICES: PERSONS .- 7 BATHROOMS I i LOT,SITtE BEDROOMS / BASEMENT PLIIUMBING a WATER SUPPLY i WR TYPE OF SEWAGE DISPOSAL REQUESTED: L AJ1&$be t i Applicant acknowledges that the completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or by the Weld County Health Department for purposes of the evaluation of the-application,and the issuance"of,the permit Is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article..10,. Title 25, CRS 1973, as amended-The applicant certifies that the proposed system will not be located within 400,feet of a com- munity sewage system.The undersigned hereby certifies'that all_statements made,information and reports submitted-here;-L' with and required to be submitted by the applicant are, or will be;represented to be true and correct to'-Ute"best of-my knowl- edge and belief, and are designed to be relied on by the:Weld County Health Department in evaluating'the same,for purposes of Issuing the permit applied for herein- I further understand that any,,,faJsification or misrepresentation may result Ingle denial of the application or revocation of any permit granted based upon sajd application and )gal action for perjury as provided by law. Application fee 35. Q f.. )'t- C. , t ll, /Lr4/ Rec'd by —12-10.-4---\--- i=6-0--“9--- Date/11'1-N�� / Owner/Agent Signature' / ; Date * */417, A tor � / e..,wl♦n�S*J♦ ♦ ♦ • rre(Q " ♦,(.,yam. ♦ Coet ,eLv zn�+c aN4N5♦ *4s;-r$C-trir i FOR DEPT. PERCOLATION RATES`'e P'+'N'. // 7- 3--- , • WATER TABLE DEPTH-- USE ONLY SOIL TYPE �� `PERCENT GROUND'SLOPE ' REQUIRES ENGINEER DESIGN ( )YES(L) N0 , * ♦ ♦ • ♦ • . r ♦ ♦ t '♦ * * * * * * { * * • •-♦ * * *-* •"-• ♦_ • * ♦117j.•' *), -,2 v., INDIVIDUAL SEWAGE DISP0SE►} SYS i 4 PERMIT From the application information supplied and the on-site-soil.percola io&datar.the;olloWingVnimurn Installation specifi- cations are required: If SEPTIC TAN CU5r' GALLONS, ABSORPTION TRENCH, ' ' SQ. FT �I � 5`°),qd� add °f. >l Al ABSORPTION BED SQ. FT. _ /D H �J--C In addition, this Permit is subject to the/pfpllow Ing addiiyonal ter/ms-and conditi ns:— -_ lc, SOre /rl9P1- /f /r OalD-Lt/ Pe¢ xe. G.(.j1- 4 ,This Permit is granted to orarily to allow construction to cbmrr This Permit rgay be revoked or suspended by the Weld. 'County Health Department for reasons set forth in the Weld Countlhdividual Sewage Disposal System Regulations, Including failure to meet any term or condition imposed thereon during$emporary or finarapproval—Thelssuance of this Permit does not cons11mute,,aassumption by the pepartmery r It%e�rpployre c�lia¢Jllityr/d t �ektr�_ eq t s ya a disposal system. Mob* PiDm/es w y ki 4-ke r _ E�y Y o gY� 9 P �j �EO � �! //��/r// Environmental Specialist / Dale This Permit is not transferrable and shall become void if system construction has not commenced within one-year of its issuance. Before issuing final approval of this Permit the Weld County Health Department.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 in- spection of the completed system by the Weld County Health Department. SYSTEM CONTRACTOR � \ FINALINSPE(,C�TION SYSTEM ENGINEER- U APPROVAL I v \ cAti,.I�o __ loll 0- SYSTEM �.. —7—Cr �as,//�—/ 3 —6s4 Environ ntal Specialist Date he issuance of this Permit does not imply compliance with other state, county or local regulatory or building reouirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted pursuant to Article 10, Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of an installed system for issuance of a local occupancy permit pursuant to CRS 1973 25-10.111 (2). . Original-Applicant; Copy-WCHD _ WCHD—EHS February, 1981 /;- 77— /56 0 (-I" -C^� -- , Fx � ; APPLICATIC.N CR INDIVIDUAL SEWAGE DIS� SAL SYSTEM No. /77-1).°) ; WELD COUNTY HEALTH DEPARTMENT New ':" ENVIRONMENTAL HEALTH SERVICES 1516 Hospital'Road, Greeley, CO 80631 Repair _ f,. - 353-0540 EXT. / / /T(/ BP uWNER 1 idrre II .�iivf i.S0 ft. 'ADDRESS/�: /C ≤OJ ( ( 'r^,(� a7c> /7 1 7, (PHONE eit 5`,-A--/'/lam ADDRESS OF PROPOSED SYSTEM L< (r / h LEGAL DESCRIPTION OF SITE PT �,�� S �� ,T 2 , R � ' SUBDIVISION LOT , BLOCK , FILING USE TYPE: RESIDENTIAL X /77 on,b;le /cm e. INSTITUTION COMMERCIAL OTHER SERVICES: PERSONS / BATHROOMS / LOT SIZE Le i a(U'ec'S • BEDROOMS a BASEMENT PLUMBING he' WATE JJJ SUPP_�.Y (/.-y /7 TYPE OF SEWAGE DISPOSAL REQUESTED: ) - -I'a t1 �c Prae°7? T-i 'p/( Applicant acknowledges that the completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Health Department to be made and furnished by the applicant or,by the Weld County Health Department for purposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under;Article 10, Title 25, CRS 1973, as amended.The applicant certifies that the proposed system will not be located within 400 feet of a com- munity sewage system.The undersigned hereby certifies that all statements made,information and reports submitted here- with and required to be submitted by the applicant are, or will be, represented to be true and correct to the best of my knowl- edge and belief, and are designed to be relied on by the Weld County Health,Department in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsificatio or misrepresentation may result in the denial of the application or i revocatigr1of any permit granted based upon said pplicatlon an legal action for perjury as provided by law. Applicatio fee ,� / ✓y w- .�j_sRec'd by("tilec (�%en ls� Date�-:1x-4,3 Owner/Agent Signat4jtre Date * * * * * * * * * ♦ • * * * * * * * • * * * * * * * * * * * * * * • * * * * T* • * * * * • * * * •* * *4. f., F DEPT. PERCOLATIO RATE f QA f U WATER TABLE DEPTH u-c•-l'.-----Y`10NLY SOIL TYPF t ✓ �� 47"4"ERCENT GROUND SLOPE/Pa-1r I REQUIRES ENGINEER SIGN ( )YES34No - ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT From the application Information supplied and the on-site soil percolation data, the following inimu mstaliation specifi- cations are required: �S JAv SEPTIC TANK /1wv GALLONS,ABSORPTION TRENCH,3,30 ,t2i 3 0 SQ. FT. "+ '�0 r Or ABSORPTION BED '7.�O SQ. FT. . In ddition, this Permit is subject to the following additional terms and conditions: ` ) /` `f° /r!- ll✓f (cf t.r 4 jF�'^7 K �, � � r 7i ! !CJ �.- l/flii �� •This Permit is granted temporarily Mallow construction to corV7mence. This Permit ma be revoked or suspended by the Weld D ;. County Health Department for reasons set forth in the Weld County Individual Sewage Disposal System Regulations, including failure to meet any term or condition imposed thereon during temporary or final approval. The issuance of this Permit does not constitute su b j assumption by the Dep rtment or Its employees of IIIfor te fail re or inadequacy of the sewage disposal system. // Environ irSi Specialist / Date This Permit is not transferrable and shall become void if syste construction has/not commenced within one year of its Issuance. Before Issuing final approval of this Permit the Weld County Health Department 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 in- spection of the completed system by the Weld County Health Department. SYSTEM CONTRACTOR NGINEER FINAL PPROV SPE � P 4 .^TEM ENGINEER APPROVAL Pc. 34,1___- r6 /7— f3 nvironment ecialist / Date he issuance of this Permit does not imply compliance with other ate, county or local regulatory or building requirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted pursuant to Article 10,Title 25, CRS 1973, as amended, except for the purposes of establishing final approval of an - installed system for Issuance of a local occupancy permit pursuant to CRS 1973 25-10-111 (2). Original-Applicant; Copy-WCHD WCHD—EHS February,1981 . HSPt06!" APPLICATION FOR INDIVIDLAL SEWAGE DISPOSAL SYSTEM NO. G-87(1::; • WELD COUNTY HEALTH DEPARTMENT NEW APPLICATION; ENVIRONMENTAL HEALTH SERVICES 1516 HOSPITAL ROAD, GREELEY, CO 80631 353-0635 EXT.2225 OWNER PEARSON, MICHAL S. ADDRESS 10501 WCR 25-•1/2 PH (303) 857-64. FT. LUPTON CO 8062f ADDRESS OF PROPOSED SYSTEM PENDING WCR 16 re WCR 2i FT. LUPTON CO 80621 LEGAL. DESCRIPTION OF SITE: W2 SE4 SEC 27 TWF' 2 RNG 67 SUBDIVISION: LOT 0 BLOCK 0 FILING 0 USE TYPE: RESIDENTIAL 2 MOBILE HOMES ON 1 LOT SERVICES: PERSONS 3 BATHROOMS 3.00 LOT SIZE 80.00 ACRES BEDROOMS 6 BASEMENT PLUMBING NO WATER St1F'F•LY CWCWD APPLICANT ACKNOWLEDGES THAT THE COMPLETENESS OF THIS APPLICATION IS CONDITIONAL UPON FURTHER MANDATORY AND ADDITIONAL TESTS AND REPORTS AS MAY BE REQUIRED BY THE WELD COUNTY HEALTH DEPARTMENT TO BE MADE AND FURNISHED BY THE APPLICANT OR BY THE WELD COUNTY HEALTH DEPARTMENT FOR PURPOSES OF THE EVALUATION OF THE APPLICATION; AND THE ISSUANCE OF THE PERMIT IS SUBJECT TO SUCH TERMS AND' CONDITIONS AS DEEMED NECESSARY TO INSURE COMPLIANCE WITH RULES AND REGULATIONS ADOPTED UNDER ARTICLE • 10, TITLE 25, CRS 1973, AS AMENDED. THE APPLICANT CERTIFIES THAT THE PROPOSED SYSTEM WILL NOT BE LOCATED WITHIN 400 FEET OF A COMMUNITY SEWAGE SYSTEM. THE JNDERSIGNED HEREBY CERTIFIES THAT ALL STATEMENTS MADE, INFORMATION AND REPORTS 'UBMITTED HEREWITH AND REQUIRED TO BE SUBMITTED BY THE APPLICANT ARE, DR WILL. BE, tEPRESENTED TO BE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND %RE DESIGNED TO BE RELIED ON BY THE WELD COUNTY HEALTH DEPARTMENT IN EVALUATING "HE SAME FOR PURPOSES OF ISSUING THE PERMIT APPLIED FOR HEREIN. I FURTHER UNDER- :TAND THAT ANY FALSIFICATION OR MISREPRESENTATION MAY RESULT IN THE DENIAL OF THE IPPLICATION OR REVOCATION OF ANY PERMIT GRANTED BASED UPON SAID APPLICATION AND •N LEGAL ACTION FOR PERJURY AS PROVIDED BY LAW. PFLICATION FEE $150.00 MICHAL S. BEARSON EC'D BY COFFEY, DIANNE �Jotl!-,4-43,40:?Zd.ArZ 10/06/87 �.. DATE 10/06/87 OWNER/AGENT SIGNATURE DATE 871560 (GINAL-APPLICANT; COPY-WCHD WCHD-EHS MAY, 1984 Hello