HomeMy WebLinkAbout20083381.tiff Form No. OFFICE OF TO STATE ENGINEER
GWS-25 COLORADO DIVISION OF WATER RESOUR S
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
(303)866-3581
EXST
• WELL PERMIT NUMBER 277800 - -_
APPLICANT DIV. 1 WD2 DES. BASIN MD
APPROVED WELL LOCATION
WELD COUNTY
NW 1/4 NW 1/4 Section 20
GLAZE INDUSTRIAL PROPERTIES LLC Township 1 N Range 66 W Sixth P.M.
748 S 13TH AVENUE DISTANCES FROM SECTION LINES
BRIGHTON, CO 80601- 1 Ft. from North Section Line
88 Ft. from West Section Line
(303) 981-8999 UTM COORDINATES (Meters,Zone:13,NAD83)
CHANGE/EXPANSION OF USE OF AN EXISTING WELL Easting: Northing:
ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT
CONDITIONS OF APPROVAL
1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit
does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from
seeking relief in a civil court action.
2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402-2, unless approval
of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation
Contractors in accordance with Rule 18.
3) Approved for the use of an existing well registered under permit no. 267832.
• Approved pursuant to CRS 37-92-602(3)(b)(I)and the policy of the State Engineer dated 4/9/85 for appropriation of ground
water tributary to the South Platte River system.
5) The use of ground water from this well is limited to drinking and sanitary facilities as described in CRS 37-92-602(1)(c),
for a commercial business. Water from this well shall not be used for lawn or landscape irrigation or for any other purpose
outside the business building structure.
6) Production from this well is restricted to the Alluvium.
7) The pumping rate of this well shall not exceed 15 GPM.
8) The annual amount of ground water to be diverted by this well shall not exceed 1/3 acre-foot(108,600 gallons).
9) Approved as the only well on a tract of land of 1.00 acre(s) described as a portion of the NW 1/4 of the NW 1/4, Sec. 20,
Twp. 1 North, Rng. 66 West.6th P.M., Weld County, reference attached exhibit"A".
10) The return flow from the use of this well must be through an individual waste water disposal system of the
non-evaporative type where the water is returned to the same stream system in which the well is located. The maximum
consumptive use of ground water shall not exceed 10 percent.
11) A totalizing flow meter must be installed on this well and maintained in good working order. Permanent records of all
diversions must be maintained by the well owner(recorded at least annually) and submitted to the Division Engineer upon
request.
12) This well shall be located no more than 200 feet from the location specified on this permit.
13) The issuance of this permit hereby cancels permit no. 267832. Q
(� EXHIBIT
2008-3381
r
•PROVED
JLV C`
State Engineer / By
Receipt No. 3629612 DATE ISSUED 06-11-2008 EXPIRATION DATE
Form •
No. GWS-7 EX T PERMIT INFORMATION SHEET
6/2006 STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
• (303) 866-3581 Fax (303) 866-3589
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-92-602
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully read the conditions of approval on your well permit. The conditions and the information on this
information sheet must be complied with in order for the permit to remain valid.
THE PERMIT EXPIRATION DATE IS TWO YEARS FROM THE DATE ISSUED. The well must be constructed and
evidence of it's construction must be received by this office in the form of a Well Construction and Test report from
the well construction contractor confirming that the well was constructed prior to expiration of the well permit. The
well permit number is located in the upper right hand corner of the permit, and the expiration date is located in the
lower right hand corner. The expiration date of the permit may be extended one year at a time at the discretion of
the State Engineer for good cause shown. If an extension of time is necessary to construct the well, a written
request for the extension of time must be received by this office prior to the expiration date of the well
permit. In the request, you must provide the well permit number, your name and mailing address and the
reasons why the well has not been constructed and approximately when it will be constructed.
Water well construction and pump installation contractors are specifically licensed in Colorado to perform these
specialized tasks. It is illegal for contractors who do not hold these licenses to construct wells and/or install pumping
equipment in or on wells. The well must be constructed and the pump installed by contractors with current license(s)
issued by the State of Colorado unless exempted as described on the reverse side. Please ask to see their
license(s). Backhoe Operators and Licensed Plumbers may or may not hold the respective Well Construction and/or
Pump Installation licenses. Please be aware of this when you contract to construct the well and install pumping
equipment. The well construction report including a test of the well yield must be submitted to the office of the State
Engineer within sixty (60) days of completion of the work or within seven days after expiration of the permit,
Whichever is earlier. The pump installation report including a pumping system test must be submitted within sixty
0) days of completion of the work. The contractor(s) must provide you with a copy of the work report(s)filed with
the State Engineer. The Well Construction and Test Report, Form Number GWS-31 and the Pump Installation and
Test Report, Form Number GWS-32 are available from the Division of Water Resources offices. Additional
information regarding well construction, pump installation, required testing and well plugging and sealing regulations
are found on the reverse side of this sheet.
You have been provided with at least two copies of the well permit. Keep a copy for your records. There is
also a copy for the pump installation contractor. Copies have been sent to the driller if you indicated a driller
license number on the application, or two additional copies have been enclosed. You may make additional copies
for the well construction contractor if you select one different from the one indicated in your application.
The original permit is on file in the Denver office Records Section. Copies may be obtained for a fee of 50 cents per
page. Statutes require that any change of mailing address or ownership be reported to the State Engineer. Form
number GWS-11 is used both by new owners to report ownership changes and current owners to report address
changes.
If you have questions, contact the Denver Office, or the Division Office in the area where your well is located.
Division 1 Division 2 Division 3 Division 4
810 9h St. 2" Floor 310 E.Abriendo Ave Ste B 301 Murphy Drive 1871 East Main St.
Greeley, CO 80631 Pueblo, CO 81004 Alamosa, CO 81101 Montrose, CO 81401
(970)352-8712 (719)542-3368 (719)589-6683 (970)249-6622
Fax (970) 392-1816 Fax(719) 544-0800 Fax(719)589-6685 Fax(970)249-8728
Division 5 Division 6 Division 7 Denver Office
Direct mail to Box 396 Direct mail to Box 773450 701 Camino Del Rio Ste. 1313 Sherman St. Rm. 818
Glenwood Spgs CO 81602 505 Anglers Dr. Suite 101 205 Denver, CO 80203
50633 U.S. Hwy 6 & 24 Steamboat Spgs, CO Durango, CO 81301 (303)866-3581
.lenwood Spgs., CO 81601 80477 (970)247-1845 Fax(303) 866-3589
970)945-5665 (970)879-0272 Fax (970)259-0944
Fax (970) 945-8741 Call first Fax (970)879-1070
WELL CONSTRUCTION AND PUMP INSTALLATION BY THE WELL OWNER
You may construct the well and/or install the pump yourself if the well is for your own use, is on property
you own, and is constructed or pumping equipment is installed with equipment owned and operated by you. It is
sour responsibility to complete and submit the Well Construction and Test Report, Form Number GWS-31 and/or
•the Pump Installation and Test Report, Form Number GWS-32. These forms are available from our offices. The
well must be constructed and the pump installed in accordance with the well construction standards of the State
Board of Examiners of Water Well Construction and Pump Installation Contractors.
The Water Well Construction Rules are available from Division of Water Resources offices for a fee of $5.00.
The Rules cover the minimum requirements for well construction, pump installation, disinfection, plugging and
sealing and include contractor licensing regulations. If you are constructing your own well or installing pumping
equipment, it is recommended that you obtain a copy of these Rules for reference.
RULE 12 WELL TESTING
12.1 General - The provisions of this rule establish minimum standards for the testing of water wells. Every
well constructed for the purpose of producing ground water shall be tested to determine:
a. a stabilized yield for the well; and
b. the production rate of the equipment installed when the well is placed into service.
12.2 Well Yield Test - The yield of a well shall be determined as a stabilized production rate where the
withdrawal rate and the drawdown do not change by more than 10 % during the last hour of the test. The test
shall demonstrate that either:
a. the well is capable of producing the permitted pumping rate for the well; or
b. that the maximum yield of the well is less than the permitted production rate.
12.3 Responsibility for Well Yield Test - Well construction contractors are responsible for performing the
well yield test and submitting the test data to the State Engineer. If the construction contractor also installs the
production equipment, the well yield test may be combined with the production equipment test, provided that the
test meets the requirements of Rule 12.2. The construction contractor may forgo the well yield test if he can show
that a licensed pump installer will perform the well yield test with the permanent production equipment within thirty
30) days of completion of construction of the well. If the pump installation contractor performs the well yield test,
e/she shall submit the test information on the Pump Installation and Test Report.
12.4 Production Equipment Test- The production equipment installed in wells shall be tested to ensure it
is functioning as designed. The test shall demonstrate the production capacity of the equipment as actually
installed in the well. It is the responsibility of the person installing the pumping system to ensure that the
production from the well complies with the conditions of the permit.
12.5 Responsibility for Production Equipment Test - Pump installation contractors are responsible for
testing the production equipment installed in a well upon completion of their work. If the well construction
contractor determined the well yield and submitted a report, the pump installer need not perform another well
yield test. If the pump installer does not perform a well yield test with the permanent production equipment, he
shall perform a production equipment test and report the data (results) to the State Engineer on the Pump
Installation and Test Report.
Wells to be plugged and sealed must be plugged in accordance with of the Water Well Construction
Rules. A Well Abandonment Report, form number GWS-9 must be submitted to confirm plugging and sealing of
the well. This form is available from our offices. The general Rule for plugging and sealing wells is printed below.
The specific rules are found on the reverse side of the Well Abandonment Report form.
RULE 16 STANDARDS FOR PLUGGING AND SEALING WELLS AND WELL EXCAVATIONS
16.1 General - The plugging, sealing and abandonment of all wells, monitoring and observation wells,
monitoring and observation holes and test holes that are no longer intended for use, and the plugging, sealing,
and abandonment of dry holes, collapsed or unusable boreholes, and other incomplete wells or excavations is
necessary to prevent contamination of ground water and the migration of water through the borehole. It is the
ultimate responsibility of the well owner to have an existing well properly plugged, sealed and abandoned. The
well construction contractor or authorized individual is responsible for notifying the well owner in writing of these
plugging requirements.
•
• •
• DEPARTMENT OF PUBLIC HEALTH &ENVIRONMENT
1555 N. 1
Greeley,CO 130631
Website: www.co.weld.co.us
Administration: (970)304-6410
Fa x: (97D)304-6412
Public Health Education 8.Nursing: (970)304-6420
Fax: (970)304-6416
Environmental Heath Services: (970)304-6415
COLORADO Fax: (97D)304-6411
January 23, 2006
Frank Tenorio and Karen Lohman •
16109 Highway 392
Greeley, CO 80631
RE: Frank Tenorio and Karen Lohman No: ISDS-06004
Permit No.: SE-0600004
On January 19, 2006 an evaluation of the existing individual septic disposal system at:
13046 County Road 8, Fort Lupton;
Section 20, Township 01,Range 66,
• was conducted by Stephen J. Wiatrowski, an Environmental Specialist of this department.
The existing individual septic disposal system is of sufficient size and capacity to adequately
handle the proposed load. This evaluation is based on a final treatment capacity for a 3 bedroom
residence.
Be advised,neither the County of Weld nor any of its agents or employees undertake or assume
any liability to the owner of the above property, to any purchaser of the above property or to any
lending agency making a loan on the above property or in the report.
This inspection was conducted for the purpose of determining compliance with current
regulations and for detecting health hazards observable at the time of inspection. This does not
constitute a warranty that the system is without flaw or that it will continue to function in the
future. Inspections requested during periods of snow cover and high soil saturation maybe of
questionable value to potential buyers due to adverse conditions. Evaluations based on
Statements of Existing(S.O.E.)relies on information the property owner provides, under oath,
indicating current status of the system and representing to the best of his/her knowledge the
system is not failing to function properly.
If we can be of any further assistance, please contact our office at(970) 304-6415.
Sincerely,
•
Stephen J. Wiatrowski
Environmental Health Specialist
farm:peI73App•d
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• WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 NORTH 17TH AVENUE
GREELEY, COLORADO 80631
PHONE(970)304-6415 FAX (970) 304-6411
STATEMENT OF EXISTING SEPTIC PERMIT
Permit #: SE-0600004 Sec/Twn/Rng: 20 01 66 PERMIT3/2006
Owner: TENORIO FRANK& LOHMAN KAREN Applied:
Applicant: TENORIO FRANK & LOHMAN KAREN
Parcel #: 1471-20-0-00-030
Location: 13046 WCR 27
Legal Desc: 15941 PT NW4 20 1 66 BEG 30' E & 30' S O F NW COR SEC 20 E200
Description: HOUSE
Commercial: N Residential: Y Acres: 1
# of Persons: 2 Basement Plumbing: Y
# of Bedrooms: 3 Bathrooms- (Full): 1 (3/4): 0 (1/2): 1
•
IIIWater Public: N Water Source: .
Water Private: Y Cistern: N Well: Y Well Permit Number:
Septic Tank: 2000 Tank Material: CONCRETE
Absorption Trench: 0 sq. ft. Year Installed: UNK
Absorption Bed: 1100 sq. ft.
NOTICE
The property owner/agent has certified by Notary Seal that the above described septic system is in fact installed as described,and
exists at this time on the parcel identified above by the parcel number and/or legal description,and further states that the system
IS/IS NOT in good working order and to the best of his/her knowledge IS/IS NOT failing to function properly.
The property owner/agent further understands that any falsification or misrepresentation may result in the revocation of any permit
granted based upon this information hereby submitted and in legal action for perjury as provided by law.
The Statement of Existing Record relics on information the property owner or his/her representative provides,under oath,indicating
current status of the system and representing to the best of his/her knowledge that the system IS/IS NOT failing to function properly.
Issuance of the Statement of Existing Permit for any system does not constitute assumption that the site was evaluated or inspected
during any phase of construction by this Department to meet regulations.
E vironmbntal Health Specialist Date
•
Form:SEXIST
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