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Home My WebLink About20083036.tiff • i _ wn.r25.73 THIS FORMMUSTBE: ' SUBMITTED PRIOR TO RECEIVED THE EXPIRATION OF THE COLORADO DIVISION OF WATER RESOURCES PERMIT. TYPE OR 300 Columbine Bldg., 4 WRINT IN 84ACK INK. 1845 Sherman $t. PY OF ACCEPTED Denver, Colorado 80203 PR 12:? L ATEMENT MAILED ON REQUEST. RESOWICa _�_ STATEMENT OF BENEFICIAL USE OF GROUND WATER ws ERE vaiNBER FOR OFFICE USE ONLY AMENDMENT OF EXISTING RECORD Div.4_, Cte. ire PERMIT NUMBER 71545 STATE OF COLORADO fSS. COUNTYOF Weld LOCATION.0F WELL • THE AFFIANT(S) Richard and Donna Woodruff county Weld whose mailing address is SF. 34 of the NE '4, Section _ City Fg+prt �(� 6 }�j t�1i7 (sta ti§15 Twp. DA s) ,Rng• (e dm, --�"' P. being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well i located as described above, at distances of 2O2O feet from the North. section line and 920 feet from th WORTH OM zinnia East section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the.J.; (Dist OR wseT) day of November , 19_21; the maximum sustained pumping rote of the well is —1.5____gallons per minute, the pumpin Ike claimed hereby is 15 gallons per;minute; the total depth of the well is 255 feet; the average annual amour of water to be diverted is 2 acre-feet; for which claim is hereby made for Domestic purpose(s); the legal description of the land on which the water from this well is used i Part of the SEt of the NEj. section 22 . T6N.R62W which total acres and which is illustrated on the mop on the reverse side of this form; that this well was completed in compliant with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he (they) ha (have) read the statements made hereon; knows the content thereof; and- at the same are true of his (their) knowledge Signature( -. ire / $ubseribuxl ofDd.s ,otn, FOR OFF E} O LY to.hefore me on thisail-. day of n 192,/ i C Court Case No. hlyrComnassion expires-: 9DeN 15.• ft? 77 ia€nu / .. sae. Y. %, B, ' - NOTARY raaltc Well Use/ ACCEPTED.FoR#1LING BY THE STATE ENGINEER OF COLORADO PURSUANT TO THE FOLLOWING CONDITIONS: Diet._L__ Basin Man.Ois. Prier. Mo.__Day Yr. • • 2008-3036 WELD•COUNTY HEALTH DEPAgMENT 1555 17th Ave. 21,2_ Greeley, Colorado B.P. No. Ph. 353-0540 M.H. No. application for Permit to Install, Construct, Alter or Repair Individual Sewage Disposal System. OwnerAddress Phone 1 4r /11.n ( t, os-AhuR� n. t3 ye) S4 EQ--ell y `I - 376S Legal Description Description , p p Direction ! tv\4A(9 0 o a &+C P��G11151�'{l:Lt ,1 s i 4J(4La on . Gen I Informal' Septic Tanktog- J 1. Living Units b 1. Liquid Capacity 7 5+') iNC—Gallons 2. No. of Bedrooms 2. Dimensions , w L D 3. No. of Baths 3. Material (.rreei 1n-r 4. Basement Drain o 4. Type Inlet 5. Automatic Dishwas r Type Outlet - 6. Garbage Disposal e S 7. Automatic Lapndry e S Secondary Treatment 8. Size of Lot Do c e rS 9. Type of Soil fl I y L-4 s�i S n n il y Field 3 5Q- 1`em 3u Bed s +�1 x 10. Percolation Test u 1 nil1. No.of distribution lines x+=10. a 11. Water Supply ID el) 12. Lot Grade 2. Trench: Width 17 'CS?. Length 13. Water Table Depth 3. Type Filler Material iv?wvEw3 14. Other 4. Depth of Filler h{tteria , 1',� rnS" 5. Gravel Size '3A+ — .;?.-A, " Wee 6. Type Tile • 7. Depth of Cover 8. Other %4uW .of \POI ?ecfr4 W6h The Permit is to remain in full force and effect for six (6) months from date, until revoked for non-compliance. This system will be constructed in accordance with the above specifications and regulations governing non- municipal sewage disposal systems, in accordance with Regulation No. 1 of th Id County H al,h D partment. Owner cannot transfer permit. r Owned G j Date: 9 ' 2 l " 3 Applicant: The plans and specifications as shown are approved, pending payment o permit^fe� Sanitarian. . -I1 EL iV,4-,dt,.. Date: OCr0 V2 R. ) 27 / l The above system inspected and found to comply with the plan and description. Installed by Date: Sanitarian: 1412 PERMIT FEE $ �1 p 1 •ceived by <hp i\ t i- 4 AQA. Date 9 -g c" / 3 Please use reverse sad for P1 Plan or use separate sheet of paper. • • • Office Memorandum WELD COUNTY HEALTH DEPARTMENT DATE-----'_-- Time__ _ To, Mi 1. a APPROVALS of Eig.fi NG I25 - Additions anges Owner: ha on%j4 e Cheuci ra-F Address: 397Ro w Co ed. 4F Phone No. d(ter.. Add. Move In "c - Chg. Other Legal Desc Presently have: Addition 5 Khapge4 dou44 Persons v Bedroans 2 4- : 3 • Bathroans Size/Systen (OU°_ o3ysy en Permit . Record cc.P1 Com 1dg Insp V.y4 • • WELD COUNTY HEALTH DEPARTM• New ENVIRONMENTAL HEALTH SERVICES • 1516 Hospital Road, Greeley, CO 80631 Repair 17to,M©y a Tu r k 353-0540 EXT. 270/ 1 r- J BP SWNER Cal-A y/ 1- ---14f r/e y ADDRESS ,9 '7170 (L JCJV g^ P INE �a 9(® -.S- DDRESS OF PROPOSED SYSTEM/ ,. 9".79c) cock .6j sP- LEGAL DESCRIPTION OF SITE: PT A/C Yi S 7 7 ,T _, R 4.--).2Z-L) SUBDIVISION_ ----- LOT , BLOCK_ , FILING USE TYPE: RESIDENTIAL 'TYQ; kr INSTITUTION _ COMMERCIAL OTHER SERVICES: PERSONS 2 BATHROOMS 2 _LOT SIZE 441 Gf crQ S BEDROOMS .3 BASEMENT PLUMBING ,(I WATER SUPPLY (J 4.i04.i0: o J / TYPE OF SEWAGE DISPOSAL REQUESTED: -Tra lie / Applicant acknowledges that the completeness of this application is conditional upon further mandatory and additional test; 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 subjecl 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. Tie 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 falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided by law. - Application fee, '._�(-,,- '2(;2S,Oa \ :� ` Rec'd by ..t.' -1.--, Date t,-- 'C - 'c Owner/AA45iSignature ` Date * • • ♦ • • • ♦ • ♦ • ♦ * ♦ * * * * • * * * * * ♦ • • • • • FOR DEPT. PERCOLATION RATE WATER TABLE DEPTH USE ONLY SOIL TYPE PERCENT GROUND SLOPE__ • REQUIRES ENGINEER DESIGN ( )YES( ) No * * * * * * • * • * * * * * * * * * • * * * * * * * * * * • * * * ♦ * • • ♦ • ♦ * ♦ * INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT From the application information supplied and the on-site soil percolation data, the following minimum installation specifi- cations are required: SEPTIC TANK /CYO GALLONS, ABSORPTION TRENCH -n7 SQ. FT. or ABSORPTION BED /OW SQ. FT. In addition, this Permit is subject to the following additional terms and conditions: IQu \c4a eflosir-t iS.. 5_2 c u -not.�-s &7Pu-f This Permit is granted temporarily to allow construction to commence. This Permit may be revoked or suspended by the Welc 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 f liabili�y for the�failure r or inadequacy of the sewage disposal system. y �l.�uh..tCk) t` oz�`vq z e z Z. environmental Specialist Dat 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 FINAL INSPECTION SYSTEM ENGINEER _ APPROVAL Environmental Specialist Date The issuance of this Permit does not imply compliance with other state, county or local regulatory or building requirements, The issuance of this Permit does not imply compliance with other state, county or local regulatory or building requirements, or 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 75,- ./5 �CC, C So,ct� \o czccc\ WELD COUNTY HEALTH DEPARTMENT • 1517 16TH AVENUE COURT, GREELEY, CO 80631 (970) 353-0635 EXT 2225 FAX (970) 356-4966 Permit # : SP-9600012 Sec/Twn/Rng: 22 06 62 Status: FINALED Permit Type : ANEW C=commercial, R-residential + NEW, REPair, VauLT Applied: 01/09/1996 Parcel No : 0797 22 000016 Issued: 12/27/1995 Finaled: 01/11/1996 Location: 39790 WCR 68, BRIGGSDALE 22-06-62 Legal Desc : 6043-A SE4NE4 22 6 62 EXC OG&M APPLICANT TURLEY CATHY OWNER TURLEY DE ROY J & CATHY L 39790 WELD CO RD 68, BRIGGSDALE CO 80611 SEPT-INSTL CASS WELL & BACKHOE SRV Phone : (970) 656-3540 42085 WCR 80, BRIGGSDALE CO 80611 Description: TRAILER Commercial (Y/N) : N Residential (Y/N) : Y Acres : 40 . 00 Number of Persons : 2 Basement Plumbing (Y/N) : N Number of Bedrooms : 3 Bathrooms-> Full : 2 3/4 : 1/2 : Water Public (Y/N) : N Utility Name : WiltPrivate (Y/N) : Y Cistern (Y/N) : Well (Y/N) : Y ater Permit No: lQ�� Percolation Rate: 30 . 1 Limiting Zone: ?o8 ft 00 in Desc : Ground Slope: Dir: Soil Suitable (Y/N) : Y Engineer Design Req' d (Y/N) : N In 100 Yr Flood Plain (Y/N) : Minimum Installation Septic Tank: 1000 gal Absorption Trench: 774 sq. ft . Absorption Bed: 1020 sq. ft . Actual Installation Septic Tank: 1000 gal Absorption Trench: 780 sq. ft . Absorption Bed: sq. ft . NOTICE The issuance of this permit does not imply compliance with other state, 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 persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). This permit is not transferable. 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 was contingent upon the final inspection of the completed system by the Weld County Health Department. • Environmental Specialist Date Hello