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Home My WebLink About20242138.tiffWeld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 Web: weldhealth.org Septic Permit - Final Application Number: SP -1400103 Owner Name: JUSTICE RUSS & REYNOLDS JULEE Site Address: 24125 CR 42 LA SALLE, CO 80645 App Type: HealthlCommerciaI Repair\Minor RUSS JUSTICE JUSTICE TRUCKING INC 24125 CR 42 LA SALLE, CO 80645 Parcel #: Legal Desc: App Specific Info: 105320000009-O4276066 8892-B LEASEHOLD INT SW4NW4 20 4 64 PREBISH #280530 Finaled Application Status: Finaled Applied Date: 04/1012014 Issued Date: 04/11/2014 Finaled Date : ti• Location Description Repair Reason Type Associated Disaster Permit Application Date Septic Permit Expiration Date Waive Fees Number of Persons Number of Bedrooms Basement Plumbing Full Bathrooms 3/4 Bathrooms 1/2 Bathrooms Public Water Supply Private Water Supply Parcel Acres Year Installed 24125 CR 42 LA SALLE CO Repair for Upgrade No 04/10/2014 04/10/2015 No 7 0 No 0 0 1 No Well 8.69 2004 Actual Installation: Dgas gallons Absorption Bed : sq ft Chamber Model Chambers 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). Thi uerfntt is nonSinsferable and non -refund le. The Weld ciounty Department of Public Health and Environment reserves the right to impose additional terms and conditions required to meet o r regulations a continuing basis, Final permit approval was contingent upon the final inspection of the completeg,Jstem by the Weld County Depart, nt e-Tf lIic Hth and Environment. X \i4N,\ Environmental Health Specialist Date disleibu Report ID: EHS00033v006 Print Date Time: 5/6/2014 1:47:04PM �-i 5 JZZDZKA Mill ON) a%a t `I Page 1 of 2 Application Number: SP -1400103 Owner Name: JUSTICE RUSS & REYNOLDS JULEE Site Address: 24125 CR 42 LA SALLE, CO 80645 Report ID: EHS00033v006 Page 2 of 2 Print Date Time: 5/612014 1:47:04PM ,S(?. kPIOOkOS May 2, 2014 RE: Commercial Septic evaluation Justice Trucking 24125 WCR 42 LaSalle, CO 80645 To whom it may concern: RECEIVED MAY 052014 ENVIRONMENTAL HEALTH SERVICES THEngineering has reviewed the modified septic system for the above referenced property in association with USR12-0061. On June 20, 2013 THEngineering evaluated the systems adequacy for its amended use as a commercial system. On April 24, 2014 THEngineering evaluated the installation to verify that they system was installed as per Weld County Code. On April 24, 2014 I inspected open excavations to verify to the extent practical that the shop addition was tied in as per code. On the site visit I observed a portion of pipe exiting the shop and verified that 4" SCH 40 pipe was utilized which exceeds code requirements. Depth of bury exceeded 30". The entire route of the pipeline was not excavated however the grade was surveyed between the excavation and the septic tank and determined that there is approximately 3% slope available which exceeds the one -eighth inch per foot minimum outlined in Section 30-5-30.B. 4.b. On May 1, 2014, Front range septic pumped the tank and verified the capacity, condition, and verified connection to shop. With this investigation it is my opinion that the installation of the septic line from the shop to the existing system meets code requirements. As always if you have any questions or concerns please don't hesitate to call. J Travis Hertneky, PE Agricultural Engineer Attachments: Septic Permit Application (repair) Septic Pumping field notes 8605 17th St. Dr. Greeley, CO 80634 719-661-6209 20997 County Rd 90 thengineeringonline.cem Calhan, CO 8O8O8 COLORADO SEPTIC PERMIT INFORMATION FORM To obtain an I.S.D.S. permit, one must file an "application for Individual Sewage Disposal System" at the Weld County Environmental Health Services office and pay the application fee. A "repair' fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be provided on the septic information form. COMMERCIAL PERMIT RESIDENTIAL PERMIT NEW or REPAIR $850.00 VAULT PERMIT NEW or REPAIR $250.00 NEW or REPAIR $750.00 MINOR REPAIR PERMIT X $100.00 PARCEL NO.; 105319300033 (12 DIGIT NUMBER) LEGAL DESCRIPTION: SECTION 19 TOWNSHIP 4N RANGE 64W ACRES 8.69 SUBDIVISION LOT A BLOCK FILING RE -1506 THIS INFORMATION CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 SITE ADDRESS 24125 WCR 42, LASALLE, CO _ 80645 DIRECTIONS TO SITE FROM INTERSECTION OF WCR 49 AND WCR 42. PROCEED EAST 1/8 MI TO DRIVE ON LEFT PROPERTY OWNER: MAILING ADDRESS: HOME PHONE: ( ) EMAIL ADDRESS: APPLICANT NAME: RUSSELL JUSTICE 24125 WCR 42 CITY LASALLE WORK PHONE ( 970) 309-060 ST CO ZIP 80645 FAX ( RUSSELL JUSTICE MAILING ADDRESS: 24125 WCR 42 CITY LASALLE ST CO ZIP 80645 HOME PHONE: ( ) WORK PHONE ( 970) 309_0605 FAX ( ) EMAIL ADDRESS: DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) HOUSE, SHOP IF OBTAINING A REPAIR PERMIT, WHAT IS BEING REPAIRED? DOCUMENTING SHOP CONNECTION TO HOUSE NUMBER OF PERSONS 30 EMPLOYEE NUMBER OF BEDROOMS 3 BASEMENT PLUMBING YES / NO BATHROOMS: FULL PUBLIC WATER SUPPLY YES /NO NAME IN FLOOD PLAIN AREA? YES /II PERCOLATION HOLES MUST BE MARKED FOR INSPECTION ORA $50.00 FEE WILL BE CHARGED CENSUS TRACT PRIVATE WATER SUPPLY YES / NO _ WELL /CISTERN PERMIT # EXISTING SEPTIC SYSTEM AS PER PERMIT SP -0400180 roe !EXISTING ACCESS 0' 24125 VVCR 42 � ��► =— silt WCR 42 Ame .1-.290' 4" SOH 40 SEWERLINE FROM SHOP TO SEPTIC EXI LNC3 ACCESS SHOP 719-661-6209 8605 17th St Dr, Greeley, CO 24125 WCR 42 SHOP SEPTIC TIE-IN Date: 4/24/2014 Sheet No. ioFi Letter_Lauren_5-2-20 14.Docx Page 2 of 2 May 2, 2014 Photo Log Open excavation adjacent to shop showing Stamp on pipe indicating 4" SCH44 PVC pipe. septic pipe. Company Name: CrOAf �r•oje _ k) L' Customer Name: rg% v GS -J t►� �. Address of Pumping: _� `� � 1,6 . G (a. a jiEllia_ ESO10 e15 0 "o5,;(7 4 Phone number: `f 70- 35girreen- Pumping Date: 5// /// 1. Tank Size: /5(20 Gallons Pumped: 2. Lift Station: Yes No _ If yes, functioning: Yes No 3. Excessive water running back into tank from field? Yes No.K. If yes, estimate in gallons: 4. Liquid level in tank over inlet line? Yes No K 5. Tank Construction (check one) Concrete. SC Metal Brick Cesspool or Seepage Pit Other Plastic or Fiberglass _ 6. Tank Construction observed: One Compartment Two Compartment Y.7. Inlet/outlet tees and/or baffles in good condition? Yes K, No____� 8. FiltereFilteron outlet cleaned and inspected (if applicable)? Yes No .41 At 9. Access to cl n -out lids within 8 inches of grade? Inlet: Yes No Outlet Yes No 10. 20 ml_ plastic replaced and sealed over tank lid (flood plain only)? Yes No ,.I ,/i4 11, Tankflid structurally sound and water tight? Yes X No 12. Obvious cracks/leaks observed? Yes No K.._ If yes, explain area: 13. Other conditions noted which may affect proper functioning of system? 14. Reason for Service: Maintenance K Real Estate Sale Emergency/Backup Other 15. Notes: (-14'4 ;170 0 -Hr —raft fic a 4 FRONT RANGE SEPTIC 33431 WCR 53 • Gill, CO 80624 Phone: (970) 302-0457 • Fax: (970) 352-4277 Customer Name 472 Job Address az t - 5 L K: Phone :: 70 r t e ' • L • - N1.• Cell County 1j, Mailing Address Date Pumped 4 /// Pumper ; , • IP Septic tank Tank size: fl Contact 0 Grease trap 0 Vault 0 Other Tank construction: tiNconcrete Liquid level in tank over inlet line? .4' • I • Compartments:CI -I Ail. 2 0 Can't verify Gallons Pumped Q Plastic/Fiberglass a Metal Q Other No Cl Yes ❑ Can't verify Leach field running back: fO No CI Yes Ca Extra heavy LI Can't verify re:teeSaffle••-,' Concrete Baffle: Inlet: C? No aYes Outlet: CI No ayes Can't verify 0 Lids within 8" of surface: inlet: CI No ap Yes Outlet CI No f::Yes Outlet Filter: No ❑ Yes If yes - Filter should be cleaned every year Pumper Comments: - -' 7(41 ., t tI 1 r i kr 1 • - + ti I - , / el i ‘'arl . e- A Ci I . CA t. • * • Pii Carr\ I 4 1 .. Fel . 1.I 7 • 1 01 ‘..)c 1/4., I. et i : .4 r I . 1 .tit;1%:. 1; < ,� + • ji • : •,. '_. i' �iCr) _. t in fi ' i i P �. ` h ' 1 w _ Ro1/4.‘ t L. C' far/ Ica cft.3 MF❑ I FC❑ K Amount First 1000 Gallons Pumped 5 Li, ' 12 ♦' 'I cc Additional Gallons Pumped ...KR� 7 ,l. 5.-, ° Septic Enzyme 1 tit r - ' Locate Fee Digging Fee ...........�........4.-.... I Other f 7 4Vic 6.. / a• : C c:. BALANCE DUE �yW r. Signature DAMAGE WAIVER: The company assumes no responsibility for damages inside of curb of property line or where•damage may occur. Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 Web: weldhealth.org Septic Permit Repair Application Number: SP -1400103 Owner Name: JUSTICE RUSS & REYNOLDS JULEE Site Address: 24125 CR 42 LA SALLE, CO 80645 App Type: Health\CommerciaRRepairAMinor RUSS JUSTICE JUSTICE TRUCKING INC 24125 C R 42 LA SALLE, CO 80645 Parcel Number 105320000009-04276086 Legal Desc: 8892-B LEASEHOLD INT SW4NW4 20 464 PREBISH #280530 EHS Septic General: Application Status: In Review Applied Date: 04/10/2014 Intake Person: SCERRILLO Permit Expiration Date: 04/10/2015 Location Description Repair Reason Type Associated Disaster Permit Application Date Septic Permit Expiration Date Waive Fees Number of Persons Number of Bedrooms Basement Plumbing Full Bathrooms 3/4 Bathrooms 1/2 Bathrooms Public Water Supply Private Water Supply Parcel Acres Year Installed 24125 CR 42 LA SALLE CO Repair for Upgrade No 04/10/2014 04/10/2015 No 7 0 No 0 0 1 No Well 8.69 2004 Report ID: EHS00028v009 Page 1 of 2 Print Date - Time: 4/10/2014 11:39:55AM Application Number: SP -1400103 JUSTICE RUSS & REYNOLDS JULEE 24125 CR 42 LA SALLE, CO 80645 Owner Name: Site Address: ircolation Rate -�z % Ground Slope Engineering Design Required (YIN) Limiting Zone Direction ft in Description ill Suitable (YIN) fn 100 Year Flood Plain (YIN) Pp supplied specifications the application information and the on -site soil per:�;;��t��n day-12�� ng minimum installationare required: Septic Tank gallonsrpt Trench Chambers: Standard BiotTer lnfiltrat r- iiick4 Standard or Hi Capacity Amer Arc 36 Standard or Hi Capacity Infiltrator Quick4 EQ36 Infiltrator Quick4 Plus Standard Low Profile sq ftz = tz or Absorption Bed sq ft ch Bed Trench Bed Trench Bed Trench Trench All Weld County ISDS regulations apply. In addition, this permit is subject to the following additional terms and conditions: Bed ri of 4 c kat") --r- _ rekirvi fic3r..e) ciekr---- K. - :Pied„ NOTICE This permit is granted temporarily to allow construction to commence. This permit may be revoked or suspended by the Weld County Department of Public Health and Environment for reasons set forth in the Weld County Individual Sewage Disposal System Regulations including failure to meet any term or condition imposed theron 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. Thippermit Is non -transferable and non-refundable. Before issuing final approval of this permit the Weld County Department of Public Health and Environment 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 inspection of the completed system by the d County Department of Public Health and Environment This permit expires one year from the application ate. Environmental Health Specialist Date Report ID: EHS00028v009 Print Date - Time: 4/10/2014 11:39:55AM \(\iek Page 2 of 2 Application Number App Type: Owner Name: Parcel #: Legal Desc: Site Address: App Specific Info: Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 Web: www.co.weldhealth.org Septic Permit Application SP -1400103 Health\CommerciallRepa irrMinor RUSS JUSTICE JUSTICE TRUCKING INC 24125 CR 42 LA SALLE, CO 80645 JUSTICE RUSS & REYNOLDS JULEE 105320000009-O4276086 8892-6 LEASEHOLD INT SW4NW4 20 464 PREBISH #280530 24125CR42 LA SALLE, CO 80645 1/2 Bathrooms 3/4 Bathrooms Basement Plumbing Full Bathrooms Location Description Number of Bedrooms Number of Persons Parcel Acres Private Water Supply Public Water Supply 1 0 No 0 24125CR42 LA SALLE CO 0 7 8.69 Well No TERMS AND CONDITIONS A permit fee, as set by separate ordiance of the Board of Weld County Commissioners, shalt be required of applicants for new individual sewage disposal systems (ISDS), payable at time of application. Permit fees are nonrefundable; permit applications are non -transferable. If both a building permit and an ISDS are issued for the same property and construction is not commenced prior to the expiration date of the building permit, the [SOS permit shall expire at the same time as the building permit If an ISDS permit is issued for a property that does not require a building permit, the ISDS permit shall expire one year after its issuance if construction on the septic system has not commenced. Any change in plans or specifications after the permit has been issued invalidates the permit unless approval is secured from the Health Officer or his/her designated agent. Expired permits can be renewed by payment of the permit fee onty if: A. There has been no change in the plans and specifications of the proposed system as set out in the original application or such change is reviewed and approved by a Division Representative. B. The surrounding land, its use or zoning has not changed so -as -to riwse the original application not to be acceptable under these regulations. NOTICE The completeness of this application is conditional upon further mandatory and additional tests and reports as may be required by the Weld County Department of Public Health and Environment (WCDPHE). The issuance of the permit is subject to such terns and conditions as deemed necessary to insure compliance with rules and regulations adopted under article 10 title 25, CRS as amended. The applicant certfies that the proposed system will not be located within 400 feet of a community sewage system. The undersigned certifies that all statements made, information and reports submitted herewith are, or will be, represented to be true and correct to the best of his/her knowledge and are designed to be relied on by the WCDPHE for evaluation for purposes of issuing the permit applied for herein. Applicant further understands that falsification or misrepresentation may result in the denial of the application or revocation of any permit granted, and in legal action or perjury as provided by law. X etzee.„,/,?2, (Jrn r/Applicant Report ID: El-1S00056v003 Print Date Time: 4/10/2014 11:41:26AM Date Page 1 of 1 or; WING COLORADO tip -100103 SEPTIC PERMIT INFORMATION FORM To obtain an I.S.D.S. permit, one must file an "application for Individual Sewage Disposal System" at the Weld County Environmental Health Services office and pay the application fee. A L'repair" fee shall be charged for the expansion, replacement, or repair of an existing system. The following information must be provided on the septic information form. COMMERCIAL PERMIT NEW or REPAIR $850.00 VAULT PERMIT RESIDENTIAL PERMIT NEW or REPAIR $750.00 MINOR REPAIR PERMIT NEW or REPAIR $250.00 _ $100.00 PARCEL NO.: /C53cZ0 - OOOOC I (12 DIGIT NUMBER) LEGAL DESCRIPTION: SECTION TOWNSHIP � RANGE 6 1 j'✓ ACRES Ye, 6 9 SUBDIVISION LOT BLOCK FILING THIS INFORMATION CAN BE OBTAINED FROM THE ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650 SITE ADDRESS d_V/A Cg la La Sa //e, Ce, • 8C76 DIRECTIONS TO SITE PROPERTY OWNER: Ru cs J GI.ShGC'� �Cf /eve ger DI�� MAILING ADDRESS: 5 Cie VA. an I -el SO. Ile ST Co ZIP ?o6 145 i-IOME PHONE: qpcgg4t4oxw0RK PHONE (€9yd)SOc1-o 605 FAX {97V) a7S1.4C?tai EMAIL ADDRESS: tiltSliCE' set/ LCseliCC"''.irL(Cklny, CUB APPLICANT NAME: 4JuSfiee %Wc_tir?�t -27-7C •� MAILING ADDRESS: ea Vi,eg `J Giq 41973/4- CITY La SCI. Lie ST Co SIP 164 545 - HOME PHONE: ( ) WORK !HONE FJTG)) a) 9 Q60S FAX (971) oZS itloAP- EMAIL ADDRESS:_rj'GfS77C"�6iijLis -1:1Cn'Lle:' i in . C ' !'?'m, DESCRIPTION OF BUILDING (EX: HOUSE, MOBILE HOME, MODULAR, SHOP, OFFICE) ii/CeeSee/5170/0 IF OBTAINING A REPAIR PERMIT, WHAT IS BEING REPAIRED? NUMBER OF PERSONS NUMBER OF BEDROOMS O BASEMENT PLUMBING YES J f�t BATHROOMS: FULL 3 �IX PUBLIC WATER SUPPLY • YES / (J NAME IN FLOOD PLAIN AREA? YES l NO PERCOLATION HOLES MUST BE MARKED FOR INSPECTION OR A $50.00 FEE WILL BE CHARGED CENSUS TRACT 9 PRIVATE WATER SUPPLY YES NOWELL /CISTERN PERMIT # .• 1 N PLEkSF/DRAW A MAP TO YOUR PROPERTY. 1 1. •• 0 • / 00 i ....�•...... .. `fir' t 6(f p cit Y el •••\♦ ....M . O' )9O (f /I if 2. ‘42. Sn-(eitz Coy s " -1f≤ t,�c ..••.+•.1 r.•4 r• ••war• Nit L. /i /CI f tiej 11 June 20, 2013 RE: Commerdal Septic evaluation Justice Trucking 24125 W .42 LaSalle, CO 80645 To whom it may concern: mEngineering has performed an adequacy evaluation of a currently installed septic system located at the above mentioned address. This evaluation included a site inspection to visually inspect the system condition, review of original design information, and evaluation of its adequacy for commercial service. This system was originally designed, installed, and approved in 2004. Original septic permit number SP -0400180 indicates a percolation rate of 8.5 (min/in) and a design criteria of a 4 bedroom residence. Owner information and Weld County Property profiles indicate that the residence was constructed as a 3 bedroom. The installed system also exceeded the design criteria by installing a larger tank and absorption bed, The installed system as determined by the original permit indicates a constructed absorption capacity of 1,008 (gal/day), and tank capacity of 1,500 gallons. Utilizing the tables provided in Weld County ISDS regulations Chapter 30, it has been determined that the appropriate expected flow for the combined residence and commercial use is 75 (gal/hd/day) for the residence, 15 (gal/hdfday) for office buildings, 20 (gal/hd/day) for shop employees, and 5 (gal/ hd/day) for truck drivers which will utilize the facilities intermittently. Justice Trucking, Inc estimates a maximum of 30 Full time employees that will utilize the facility. The new expected daily flow of 997 (gal/day) is less than the design capacity of 1,008 gal/day) and the installed 1,500 gal capacity tank exceeds the requirements of 1,296. This system exceeds the regulation requirements and is suitable for this commercial application. As always if you have any questions or concerns please don't hesitate to call. Sincerely, Travis I-iertneky, PE Agricultural Engineer Attachments: 8605 17th St Dr. Greeley, CO 80634 Commercial Septic Evaluation as -built map Finalized septic permit SP -0400180 719-661-6209 20997 County Rd 90 thengineeringanline.com Caihan, CO 80808 TV(H'/Ntfl?/NS L-LG Justice Trucking, Inc. 24125 WCR 42 LaSalle, Co 80645 Commercial Septic Evaluation Current System SP -0400180 Perc Rate: Limiting Zone: Style: Tank Capacity: Design Criteria: Constructed capacity: Absorption area: Proposed Use Use Type: Constructed Residence: Required Tank Size: Residence flow: Expected Employees: Office employees: Shop Employees: Truck Drivers Average expected flow per employee: Shop expected flow rate: Total system expected flow rate: Total system expected design flow rate: Total tank requirement: 8.5 (min/in) 7'6" Weathered Bedrock Absorption/E7 bed 1250 gal required, 1500 gal installed 4 bedroom, 600 (gal/day) 1,008 (gal/day) 948 (ftA2) designed, 1,092 (ft'2) installed Residence/Commercial office 3 Bedroom 1,000 gal 30 2 @ 15 gal/hdJday) 3 @ 20(gal/lid/day) 450 (gal/day) 25 @ 5 (gal/hcliday) 7.2 (gal/hd/day) 215 (gal/day) 450 (gal/day) + 215 (gal/day) 665 (gal/day) 665 (gal/day) x 150% 997 (gal/day) 997 (gal/day) x 30hrs 1,296 (gal) _ Constructed capacity as per permit #SP -0400180 of 1,008 (gal/day) exceeds the new use total system expected design flow rate of 997 (gal/clay). 8605 17th St. Dr, Greeley, CO 80634 719-661-6209 thengineeringonii ne. corn 20997 County Rd 90 Caihan, CO 80808 0 COLORADO Division of Water Resources Department of Natural Resources WELL PERMIT NUMBER 294098 - RECEIPT NUMBER 3663643 ORIGINAL PERMIT APPLICANT(S) RUSS JUSTICE APPROVED WELL LOCATION Water Division: 1 Designated Basin: Management District: County: Parcel Name: Water District: 1 N/A N/A WELD RECORDED EXEMPTION NO. 1053-19-3 RE1506 Lot: A Block: Filing: Physical Address: 24125 COUNTY ROAD 42 LASALLE, CO 80645 SW 1/4 SW 1/4 Section 19 Township 4.0 N Range 64.0 W Sixth P.M. UTM COORDINATES (Meters, Zone:13. NAD83) Easting: 533956.6 Northing: 4460226.3 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 change/expansion in use of an existing well constructed under permit no. 249110. The issuance of this permit hereby cancels permit no. 249110. 4) Approved pursuant to CRS 37-92.602(3)(b)(I) and the policy of the State Engineer dated 4/23/86 under the following conditions. 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 Laramie Fox Hills aquifer. 7) The pumping rate of this well shall not exceed 15 GPM. 8) The annual amount of ground water to be withdrawn shall not exceed 0.33 acre-feet (108,600 gallons), as applied for. 9) Approved as the only well on a tract of land of 8.69 acre(s) described as a portion of the SW 1/4 of the SW 1/4, Sec. 19, Twp. 4 North, Rng. 64 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 type so that not less than 4% of the total amount of water withdrawn is returned to the same stream system in which the well is located. 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 constructed not more than 200 feet from the location specified on this permit. NOTE: To ensure a maximum productive life of this well, perforated casing should be set through the entire producing interval of the approved zone or aquifer indicated above. Issued By Date Issued: 4/17/2014 Expiration Date: N/A Printed 07-24-2023 For questions about this permit call 303.866.3581 or go to https://dwr.colorado.gov Page 1 of 2 WELL PERMIT NUMBER 294098- RECEIPT NUMBER 3663643 PERMIT HISTORY 07-03-2023 CHANGE IN OWNER NAME/MAILING ADDRESS. CHANGED TO COLORADO PROPERTY HOLDING COMPANY, LLC (WILLIAM P. GUTTERSEN) Printed 07-24-2023 For questions about this permit call 303.866.3581 or go to https://dwr.colorado.gov Page 2 of 2 Hello